CHIEF COMPLAINT: somnolence

PRESENT ILLNESS: 48 yo M with hx epilepsy, mental retardation, HIV, VL
undetectable, CD4 850 in [**3-18**] on HAART, DM2, HLD, HTN, and with
recent admisssion to EMU in [**Month (only) 547**] for drowsiness comes to ED for
increasing drowsiness. Once again, Neurology was called.

MEDICAL HISTORY: -epilepsy as above
-mental retardation (presumed [**2-9**] lead poisoning)
-HIV, VL undetectable, CD4 850
-DM2
-HLD
-HTN
-anxiety

MEDICATION ON ADMISSION: -stavudine 30 mg [**Hospital1 **]
-docusate 100 mg [**Hospital1 **]
-lipitor 20 mg daily
-dilt XR 120 mg daily
-colchicine 0.6 mg [**Hospital1 **]
-lisinopril 20 mg daily
-abacavir 300 mg [**Hospital1 **]
-phenobarbital 90 mg night
-kaletra 2 tabs [**Hospital1 **]
-keppra [**2135**]/2500
-Vimpat 150 [**Hospital1 **]

ALLERGIES: Penicillins / Aspirin

PHYSICAL EXAM: Exam on day of discharge [**2146-5-17**]:  Sitting in chair, NAD, OP
clear, rrr, cta, abd soft and ext nonedematous.  AAOx3, speech
is clear fluent and appropriate, attentive able to follow simple
and complex commands, PERRL, EOMI without nystagmus, face
excursion is symmetric, V1-V3 intact, palate elev symm, tongue
midline, no asterixis or drift, [**5-12**] full strength throughout,
slow FNF b/l.

FAMILY HISTORY: No seizure disorders in family.

SOCIAL HISTORY: -lives in a group home ([**Street Address(2) **], [**Location (un) **])
-no tobacco, etoh, or drugs
Poisoning by barbiturates,Suicide and self-inflicted poisoning by barbiturates,Generalized convulsive epilepsy, without mention of intractable epilepsy,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified intellectual disabilities,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Unspecified essential hypertension,Anemia, unspecified,Gout, unspecified
Poisoning-barbiturates,Poison-barbiturates,Gen cnv epil w/o intr ep,Hx of past noncompliance,Intellect disability NOS,Asymp hiv infectn status,DMII wo cmp nt st uncntr,Elev transaminase/ldh,Hypertension NOS,Anemia NOS,Gout NOS
Name:  [**Known lastname 2976**],[**Known firstname 2977**]                   Unit No:   [**Numeric Identifier 2978**]

Admission Date:  [**2146-5-9**]              Discharge Date:   [**2146-5-17**]

Date of Birth:  [**2097-5-27**]             Sex:   M

Service: NEUROLOGY

Allergies:
Penicillins / Aspirin

Attending:[**First Name3 (LF) 2980**]
Addendum:
I spoke with his pharmacy and clarified all of his medications.
I found out that he had four prescriptions available for
phenobarbital each with multiple refills.  Those have now been
cancelled.  I had the pharmacy label him as an abuser and they
will [**Name8 (MD) 233**] MD if any attempted refill prior to one month.  They
will continue to give medications in packets (one day's supply
of pills for one packet) and only given one month supply.


Physical Exam:
Exam on day of discharge [**2146-5-17**]:  Sitting in chair, NAD, OP
clear, rrr, cta, abd soft and ext nonedematous.  AAOx3, speech
is clear fluent and appropriate, attentive able to follow simple
and complex commands, PERRL, EOMI without nystagmus, face
excursion is symmetric, V1-V3 intact, palate elev symm, tongue
midline, no asterixis or drift, [**5-12**] full strength throughout,
slow FNF b/l.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 42**] VNA

                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 2981**]

Completed by:[**2146-5-17**]

Admission Date:  [**2146-5-9**]              Discharge Date:   [**2146-5-17**]

Date of Birth:  [**2097-5-27**]             Sex:   M

Service: NEUROLOGY

Allergies:
Penicillins / Aspirin

Attending:[**First Name3 (LF) 9152**]
Chief Complaint:
somnolence


Major Surgical or Invasive Procedure:
none


History of Present Illness:
48 yo M with hx epilepsy, mental retardation, HIV, VL
undetectable, CD4 850 in [**3-18**] on HAART, DM2, HLD, HTN, and with
recent admisssion to EMU in [**Month (only) 547**] for drowsiness comes to ED for
increasing drowsiness. Once again, Neurology was called.

