CHIEF COMPLAINT: suicide attempt by drug overdose

PRESENT ILLNESS: HPI: 29 yo male, h/o BPD, schizoaffective disorder,
polysubstance abuse, s/p prior suicide attempts (with multiple
hospitalizations for suicidality), presenting s/p ingestion of
multiple substances. Per ED notes, pt took an unknown quantity
of Zyprexa/Klonopin as a suicide attempt; he denied ingestion of
other substances. In the ED,pt was somnolent (hemodynamically
stable, saturating adequately). Received 2 mg of Naloxone in ED
with mild improvement but then became more somnolent requiring
intubation for airway protection. NGT was also placed, and he
received 50 gm of activated charcoal. Serum/urine tox screens
were obtained; urine tox came back positive for benzos,
barbiturates, opiates, and cocaine (negative for methadone and
amphetamines).

MEDICAL HISTORY: PMH: (obtained via [**Month/Year (2) **] notes)
1. Bipolar Disorder, Schizoaffective disorder, with multiple
prior suicide attempts/hospitalizations for this (most recently
[**10-4**], methadone, klonopin, chloral hydrate). First admission
for suicidality was at age 13 (ASA overdose)
2. Chronic LBP x 9 yrs, s/p injury to 2 lumbar discs
3. Trigeminal neuralgia
4. Migraines

MEDICATION ON ADMISSION: Meds on Admission: (as per [**Last Name (LF) **], [**First Name3 (LF) **] notes)
methadone 20 mg po qam
klonopin 1 mg po tid
albuterol
zyprexa 20 mg po qhs
effexor XR 75 mg po bid
fioricet
clorhydrate 500 mg po qhs

ALLERGIES: Haldol / Penicillins / Toradol

PHYSICAL EXAM: VS: on admission: 97.5 96 101/55 18 97% RA
s/p intubation: 92/41 81 21 100% on AC--
AC: 600/12, PEEP=5, RR=20-21
Gen: intubated, sedated, lying in bed
HEENT: PERRL, OP clear, MMM
Neck: no JVD or LAD
Lungs: CTA ant/lat
CV: RRR, nl s1/s2, no m/r/g
Abd: obese, with pannus, decreased BS, no reb/guard, no
tenderness
Extr: no c/c/e, 2+ PT/DP bilat
Neuro: sedated, not responsive to commands
Skin: erythematous macular rash under pannus, groin region.

FAMILY HISTORY: FH: Mother with BPD, schizophrenia, EtOH
Father with BPD
Maternal GM with alcoholism

SOCIAL HISTORY: SH: polysubstance abuse, including IV heroin, cocaine,
methadone, speedballs, benzos, smokes 1 ppd, longest sobriety
period 1 yr
?Sexual abuse in childhood, left school in 12th grade and was
working in family business, homeless, homosexual
Poisoning by benzodiazepine-based tranquilizers,Schizoaffective disorder, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Bipolar I disorder, most recent episode (or current) unspecified,Lumbago,Depressive disorder, not elsewhere classified,Lack of housing,Trigeminal neuralgia
Pois-benzodiazepine tran,Schizoaffective dis NOS,Poison-psychotropic agt,Bipolor I current NOS,Lumbago,Depressive disorder NEC,Lack of housing,Trigeminal neuralgia
Admission Date:  [**2155-11-17**]              Discharge Date:   [**2155-11-19**]

Date of Birth:  [**2126-3-8**]             Sex:   M

Service: MEDICINE

Allergies:
Haldol / Penicillins / Toradol

Attending:[**First Name3 (LF) 8487**]
Chief Complaint:
suicide attempt by drug overdose

Major Surgical or Invasive Procedure:
Intubation [**11-17**], extubation [**11-18**] for airway protection


History of Present Illness:
HPI: 29 yo male, h/o BPD, schizoaffective disorder,
polysubstance abuse, s/p prior suicide attempts (with multiple
hospitalizations for suicidality), presenting s/p ingestion of
multiple substances. Per ED notes, pt took an unknown quantity
of Zyprexa/Klonopin as a suicide attempt; he denied ingestion of
other substances. In the ED,pt was somnolent (hemodynamically
stable, saturating adequately). Received 2 mg of Naloxone in ED
with mild improvement but then became more somnolent requiring
intubation for airway protection. NGT was also placed, and he
received 50 gm of activated charcoal. Serum/urine tox screens
were obtained; urine tox came back positive for benzos,
barbiturates, opiates, and cocaine (negative for methadone and
amphetamines).

