CHIEF COMPLAINT: Vomiting.

PRESENT ILLNESS: Ms. [**Known firstname 6870**] [**Known lastname **] is a
19-year-old woman with a 15-month history of bipolar
disorder.  Beginning two weeks ago, her mother said she had
several episodes of vomiting and was drinking lots of water
(about 15 cups per day) in an attempt to lose weight.  Her
mother also notes that she has been unusually irritable and
angry during this time.  The patient is from [**Location (un) **] and
was in town for the Fourth of [**Month (only) 205**] visiting her mother's
aunt.

MEDICAL HISTORY: 1.  Bipolar disorder diagnosed in [**2126-5-12**]; at which
time she was admitted to a psychiatric hospital for one
month.  She has been on medications up until this current
admission.
2.  Questionable mitral valve prolapse which is being worked
up by her primary care doctor in [**State 531**].
3.  No history of seizures.

MEDICATION ON ADMISSION: 1.  Trileptal 600 mg p.o. b.i.d.
2.  Topamax 25 mg p.o. q.i.d.
3.  Geodon 40 mg p.o. b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Her father's sister has bipolar disorder.
Her father's brother has schizophrenia.

SOCIAL HISTORY: The patient currently lives with her mother
and older sister in [**Name (NI) **] where she sleeps in the corner
of the living room behind divider.  She graduated from high
school early and began attending [**Location (un) 42830**]in the
Fall of [**2126**], at which time her psychiatric problems began.
She left school in [**Month (only) 547**], at which time she went to live with
her aunt in [**Name (NI) 760**] where she could receive 24-hour care.
She moved back to [**Location (un) **] in [**Month (only) 956**], and is currently
doing data entry and taking courses for certification in this
field.  She denies any alcohol or drug use.
Hyposmolality and/or hyponatremia,Other convulsions,Bipolar I disorder, most recent episode (or current) unspecified,Mitral valve disorders
Hyposmolality,Convulsions NEC,Bipolor I current NOS,Mitral valve disorder
Admission Date:  [**2127-8-15**]       Discharge Date:  [**2127-8-20**]

Date of Birth:   [**2108-3-19**]       Sex:  F

Service:  Medicine, [**Hospital1 139**] Firm

CHIEF COMPLAINT:  Vomiting.

HISTORY OF PRESENT ILLNESS:  Ms. [**Known firstname 6870**] [**Known lastname **] is a
19-year-old woman with a 15-month history of bipolar
disorder.  Beginning two weeks ago, her mother said she had
several episodes of vomiting and was drinking lots of water
(about 15 cups per day) in an attempt to lose weight.  Her
mother also notes that she has been unusually irritable and
angry during this time.  The patient is from [**Location (un) **] and
was in town for the Fourth of [**Month (only) 205**] visiting her mother's
aunt.

Early in the morning of [**8-15**], she locked herself in the
bathroom with the water running.  Her aunt heard moans coming
from the bathroom and called Emergency Medical Service who
broke down the door and brought her in.

On the way to the Emergency Department she reportedly vomited
three to four gallons of clear fluid.  She denies any drug
overdose attempts, and no bottles were found in the bathroom.
It is unclear whether or not this was a suicide attempt.

A Psychiatric consultation note dated [**2127-8-16**] states
that the patient did feel that there was sperm everywhere
including her stomach and that she was drinking water in an
effort to cleanse herself.  Her mother states that a similar
bathroom and water episode occurred in [**2126-5-12**] prior to
this current hospitalization.

While in the Emergency Department, the patient seized twice
and was intubated.  She was also given charcoal and
intravenous Ativan.  She was found to be hyponatremic with a
sodium of 111, urine osmolality of 461, and a serum
osmolality of 235.

In the Medical Intensive Care Unit, she was started on 3%
sodium chloride at 20 cc an hour, and her sodium started
climbing fairly rapidly.  The 3% sodium chloride was
discontinued, and she was started on D-5-W to lower the
sodium to 123 since it had been climbing too rapidly.  By the
morning of [**2127-8-16**] she had received a total of 12 liters
of free water and diuresed 16 liters since admission on [**2127-8-15**].  She was extubated on the morning of [**2127-8-16**]
and was awake and alert.

A Neurology consultation found no signs of central pontine
myelinolysis.  She was subsequently transferred to the
General Medicine floor from the Medical Intensive Care Unit
on [**2127-8-17**].

REVIEW OF SYSTEMS:  The patient states that she has had a
50-pound to 60-pound weight loss since [**2127-5-12**].  She
denies any visual disturbances, headaches, or dizziness.

PAST MEDICAL HISTORY:
1.  Bipolar disorder diagnosed in [**2126-5-12**]; at which
time she was admitted to a psychiatric hospital for one
month.  She has been on medications up until this current
admission.
2.  Questionable mitral valve prolapse which is being worked
up by her primary care doctor in [**State 531**].
3.  No history of seizures.

MEDICATIONS ON ADMISSION:
1.  Trileptal 600 mg p.o. b.i.d.
2.  Topamax 25 mg p.o. q.i.d.
3.  Geodon 40 mg p.o. b.i.d.

ALLERGIES:  No known drug allergies.

FAMILY HISTORY:   Her father's sister has bipolar disorder.
Her father's brother has schizophrenia.

SOCIAL HISTORY:  The patient currently lives with her mother
and older sister in [**Name (NI) **] where she sleeps in the corner
of the living room behind divider.  She graduated from high
school early and began attending [**Location (un) 42830**]in the
Fall of [**2126**], at which time her psychiatric problems began.
She left school in [**Month (only) 547**], at which time she went to live with
her aunt in [**Name (NI) 760**] where she could receive 24-hour care.
She moved back to [**Location (un) **] in [**Month (only) 956**], and is currently
doing data entry and taking courses for certification in this
field.  She denies any alcohol or drug use.

