CHIEF COMPLAINT: Intoxication

PRESENT ILLNESS: History of Present Illness: Mr. [**Known lastname **] is a 20 y/o M with a
history of bipolar disorder, polysubstance abuse who presented
to the ER after being found at the House of Blues, agitated,
diaphoretic and with dilated pupils.  After speaking with his
mother, it was discovered that he has a history of polysubstance
abuse, was admitted to [**Hospital 792**]Hospital in the past few
weeks after an episode of intoxication, thought to have taken
PCP and [**Hospital 30148**], with possible other co-ingestions at that time.
After discussion with his mother he has had multiple episodes of
stopping his lithium in the past, and recently has been doing
several different drugs.  His mother states that in [**State 87616**] his tox screen was positive for cocaine,
methamphetamines and alcohol, she also says that she knows that
he has been doing [**State 30148**] and possibly PCP [**Name Initial (PRE) 15925**].
.
In the ED, initial vs were: T-98.4 P-140's BP-130's/80's R-35 O2
sat-100% on RA. Patient was given 25mg of haldol and 8mg of
ativan, after which he was intubated for airway protection.  He
had an EKG that had normal axis and intervals, negative serum
tox screen, a lithium level of 0.3 and chemistry panel notable
for a Cr of 1.7, bicarb of 15 with an anion gap of 27.
Toxicology was consulted who felt that this fit with a
sympathomimetic clinical picture, they recommended avoiding
further haldol given that it can lower the seizure threshold,
sedation with benzodiazepines, and further work up of his acid
base status.  A head CT was done that preliminarily did not show
any acute ICH, fracture or other acute process.  VS prior to
transfer were: 97, 110's/80's, 17, 100% on ventilator settings
of 500 x 14, PEEP of 5, FiO2 of 100%, on propofol 100 and versed
8.
.
On the floor, initial VS were: 96.4, 72, 114/46, 19, 99% on 500
x 16, PEEP of 5, FiO2 of 100%.  He is intubated and sedated, not
responding to verbal stimuli.

MEDICAL HISTORY: Bipolar Disorder
Polysubstance Abuse

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.2 BP: 118/57 P: 56 R:20  O2: 100%, intubated
General: intubated, sedated
HEENT: 4mm pupils, reactive bilaterally, no nystagmus, oral MM
dry; 4cm x 4cm area of ecchymoses over right frotal forehead
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilateral anterior lung fields
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: multiple abrasions over lower extremities; some
circumferential areas of bilateral feet (related to skin
popping?), normal tone
Skin: warm, no diaphoresis

FAMILY HISTORY: NC

SOCIAL HISTORY: Tobacco:  [**12-1**] ppd
Alcohol:  frequent
Illicits:  polysubstance abuse including methamphetamines,
cocaine, PCP, [**Name Initial (NameIs) 30148**]
Poisoning by psychodysleptics (hallucinogens),Acute kidney failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Rhabdomyolysis,Bacteremia,Hallucinogen abuse, unspecified,Accidental poisoning by psychodysleptics [hallucinogens],Bipolar disorder, unspecified,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site
Poisoning-hallucinogens,Acute kidney failure NOS,Vasc comp med care NEC,Rhabdomyolysis,Bacteremia,Hallucinog abuse-unspec,Acc poison-hallucinogens,Bipolar disorder NOS,Phlbts sprfc vn up extrm,Abn react-procedure NEC,Mth sus Stph aur els/NOS
Admission Date:  [**2165-7-17**]              Discharge Date:   [**2165-7-26**]

Date of Birth:  [**2144-9-11**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2279**]
Chief Complaint:
Intoxication

Major Surgical or Invasive Procedure:
[**2165-7-17**] intubation
[**2165-7-25**] PICC line insertion