He has h/o multiple similar episodes in the past which consisted
of drowsiness and every time was found to have increased
phenobarb level. On all occasions he denies taking more than
prescribed dose of phenobarb. He was admitted recently to EMU
with high phenobarb level and was discharged home with stopping
zonegran(radiological appearance of kidney stone) and phenobarb
at 90/day. He was increasingly somnolent and "slow" for last few
days. This am, he became increasingly drowsy and called 911. He
was brought to the ED for evalaution of drowsiness. Given
similar
presentations before and high phenobarb value on earlier
occasions, his phenobarb level was checked which was 86. He was
evaluated by toxicology and next, neurology was called.


Past Medical History:
-epilepsy as above
-mental retardation (presumed [**2-9**] lead poisoning)
-HIV, VL undetectable, CD4 850
-DM2
-HLD
-HTN
-anxiety

Social History:
-lives in a group home ([**Street Address(2) **], [**Location (un) **])
-no tobacco, etoh, or drugs


Family History:
No seizure disorders in family.

Physical Exam:
VS; 99 92 127/75 18 100%
Gen; lying in bed, drowsy, arousable to voice, NAD
HEENT; MMM, oropharynx clear.
CV; RRR, no murmurs
Pulm; CTA anteriorly
Abd; bs+, soft,
Extr; no edema

Neuro;
MS; Drowsy, eyes closed, but arousable to voice, and immediately
goes back to sleep requiring to wake him repeatedly. Can answer
his name and that he is in the hospital but doesnt answer the
date or name of place. Doesnt participate in rest of the mental
status exam.

CN; PERRL 4mm-->3mm, tracks with eyes but does not sustain gaze
to assess for nystagmus.  Blinks to threat.  Face appears
symmetric, tongue midline.

Motor; normal bulk and tone.  no pronator drift.  no tremor.  +
asterixis.  maintains arms and legs antigravity against
resistance.  seems symmetric.

Sensory; intact to light touch
Reflexes; absent.  toes down
Coordination; doesnt participate
Gait; deferred


Pertinent Results:
[**2146-5-9**] 11:20PM   TYPE-[**Last Name (un) **] PO2-38* PCO2-54* PH-7.34* TOTAL
CO2-30 BASE XS-1 COMMENTS-GREEN TOP
[**2146-5-9**] 08:05PM   PHENOBARB-96.8*
[**2146-5-9**] 06:42PM   TYPE-ART PO2-102 PCO2-39 PH-7.44 TOTAL CO2-27
BASE XS-1 INTUBATED-NOT INTUBA
[**2146-5-9**] 04:00PM URINE  HOURS-RANDOM
[**2146-5-9**] 04:00PM URINE  bnzodzpn-NEG barbitrt-POS opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2146-5-9**] 04:00PM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.006
[**2146-5-9**] 04:00PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2146-5-9**] 09:00AM   GLUCOSE-131* UREA N-11 CREAT-0.9 SODIUM-137
POTASSIUM-4.2 CHLORIDE-101 TOTAL CO2-22 ANION GAP-18
[**2146-5-9**] 09:00AM   estGFR-Using this
[**2146-5-9**] 09:00AM   ALT(SGPT)-107* AST(SGOT)-94* ALK PHOS-168*
TOT BILI-0.3
[**2146-5-9**] 09:00AM   CALCIUM-9.1 PHOSPHATE-3.7 MAGNESIUM-1.7
[**2146-5-9**] 09:00AM   PHENOBARB-86.8*
[**2146-5-9**] 09:00AM   WBC-3.6* RBC-3.58* HGB-9.2* HCT-29.0* MCV-81*
MCH-25.7* MCHC-31.8 RDW-20.7*
[**2146-5-9**] 09:00AM   NEUTS-42.4* LYMPHS-50.4* MONOS-4.6 EOS-1.8
BASOS-0.8
[**2146-5-9**] 09:00AM   PLT COUNT-404
[**2146-5-9**] 09:00AM   PT-12.4 PTT-24.7 INR(PT)-1.0
[**2146-5-14**] 06:11AM BLOOD WBC-3.2* RBC-3.30* Hgb-8.5* Hct-26.1*
MCV-79* MCH-25.8* MCHC-32.6 RDW-20.4* Plt Ct-298
[**2146-5-14**] 06:11AM BLOOD Plt Ct-298
[**2146-5-9**] 09:00AM BLOOD Neuts-42.4* Lymphs-50.4* Monos-4.6
Eos-1.8 Baso-0.8
[**2146-5-17**] 06:15AM BLOOD Glucose-90 UreaN-9 Creat-0.9 Na-136 K-4.2
Cl-104 HCO3-23 AnGap-13
[**2146-5-17**] 06:15AM BLOOD ALT-78* AST-94* LD(LDH)-194 AlkPhos-113
TotBili-0.6
[**2146-5-17**] 06:15AM BLOOD Calcium-8.8 Phos-4.0 Mg-1.9
[**2146-5-17**] 06:15AM BLOOD Phenoba-29.8
[**2146-5-15**] 04:23AM BLOOD Phenoba-35.1