Past Medical History:
PMH: (obtained via [**Month/Year (2) **] notes)
1. Bipolar Disorder, Schizoaffective disorder, with multiple
prior suicide attempts/hospitalizations for this (most recently
[**10-4**], methadone, klonopin, chloral hydrate). First admission
for suicidality was at age 13 (ASA overdose)
2. Chronic LBP x 9 yrs, s/p injury to 2 lumbar discs
3. Trigeminal neuralgia
4. Migraines

Social History:
SH: polysubstance abuse, including IV heroin, cocaine,
methadone, speedballs, benzos, smokes 1 ppd, longest sobriety
period 1 yr
?Sexual abuse in childhood, left school in 12th grade and was
working in family business, homeless, homosexual

Family History:
FH: Mother with BPD, schizophrenia, EtOH
Father with BPD
Maternal GM with alcoholism

Physical Exam:
VS: on admission: 97.5 96 101/55 18 97% RA
s/p intubation: 92/41 81 21 100% on AC--
AC: 600/12, PEEP=5, RR=20-21
Gen: intubated, sedated, lying in bed
HEENT: PERRL, OP clear, MMM
Neck: no JVD or LAD
Lungs: CTA ant/lat
CV: RRR, nl s1/s2, no m/r/g
Abd: obese, with pannus, decreased BS, no reb/guard, no
tenderness
Extr: no c/c/e, 2+ PT/DP bilat
Neuro: sedated, not responsive to commands
Skin: erythematous macular rash under pannus, groin region.

Pertinent Results:
[**2155-11-19**] 10:24AM BLOOD WBC-5.3 RBC-4.05* Hgb-11.8* Hct-32.9*
MCV-81* MCH-29.1 MCHC-35.8* RDW-13.3 Plt Ct-131*
[**2155-11-18**] 04:50AM BLOOD WBC-5.6 RBC-3.86* Hgb-11.3* Hct-32.0*
MCV-83 MCH-29.4 MCHC-35.4* RDW-14.4 Plt Ct-167
[**2155-11-18**] 04:50AM BLOOD WBC-5.6 RBC-3.86* Hgb-11.3* Hct-32.0*
MCV-83 MCH-29.4 MCHC-35.4* RDW-14.4 Plt Ct-167
[**2155-11-17**] 07:50PM BLOOD WBC-10.8 RBC-4.63 Hgb-13.7* Hct-36.9*
MCV-80* MCH-29.5 MCHC-37.0* RDW-13.1 Plt Ct-207
[**2155-11-19**] 10:24AM BLOOD Plt Ct-131*
[**2155-11-18**] 04:50AM BLOOD Plt Ct-167
[**2155-11-18**] 04:50AM BLOOD PT-13.5* PTT-32.6 INR(PT)-1.2
[**2155-11-17**] 07:50PM BLOOD Plt Ct-207
[**2155-11-17**] 07:50PM BLOOD PT-13.6* PTT-31.3 INR(PT)-1.2
[**2155-11-19**] 10:24AM BLOOD Glucose-116* UreaN-6 Creat-0.7 Na-143
K-3.7 Cl-109* HCO3-24 AnGap-14
[**2155-11-18**] 04:50AM BLOOD Glucose-129* UreaN-12 Creat-0.8 Na-140
K-3.7 Cl-107 HCO3-23 AnGap-14
[**2155-11-17**] 07:50PM BLOOD Glucose-124* UreaN-13 Creat-1.0 Na-136
K-4.5 Cl-98 HCO3-23 AnGap-20
[**2155-11-18**] 04:50AM BLOOD ALT-22 AST-22 AlkPhos-77 TotBili-0.4
[**2155-11-17**] 07:50PM BLOOD ALT-27 AST-31 AlkPhos-93 TotBili-0.6

EKG: NSR=90, nl axis/intervals, ?J-pt elev in I, II, V2-V6;
unchanged from prior, nl QTc
.
CXR: NGT/ETT in place, adequate position, lung fields otherwise
clear
.
CT Head (non-contrast): No acute ICH

Brief Hospital Course:
A/P: 29 yo male, h/o polysubstance abuse,
BPD/schizoaffective/panic disorders, s/p multiple suicide
attempts, presenting s/p overdose with multiple substances.
.
1. Overdose: Multiple substances (cocaine, BZ, barb, narcotics,
zyprexa). s/p activated charcoal and narcan x 1. Neg TCA and QTc
wnl.
- Tox consult: supportive care.
- supportive care for cardiovascular/pulmonary; includes
mechanical ventilation overnight, support of BP, monitoring on
tele
- ?benzo OD; no flumazenil as this can cause withdrawal
seizures, precipitate arrhythmias if concomitant TCA OD
- ?barbits OD--can alkalinize urine, will ck urine/urine pH
- ?cocaine-can become hyperthermic, ?rhabdo, hypertensive; again
supportive measures, alpha/beta blocker
- ?zyprexa--sx can include tachycardia, bp fluctuations, EPS
symptoms

Patient is now 48 hours after admission for overdose and is
stable from a medical standpoint. He is s/p extubation and is
breathing fine on RA without any respiratory compromise. Per
psych recommendations, he has been getting prolexin and ativan
for agitation. Needs inpatient psych admission for further care
and therapy as he is now medically stable.
.
2. Respiratory failure: intubated [**1-22**] somnolence, respiratory
depression, on AC, overbreathing vent
-extubated [**11-18**] without complications, stable respiratory-wise
.
3. Hypotension: Likley secondary to sedation prior to intubation
- now resolved after extubation and off propofol gtt. With
normal BP for over 30 hours.
.
4. Psych: as above, with BPD, schizo, anxiety; will need to
clarify med regimen and consult psych; will likely need Section
12/psych treatment
-psych consult recs prolexin and ativan for agiation as needed
.
5. ?Skin rash: appears c/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], can give topical nystatin
powder, keep area dry
.
6. PPX: OOB and walking, eating
.
7. Code: presumed full
.
8. Communication: need to determine (?parents)
.
9. Access: PIVs
.
10. Dispo: ICU care -> now medically stable, to inpatient
psychiatric facility