History of Present Illness:
History of Present Illness: Mr. [**Known lastname **] is a 20 y/o M with a
history of bipolar disorder, polysubstance abuse who presented
to the ER after being found at the House of Blues, agitated,
diaphoretic and with dilated pupils.  After speaking with his
mother, it was discovered that he has a history of polysubstance
abuse, was admitted to [**Hospital 792**]Hospital in the past few
weeks after an episode of intoxication, thought to have taken
PCP and [**Hospital 30148**], with possible other co-ingestions at that time.
After discussion with his mother he has had multiple episodes of
stopping his lithium in the past, and recently has been doing
several different drugs.  His mother states that in [**State 87616**] his tox screen was positive for cocaine,
methamphetamines and alcohol, she also says that she knows that
he has been doing [**State 30148**] and possibly PCP [**Name Initial (PRE) 15925**].
.
In the ED, initial vs were: T-98.4 P-140's BP-130's/80's R-35 O2
sat-100% on RA. Patient was given 25mg of haldol and 8mg of
ativan, after which he was intubated for airway protection.  He
had an EKG that had normal axis and intervals, negative serum
tox screen, a lithium level of 0.3 and chemistry panel notable
for a Cr of 1.7, bicarb of 15 with an anion gap of 27.
Toxicology was consulted who felt that this fit with a
sympathomimetic clinical picture, they recommended avoiding
further haldol given that it can lower the seizure threshold,
sedation with benzodiazepines, and further work up of his acid
base status.  A head CT was done that preliminarily did not show
any acute ICH, fracture or other acute process.  VS prior to
transfer were: 97, 110's/80's, 17, 100% on ventilator settings
of 500 x 14, PEEP of 5, FiO2 of 100%, on propofol 100 and versed
8.
.
On the floor, initial VS were: 96.4, 72, 114/46, 19, 99% on 500
x 16, PEEP of 5, FiO2 of 100%.  He is intubated and sedated, not
responding to verbal stimuli.

Review of systems:  unable to obtain, patient intubated/sedated

Past Medical History:
Bipolar Disorder
Polysubstance Abuse

Social History:
Tobacco:  [**12-1**] ppd
Alcohol:  frequent
Illicits:  polysubstance abuse including methamphetamines,
cocaine, PCP, [**Name Initial (NameIs) 30148**]


Family History:
NC

Physical Exam:
Vitals: T: 98.2 BP: 118/57 P: 56 R:20  O2: 100%, intubated
General: intubated, sedated
HEENT: 4mm pupils, reactive bilaterally, no nystagmus, oral MM
dry; 4cm x 4cm area of ecchymoses over right frotal forehead
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilateral anterior lung fields
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: multiple abrasions over lower extremities; some
circumferential areas of bilateral feet (related to skin
popping?), normal tone
Skin: warm, no diaphoresis

Pertinent Results:
[**2165-7-17**] 01:36AM URINE  HOURS-RANDOM
[**2165-7-17**] 01:36AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2165-7-17**] 01:00AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.011
[**2165-7-17**] 01:00AM URINE  BLOOD-LG NITRITE-NEG PROTEIN-150
GLUCOSE-TR KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-NEG
[**2165-7-17**] 01:00AM URINE  RBC-0-2 WBC-[**2-1**] BACTERIA-FEW YEAST-NONE
EPI-0-2
[**2165-7-16**] 11:40PM   GLUCOSE-284* UREA N-15 CREAT-1.7* SODIUM-140
POTASSIUM-3.6 CHLORIDE-98 TOTAL CO2-15* ANION GAP-31*
[**2165-7-16**] 11:40PM   estGFR-Using this
[**2165-7-16**] 11:40PM   CK(CPK)-377*
[**2165-7-16**] 11:40PM   LITHIUM-0.3*
[**2165-7-16**] 11:40PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2165-7-16**] 11:40PM   WBC-16.8* RBC-5.65 HGB-16.8 HCT-50.9 MCV-90
MCH-29.7 MCHC-32.9 RDW-13.4
[**2165-7-16**] 11:40PM   NEUTS-79.0* LYMPHS-16.8* MONOS-3.3 EOS-0.3
BASOS-0.6
[**2165-7-16**] 11:40PM   PLT COUNT-460*

[**2165-7-20**] 7:35 am BLOOD CULTURE

                            **FINAL REPORT [**2165-7-26**]**

   Blood Culture, Routine (Final [**2165-7-26**]):
      STAPH AUREUS COAG +.
         Consultations with ID are recommended for all blood
cultures
         positive for Staphylococcus aureus and [**Female First Name (un) 564**] species.

         FINAL SENSITIVITIES.
         This isolate is presumed to be resistant to clindamycin
based on
         the detection of inducible resistance .
         Staphylococcus species may develop resistance during
prolonged
         therapy with quinolones.   Therefore, isolates that are
initially
         susceptible may become resistant within three to four
days after
         initiation of therapy.  Testing of repeat isolates may
be
         warranted.

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             STAPH AUREUS COAG +
                             |
CLINDAMYCIN-----------       R
ERYTHROMYCIN----------   =>8 R
GENTAMICIN------------ <=0.5 S
LEVOFLOXACIN----------<=0.12 S
OXACILLIN-------------   0.5 S
TRIMETHOPRIM/SULFA---- <=0.5 S

   Anaerobic Bottle Gram Stain (Final [**2165-7-21**]):
      GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS.
      REPORTED BY PHONE TO DR. [**Last Name (STitle) **] [**2165-7-21**] 14:10.
-----
Blood cultures from [**7-19**] are NEGATIVE and from [**7-21**], [**7-22**], [**7-23**],
[**7-24**] are PENDING.
-----
[**2165-7-23**] TTE
The left atrium and right atrium are normal in cavity size. Left
ventricular wall thickness, cavity size and regional/global
systolic function are normal (LVEF >55%). Transmitral and tissue
Doppler imaging suggests normal diastolic function, and a normal
left ventricular filling pressure (PCWP<12mmHg). Right
ventricular chamber size and free wall motion are normal. The
aortic valve leaflets (3) appear structurally normal with good
leaflet excursion and no aortic regurgitation. No masses or
vegetations are seen on the aortic valve. The mitral valve
appears structurally normal with trivial mitral regurgitation.
No mass or vegetation is seen on the mitral valve. There is no
pericardial effusion.