Brief Hospital Course:
Upon admission, he was placed on EEG monitoring which did not
show any seizure activity.  He was placed on Bicarb drip for
several days to help hasten phenobarbital excretion.  As his
phenobarbital levels, his somnolence improved.  He developed a
mild anemia which was thought to be secondary to the frequent
blood draws required for monitoring while on the drip.

There was strong suspicion based on the multiple admissions that
the patient may be taking extra doses of the phenobarbital at
his group home.  He apparently was still in charge of
administering his own medications despite this discussion during
previous admissions for the same problem.  There is some
suspicion that he may also have extra phenobarbital in his room
that the group home may be unaware of.

Social work was consulted to help manage this medication
situation.  They arranged for the group home to have a locked
box that would hold his medications.  To reduce the potential
for abuse, his phenobarbital dose was decreased so that it was
only 30mg QHS and therefore only one tab.  In response, his
Vimpat was increased to 200mg twice daily to help cover for the
lower phenobarbital level.

Medications on Admission:
-stavudine 30 mg [**Hospital1 **]
-docusate 100 mg [**Hospital1 **]
-lipitor 20 mg daily
-dilt XR 120 mg daily
-colchicine 0.6 mg [**Hospital1 **]
-lisinopril 20 mg daily
-abacavir 300 mg [**Hospital1 **]
-phenobarbital 90 mg night
-kaletra 2 tabs [**Hospital1 **]
-keppra [**2135**]/2500
-Vimpat 150 [**Hospital1 **]


Discharge Medications:
1. lacosamide 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
Disp:*60 Tablet(s)* Refills:*3*
2. stavudine 15 mg Capsule Sig: Two (2) Capsule PO Q12H (every
12 hours).
Disp:*120 Capsule(s)* Refills:*2*
3. diltiazem HCl 120 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily).
Disp:*30 Capsule, Extended Release(s)* Refills:*2*
4. abacavir 300 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
5. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. lopinavir-ritonavir 200-50 mg Tablet Sig: Two (2) Tablet PO
BID (2 times a day).
Disp:*120 Tablet(s)* Refills:*2*
7. levetiracetam 500 mg Tablet Sig: Four (4) Tablet PO QAM (once
a day (in the morning)).
Disp:*240 Tablet(s)* Refills:*2*
8. levetiracetam 500 mg Tablet Sig: Five (5) Tablet PO QPM (once
a day (in the evening)).
Disp:*150 Tablet(s)* Refills:*2*
9. phenobarbital 30 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Phenobarbital toxicity


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the hospital with toxic levels from
phenobarbital probably due to taking extra doses at home.

During this admission, your phenobarbital dose was decreased to
30mg once daily and your Vimpat was increased to 200mg twice
daily.