Medications on Admission:
Meds on Admission: (as per [**Last Name (LF) **], [**First Name3 (LF) **] notes)
methadone 20 mg po qam
klonopin 1 mg po tid
albuterol
zyprexa 20 mg po qhs
effexor XR 75 mg po bid
fioricet
clorhydrate 500 mg po qhs

Discharge Medications:
1. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  TID
(3 times a day) as needed.
2. Fluphenazine HCl 2.5 mg Tablet Sig: Two (2) Tablet PO Q2-4H
(every 2 to 4 hours) as needed for severe agitation.
3. Nicotine 14 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal DAILY (Daily).
4. Lorazepam 2 mg/mL Syringe Sig: One (1)  Injection Q2-4H
(every 2 to 4 hours) as needed for severe agitation.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary - Suicide attempt by drug overdose, bipolar d/o,
schizoaffective d/o, h/o multiple suicide attempts

Secondary - Chronic LBP x 9 yrs, s/p injury to 2 lumbar discs,
trigeminal neuralgia, migraines


Discharge Condition:
Medically stable and cleared for inpatient psychiatric admission


Discharge Instructions:
-please continue with medications and therapy as determined by
Psychiatry facility

-you need to obtain primary medical care here in [**Location (un) 86**] as well
as psychiatric care

Followup Instructions:
As determined by Psychiatric facility



Completed by:[**2155-12-1**]
{'Poisoning by benzodiazepine-based tranquilizers,Schizoaffective disorder, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Bipolar I disorder, most recent episode (or current) unspecified,Lumbago,Depressive disorder, not elsewhere classified,Lack of housing,Trigeminal neuralgia'}


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: suicide attempt by drug overdose

PRESENT ILLNESS: HPI: 29 yo male, h/o BPD, schizoaffective disorder,
polysubstance abuse, s/p prior suicide attempts (with multiple
hospitalizations for suicidality), presenting s/p ingestion of
multiple substances. Per ED notes, pt took an unknown quantity
of Zyprexa/Klonopin as a suicide attempt; he denied ingestion of
other substances. In the ED,pt was somnolent (hemodynamically
stable, saturating adequately). Received 2 mg of Naloxone in ED
with mild improvement but then became more somnolent requiring
intubation for airway protection. NGT was also placed, and he
received 50 gm of activated charcoal. Serum/urine tox screens
were obtained; urine tox came back positive for benzos,
barbiturates, opiates, and cocaine (negative for methadone and
amphetamines).

MEDICAL HISTORY: PMH: (obtained via [**Month/Year (2) **] notes)
1. Bipolar Disorder, Schizoaffective disorder, with multiple
prior suicide attempts/hospitalizations for this (most recently
[**10-4**], methadone, klonopin, chloral hydrate). First admission
for suicidality was at age 13 (ASA overdose)
2. Chronic LBP x 9 yrs, s/p injury to 2 lumbar discs
3. Trigeminal neuralgia
4. Migraines

MEDICATION ON ADMISSION: Meds on Admission: (as per [**Last Name (LF) **], [**First Name3 (LF) **] notes)
methadone 20 mg po qam
klonopin 1 mg po tid
albuterol
zyprexa 20 mg po qhs
effexor XR 75 mg po bid
fioricet
clorhydrate 500 mg po qhs

ALLERGIES: Haldol / Penicillins / Toradol

PHYSICAL EXAM: VS: on admission: 97.5 96 101/55 18 97% RA
s/p intubation: 92/41 81 21 100% on AC--
AC: 600/12, PEEP=5, RR=20-21
Gen: intubated, sedated, lying in bed
HEENT: PERRL, OP clear, MMM
Neck: no JVD or LAD
Lungs: CTA ant/lat
CV: RRR, nl s1/s2, no m/r/g
Abd: obese, with pannus, decreased BS, no reb/guard, no
tenderness
Extr: no c/c/e, 2+ PT/DP bilat
Neuro: sedated, not responsive to commands
Skin: erythematous macular rash under pannus, groin region.

FAMILY HISTORY: FH: Mother with BPD, schizophrenia, EtOH
Father with BPD
Maternal GM with alcoholism

SOCIAL HISTORY: SH: polysubstance abuse, including IV heroin, cocaine,
methadone, speedballs, benzos, smokes 1 ppd, longest sobriety
period 1 yr
?Sexual abuse in childhood, left school in 12th grade and was
working in family business, homeless, homosexual 

### Response:
{'Poisoning by benzodiazepine-based tranquilizers,Schizoaffective disorder, unspecified,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Bipolar I disorder, most recent episode (or current) unspecified,Lumbago,Depressive disorder, not elsewhere classified,Lack of housing,Trigeminal neuralgia'}