IMPRESSION: No vegetations or clinically-significant regurgitant
valvular disease seen (excellent-quality study). Normal global
and regional biventricular systolic function. In presence of
high clinical suspicion, absence of vegetations on transthoracic
echocardiogram does not exclude endocarditis.

[**2165-7-20**] RUE ULTRASOUND
IMPRESSION: Distal right cephalic venous thrombosis. No evidence
of DVT
within the right upper extremity.

Brief Hospital Course:
Mr. [**Known lastname **] is a 20y/o gentleman who was found down after
intoxication with what appeared to be a sympathomimetic
toxidrome (he admitted to [**Known lastname 30148**] use).

#) Overdose: toxicology consulted in the ER, who recommended
avoiding further Haldol given that it can lower the seizure
threshold. Clinical picture was consistent with a
sympathomimetic toxidrome, however tox screen was initially
negative for methamphetamines. On second screen in MICU
methamphetamines were positive.  Patient was initially intubated
in the ED but on [**7-17**] was extubated successfully in the MICU. On
[**7-18**] patient was fully awake and appropriate. Admited to [**Month/Year (2) 30148**] and
marijuana. He was transferred to the medical floor, where he was
initially on CIWA protocol but did not require any benzos.  He
was stable, without symptoms of intoxication or withdrawal.  He
has been seen by Social Work; there are plans for him to undergo
a wilderness rehab trip in [**State 38104**] in the future.  He is being
discharged to [**Hospital1 882**] inpatient rehab facility.

#) RUE Thrombophlebitis with MSSA positive blood culture
Mr. [**Known lastname **] [**Last Name (Titles) 28316**] fevers to 102 when leaving the MICU;
infectious workup was negative including CXR, UA/Urine culture,
negative blood cultures. He remained without leukocytosis.  He
was found to have a palpable cord in his RUE at an IV insertion
site; the line was removed and Ultrasound revealed superficial
venous thrombosis.  On the day the IV was removed, he had one
MSSA+ blood culture.  ID consult was obtained; TTE was an
excellent quality study showing no vegetations.  He had received
one day of Vancomycin before sensitivities had returned, at
which point he was switched to IV Nafcillin.  The plan is for a
4 week course of IV antibiotics; he is being discharged with a
PICC line.  The cord is still palpable, and he has remained
afebrile without signs or symptoms of infection.  He has
follow-up with Infectious Disease (Dr. [**Last Name (STitle) 6137**] on [**2165-8-12**].

#) ARF: creatinine 1.7 on admission, records from PCP??????s office
showed a Cr of 1.2 in [**2161**]. Continued aggressive IVF hydration
given risk for rhabdomyolysis, mildly elevated CK and U/A with
large blood but 0-2 RBC??????s.  Cr did trend down during MICU stay
and CK trended down as well.  He likely had mild rhabdomyolysis
and by the time of discharge, his creatinine was 0.9.

#) Bipolar Disorder: Per psychiatry recs, his Lithium was d/c'd.
 He remained without any hallucinations or racing thoughts, and
he will follow up with Psychiatry as an outpatient.

Medications on Admission:
none

Discharge Medications:
1. Heparin Flush (10 units/ml) 2 mL IV PRN line flush
PICC, heparin dependent: Flush with 10mL Normal Saline followed
by Heparin as above daily and PRN per lumen.
2. Nafcillin 2 gram Recon Soln Sig: Two (2) grams Intravenous
every four (4) hours for 22 days: day 1 was [**2165-7-21**], last day is
[**2165-8-17**] (total of 4 weeks).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 882**]

Discharge Diagnosis:
Substance Abuse
Superficial Thrombophlebitis
Bacteremia


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 because you were "found down"
after ingestion of drugs.  You were intubated and given
medications, and when you were more stable you were transferred
from the ICU to the medical floor.  You developed a superficial
phlebitis (superficial venous clot) which we do not believe is
currently infected, but you did have one positive blood culture
so you will need 4 weeks of IV antibiotics. You are being
discharged with a plan for you to begin treatment for your drug
use.