It is very important for you to know to only take the
medications that you are told told to take and at the exact
doses.  Taking higher or extra doses is very dangerous to your
health and could kill you.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D. Phone:[**Telephone/Fax (1) 3506**]
Date/Time:[**2146-5-24**] 11:30


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 9153**]



Admission Date:  [**2146-5-18**]              Discharge Date:   [**2146-5-24**]

Date of Birth:  [**2097-5-27**]             Sex:   M

Service: NEUROLOGY

Allergies:
Penicillins / Aspirin

Attending:[**First Name3 (LF) 9152**]
Chief Complaint:
phenobarbital toxicity

Major Surgical or Invasive Procedure:
None

History of Present Illness:
48 yo male with a past medical history of epilepsy, MR, HIV,
HTN, HLD who was discharged this morning from the Neurology
service after 9 day hospital stay for phenobarb toxicity
presents with altered mental status. The patient called 911 for
symptoms of dizziness and feeling "unwell." Per the discharge
documentation, the patient was clear an coherent. EMS found the
patient very somnolent and minimally responsive.
.
In the ED, initial vitals were 98.2 102 123/78 18 99%.  Labs
were significant for phenobarb level of 122 (nl < 40) level
prior to dc was 29.8, with normal other labs.  Of note, prior to
DC this AM, LFTs were trending up. Toxicology was consulted who
recommended alkalinization of the urine with sodium bicarbonate
drip. Most recent ABG revealed pH 7.42, HCO3 23.  Neurology was
contact[**Name (NI) **] who recommended medical admission.  The patient was
initally placed in for medical bed, but became more tachypneic
without hypoxia.  Given the frequency of lab draws, tachypnea
and AMS the patient was transfered to the MICU. VS on transfer
HR 93 119/76 26 100% on RA.
.
On the floor, the patient is minimally responsive to noxious
stimuli.

Past Medical History:
-epilepsy as above
-mental retardation (presumed [**2-9**] lead poisoning)
-HIV, VL undetectable, CD4 850
-DM2
-HLD
-HTN
-anxiety


Social History:
-lives in [**Location 18410**] housing on [**Street Address(2) **], [**Location (un) **]
-no tobacco, etoh, or drugs


Family History:
No seizure disorders in family.

Physical Exam:
On admission:
GEN: minimally responsive to noxious stimuli
HEENT:  minimally responsive pupils but equal, EOMI, anicteric,
MM dry, op without lesions, no supraclavicular or cervical
lymphadenopathy, no jvd, no carotid bruits, no thyromegaly or
thyroid nodules
RESP: CTA b/l with good air movement throughout
CV: RR, S1 and S2 wnl, no m/r/g
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT:  multiple scars in the BL ACs '
NEURO: minimally responsive, unable to assess
.
On discharge:


Pertinent Results:
Admission labs:
===============
[**2146-5-17**] 09:40PM BLOOD WBC-3.3* RBC-3.64* Hgb-9.5* Hct-29.1*
MCV-80* MCH-26.1* MCHC-32.7 RDW-20.5* Plt Ct-273
[**2146-5-17**] 09:40PM BLOOD Neuts-37.4* Lymphs-52.4* Monos-9.4
Eos-0.5 Baso-0.4
[**2146-5-18**] 03:07AM BLOOD PT-13.5* PTT-30.2 INR(PT)-1.2*
[**2146-5-17**] 06:15AM BLOOD Glucose-90 UreaN-9 Creat-0.9 Na-136 K-4.2
Cl-104 HCO3-23 AnGap-13
[**2146-5-17**] 06:15AM BLOOD ALT-78* AST-94* LD(LDH)-194 AlkPhos-113
TotBili-0.6
[**2146-5-17**] 06:15AM BLOOD Calcium-8.8 Phos-4.0 Mg-1.9
[**2146-5-17**] 06:15AM BLOOD Phenoba-29.8
[**2146-5-17**] 09:40PM BLOOD Phenoba-122.4*
[**2146-5-18**] 03:07AM BLOOD Phenoba-101.4*
[**2146-5-18**] 08:41AM BLOOD Phenoba-128.5*
[**2146-5-18**] 01:38PM BLOOD Phenoba-123.9*
[**2146-5-18**] 08:01PM BLOOD Phenoba-118.6*
[**2146-5-19**] 03:06AM BLOOD Phenoba-99.9*
[**2146-5-17**] 09:40PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-POS Tricycl-NEG
[**2146-5-18**] 12:27AM BLOOD Type-ART pO2-90 pCO2-37 pH-7.42
calTCO2-23 Base XS-1 Intubat-NOT INTUBA
[**2146-5-18**] 02:59AM BLOOD Type-ART pO2-85 pCO2-46* pH-7.37
calTCO2-28 Base XS-0
[**2146-5-18**] 08:54AM BLOOD Type-[**Last Name (un) **] Rates-/11 FiO2-100 O2 Flow-2
pO2-57* pCO2-47* pH-7.42 calTCO2-32* Base XS-4 AADO2-628 REQ
O2-99 Intubat-NOT INTUBA
[**2146-5-18**] 02:05PM BLOOD Type-[**Last Name (un) **] Rates-/8  pO2-61* pCO2-29*
pH-7.33* calTCO2-16* Base XS--9 Intubat-NOT INTUBA
[**2146-5-18**] 08:28PM BLOOD Type-[**Last Name (un) **] pO2-212* pCO2-41 pH-7.45
calTCO2-29 Base XS-4 Comment-GREEN TOP
[**2146-5-18**] 12:27AM BLOOD Lactate-1.5
[**2146-5-18**] 02:59AM BLOOD Lactate-1.9 K-4.1
.
Discharge labs:
===============

Imaging:
========
CXR: There are lower lung volumes that accentuate the cardiac
size, cardiac size is borderline. There is mild vascular
congestion and minimal bibasilar, left greater than right,
atelectasis. There is no pneumothorax or large pleural effusion.

.
ECG: Sinus rhythm. Non-specific ST-T wave changes. Compared to
the previous tracing no definite change.


Brief Hospital Course:
48 yo M with hx epilepsy, mental retardation admitted for
phenobarbitol toxicity
.
# Phenobarbitol toxicity: The patient has had multiple previous
admissions for phenobarb toxicity, as recently as discharge
earlier today. There has been suspicion that the patient is
taking phenobarbitol in excess at home. This is supported by his
level being normal at 6am the day of last discharge, and with
toxic level later that night (122) with relatively normal renal
and hepatic function (mild transaminitis). His ABG on arrival
showed mild CO2 retention with pH of 7.37. Toxicology was
consulted and recommended urine alkalinazation and frequent
monitoring of urine pH and blood phenobarb levels. Patient's
mental status improved overnight and his phenobarb level
decreased to 120. He was given activated charcoal with further
decrease in phenobarb level to 100. Electrolytes and ABGs were
monitored frequently and repleted asn eeded. His urine pH
remained alkalotic (8-8.5) on bicarbonate drip. Patient's mental
status improved and he became more awake and alert, oriented to
person, place, and month/year at time of transfer from the MICU.
Social work evaluated the patient for inability to manage his
medications adequately at home and recommended psychiatry
consult for possible attention-seeking behavior with overdose,
which patient reported to the social worker. Psychiatry was
consulted to evaluate the patient and recommended no changes.
Meetings were held with the house where [**Known firstname **] lives to determine
whether it is a safe environment. It was decided he would need
an acute rehab stay for a period of time prior to any placement.

.
#  Epilepsy: patient has been on phenobarbital, lacosamide and
keppra for seizure control. His phenobarbital was held in
setting of overdose and should not be restarted per toxicology
recs given frequent episodes of overdose. He was continued on
keppra and lacosamide and was transferred to the neurology
step-down unit for further management of his phenobarbital
toxicity and epilepsy. He did not have any seizure activity
while in the MICU.
.
#  Transaminitis: AST and ALT stable from this AM prior to DC.
Unclear etiology though likely secondary to phenobarbital
toxicity.
.
#  HIV: patient is well-controlled on HAART with last CD4 850.
He was continued on stavudine, lopinavir-ritonavir and abacavir
.
#  HTN: Continued on diltiazem and lisinopril.