Please insure that you inspect your right arm regularly and seek
medication attention for redness, warmth, swelling or pain at
the site of the superficial clot in your right arm. You should
also seek medical attention for fever. You should continue to
use warm compresses to this area as you are able to.

On the day of discharge you had been afebrile and without
evidence of infection; please ensure that you see your PCP for [**Name Initial (PRE) **]
[**Name9 (PRE) 702**] visit to insure the you remain in good health.

You do not take any medications at home; the only change is that
you will need the IV antibiotics (Nafcillin) for a total of 4
weeks.

Followup Instructions:
PRIMARY CARE:
Name:[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **],MD
When: Wednesday [**2165-8-7**] 11:30am
Location: DMA-[**Location (un) **]
Address: ONE [**Location (un) 542**] ST, [**Location (un) **],[**Numeric Identifier 9310**]
Phone: [**Telephone/Fax (1) 8506**]

INFECTIOUS DISEASE:
DR. [**First Name4 (NamePattern1) 2482**] [**Last Name (NamePattern1) **], MD
[**2165-8-12**]  10:30a
LM [**Hospital Ward Name **] BLDG ([**Doctor First Name **]), BASEMENT

                             [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2285**]
{'Poisoning by psychodysleptics (hallucinogens),Acute kidney failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Rhabdomyolysis,Bacteremia,Hallucinogen abuse, unspecified,Accidental poisoning by psychodysleptics [hallucinogens],Bipolar disorder, unspecified,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}


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: Intoxication

PRESENT ILLNESS: History of Present Illness: Mr. [**Known lastname **] is a 20 y/o M with a
history of bipolar disorder, polysubstance abuse who presented
to the ER after being found at the House of Blues, agitated,
diaphoretic and with dilated pupils.  After speaking with his
mother, it was discovered that he has a history of polysubstance
abuse, was admitted to [**Hospital 792**]Hospital in the past few
weeks after an episode of intoxication, thought to have taken
PCP and [**Hospital 30148**], with possible other co-ingestions at that time.
After discussion with his mother he has had multiple episodes of
stopping his lithium in the past, and recently has been doing
several different drugs.  His mother states that in [**State 87616**] his tox screen was positive for cocaine,
methamphetamines and alcohol, she also says that she knows that
he has been doing [**State 30148**] and possibly PCP [**Name Initial (PRE) 15925**].
.
In the ED, initial vs were: T-98.4 P-140's BP-130's/80's R-35 O2
sat-100% on RA. Patient was given 25mg of haldol and 8mg of
ativan, after which he was intubated for airway protection.  He
had an EKG that had normal axis and intervals, negative serum
tox screen, a lithium level of 0.3 and chemistry panel notable
for a Cr of 1.7, bicarb of 15 with an anion gap of 27.
Toxicology was consulted who felt that this fit with a
sympathomimetic clinical picture, they recommended avoiding
further haldol given that it can lower the seizure threshold,
sedation with benzodiazepines, and further work up of his acid
base status.  A head CT was done that preliminarily did not show
any acute ICH, fracture or other acute process.  VS prior to
transfer were: 97, 110's/80's, 17, 100% on ventilator settings
of 500 x 14, PEEP of 5, FiO2 of 100%, on propofol 100 and versed
8.
.
On the floor, initial VS were: 96.4, 72, 114/46, 19, 99% on 500
x 16, PEEP of 5, FiO2 of 100%.  He is intubated and sedated, not
responding to verbal stimuli.

MEDICAL HISTORY: Bipolar Disorder
Polysubstance Abuse

MEDICATION ON ADMISSION: none

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 98.2 BP: 118/57 P: 56 R:20  O2: 100%, intubated
General: intubated, sedated
HEENT: 4mm pupils, reactive bilaterally, no nystagmus, oral MM
dry; 4cm x 4cm area of ecchymoses over right frotal forehead
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilateral anterior lung fields
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no organomegaly
Ext: multiple abrasions over lower extremities; some
circumferential areas of bilateral feet (related to skin
popping?), normal tone
Skin: warm, no diaphoresis

FAMILY HISTORY: NC

SOCIAL HISTORY: Tobacco:  [**12-1**] ppd
Alcohol:  frequent
Illicits:  polysubstance abuse including methamphetamines,
cocaine, PCP, [**Name Initial (NameIs) 30148**] 

### Response:
{'Poisoning by psychodysleptics (hallucinogens),Acute kidney failure, unspecified,Other vascular complications of medical care, not elsewhere classified,Rhabdomyolysis,Bacteremia,Hallucinogen abuse, unspecified,Accidental poisoning by psychodysleptics [hallucinogens],Bipolar disorder, unspecified,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}