Medications on Admission:
lacosamide 200 mg PO BID
stavudine 15 mg (2) Capsule PO Q12H
diltiazem HCl 120 mg PO DAILY
abacavir 300 mg PO BID
lisinopril 20 mg PO DAILY
lopinavir-ritonavir 200-50 mg (2) Tablet PO BID
levetiracetam 500 mg (4) Tablet PO QAM
levetiracetam 500 mg (5) Tablet PO QPM
phenobarbital 30 mg PO DAILY


Discharge Medications:
1. heparin (porcine) 5,000 unit/mL Solution Sig: One (1) ml
Injection TID (3 times a day).
2. lacosamide 200 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
3. stavudine 15 mg Capsule Sig: Two (2) Capsule PO Q12H (every
12 hours).
4. diltiazem HCl 120 mg Capsule, Extended Release Sig: One (1)
Capsule, Extended Release PO DAILY (Daily).
5. abacavir 300 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
6. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. lopinavir-ritonavir 200-50 mg Tablet Sig: One (1) Tablet PO
BID (2 times a day).
8. levetiracetam 500 mg Tablet Sig: Four (4) Tablet PO QAM (once
a day (in the morning)).
9. insulin regular human 100 unit/mL Solution Sig: as directed
units Injection ASDIR (AS DIRECTED): use sliding scale sheet.
10. levetiracetam 500 mg Tablet Sig: Five (5) Tablet PO QPM
(once a day (in the evening)).
11. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
12. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID
(2 times a day).
13. phenobarbital 30 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital 745**] Health Center

Discharge Diagnosis:
Phenobarbital toxicity
Epilepsy


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
You were admitted to the neurology service after you were found
to be toxic on phenobarbital. You were initially admitted to the
MICU. You told the social worker and the team that you had
self-administered additional phenobarb. Your level was monitored
and phenobarn was restarted when it was around 40. You will
continue on 30 mg of phenobarb daily. You will need SQ heparin
and sliding scale insulin as you have been minimally active
during hospitalization. A meeting with the director of your home
was held to try to make it a safe environment, but you will need
rehab prior to return.

Followup Instructions:
Please make an appointment to see Dr. [**Last Name (STitle) 2442**] when discharged
from rehab. Phone: [**Telephone/Fax (1) 3506**]


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 9153**]

Completed by:[**2146-5-24**]
{'Poisoning by barbiturates,Suicide and self-inflicted poisoning by barbiturates,Generalized convulsive epilepsy, without mention of intractable epilepsy,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified intellectual disabilities,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Unspecified essential hypertension,Anemia, unspecified,Gout, unspecified'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: somnolence

PRESENT ILLNESS: 48 yo M with hx epilepsy, mental retardation, HIV, VL
undetectable, CD4 850 in [**3-18**] on HAART, DM2, HLD, HTN, and with
recent admisssion to EMU in [**Month (only) 547**] for drowsiness comes to ED for
increasing drowsiness. Once again, Neurology was called.

MEDICAL HISTORY: -epilepsy as above
-mental retardation (presumed [**2-9**] lead poisoning)
-HIV, VL undetectable, CD4 850
-DM2
-HLD
-HTN
-anxiety

MEDICATION ON ADMISSION: -stavudine 30 mg [**Hospital1 **]
-docusate 100 mg [**Hospital1 **]
-lipitor 20 mg daily
-dilt XR 120 mg daily
-colchicine 0.6 mg [**Hospital1 **]
-lisinopril 20 mg daily
-abacavir 300 mg [**Hospital1 **]
-phenobarbital 90 mg night
-kaletra 2 tabs [**Hospital1 **]
-keppra [**2135**]/2500
-Vimpat 150 [**Hospital1 **]

ALLERGIES: Penicillins / Aspirin

PHYSICAL EXAM: Exam on day of discharge [**2146-5-17**]:  Sitting in chair, NAD, OP
clear, rrr, cta, abd soft and ext nonedematous.  AAOx3, speech
is clear fluent and appropriate, attentive able to follow simple
and complex commands, PERRL, EOMI without nystagmus, face
excursion is symmetric, V1-V3 intact, palate elev symm, tongue
midline, no asterixis or drift, [**5-12**] full strength throughout,
slow FNF b/l.

FAMILY HISTORY: No seizure disorders in family.

SOCIAL HISTORY: -lives in a group home ([**Street Address(2) **], [**Location (un) **])
-no tobacco, etoh, or drugs 

### Response:
{'Poisoning by barbiturates,Suicide and self-inflicted poisoning by barbiturates,Generalized convulsive epilepsy, without mention of intractable epilepsy,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified intellectual disabilities,Asymptomatic human immunodeficiency virus [HIV] infection status,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Unspecified essential hypertension,Anemia, unspecified,Gout, unspecified'}