PHYSICAL EXAMINATION ON PRESENTATION:  Vital signs revealed a
temperature of 98.4, blood pressure was 100/70, pulse was 85,
respiratory rate was 20, oxygen saturation was 98% on room
air.  In general, a pleasant young female in no apparent
distress.  Head, eyes, ears, nose, and throat revealed the
oropharynx was benign.  Pupils were equal, round, and
reactive to light and accommodation.  Extraocular muscles
were intact.  Pulmonary revealed lungs were clear to
auscultation bilaterally.  Cardiovascular revealed normal
first heart sound and second heart sound.  No murmurs, rubs
or gallops.  A regular rate and rhythm.  The abdomen revealed
normal bowel sounds, mild tenderness in the left epigastrium.
No masses.  No rebound tenderness or guarding.  Extremities
revealed no clubbing, cyanosis or edema.  Neurologically,
alert and oriented times three.  Cranial nerves II through
XII were intact.  Reflexes revealed patellar was 1+ on the
right and 0 on the left.  Achilles were 1+ bilaterally.
Finger-to-nose and heel-to-shin were intact.

PERTINENT LABORATORY DATA ON PRESENTATION:  Sodium on
admission was 111 with her most recent sodium being 143.
Serum osmolalities were 235 on admission with the most recent
serum osmolalities being 288.

RADIOLOGY/IMAGING:   A negative head CT.

HOSPITAL COURSE BY PROBLEM:

1.  HYPONATREMIA:  The patient's sodium of 111, along with
her urine osmolalities and serum osmolalities levels
suggested that she had both primary polydipsia compounded
with syndrome of inappropriate secretion of antidiuretic
hormone secondary to medications; in particular, her
Trileptal.

Her sodium level was slowly corrected while corrected while
she was in the Medical Intensive Care Unit from 111 up to the
normal range for sodium.  She was then transferred to the
Medicine floor where her sodium levels remained stable with a
[**2125**]-cc fluid restriction.  She would likely benefit from
maintenance of this [**2125**]-cc fluid restriction while she is on
the psychiatric floor.  Her sodium level has remained over
the past few days, which will not require daily monitoring
with blood draws since she has been asymptomatic.

2.  BIPOLAR DISORDER:  The Psychiatry team has been following
this patient throughout her admission.  She was taking
Trileptal, Topamax, and Geodon prior to admission; however,
these medications were discontinued.  She will be transferred
to the psychiatric unit for further care an initiation of her
psychiatric medications.

It is likely that the Trilpetal contributed to a component of
her low sodium by causing medication-induced syndrome of
inappropriate secretion of antidiuretic hormone.  She should
avoid taking this medication in the future if possible.

DISCHARGE DIAGNOSES:
1.  Hyponatremia secondary to primary polydipsia and
medication-induced syndrome of inappropriate secretion of
antidiuretic hormone; this has been completely resolved, and
her sodium levels have been stable.
2.  Bipolar disorder; her psychiatric medications were held
during her hospital stay.  However, she will likely be
restarted on these medications while in the psychiatric unit.

MEDICATIONS ON DISCHARGE:   None.

DISCHARGE STATUS:  The patient was to be discharged to the
psychiatric floor.

CONDITION AT DISCHARGE:  Condition on discharge was good.

FOLLOW-UP INSTRUCTIONS:  The patient should follow up after
discharge from the psychiatric unit with her psychiatrist in
[**State 531**] (Dr. [**Last Name (STitle) **].




                            [**First Name11 (Name Pattern1) 2515**] [**Last Name (NamePattern4) 4517**], M.D.  [**MD Number(1) 4521**]

Dictated By:[**Name8 (MD) 7861**]
MEDQUIST36

D:  [**2127-8-20**]  10:01
T:  [**2127-8-20**]  10:18
JOB#:  [**Job Number **]
{'Hyposmolality and/or hyponatremia,Other convulsions,Bipolar I disorder, most recent episode (or current) unspecified,Mitral valve disorders'}


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: Vomiting.

PRESENT ILLNESS: Ms. [**Known firstname 6870**] [**Known lastname **] is a
19-year-old woman with a 15-month history of bipolar
disorder.  Beginning two weeks ago, her mother said she had
several episodes of vomiting and was drinking lots of water
(about 15 cups per day) in an attempt to lose weight.  Her
mother also notes that she has been unusually irritable and
angry during this time.  The patient is from [**Location (un) **] and
was in town for the Fourth of [**Month (only) 205**] visiting her mother's
aunt.

MEDICAL HISTORY: 1.  Bipolar disorder diagnosed in [**2126-5-12**]; at which
time she was admitted to a psychiatric hospital for one
month.  She has been on medications up until this current
admission.
2.  Questionable mitral valve prolapse which is being worked
up by her primary care doctor in [**State 531**].
3.  No history of seizures.

MEDICATION ON ADMISSION: 1.  Trileptal 600 mg p.o. b.i.d.
2.  Topamax 25 mg p.o. q.i.d.
3.  Geodon 40 mg p.o. b.i.d.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Her father's sister has bipolar disorder.
Her father's brother has schizophrenia.

SOCIAL HISTORY: The patient currently lives with her mother
and older sister in [**Name (NI) **] where she sleeps in the corner
of the living room behind divider.  She graduated from high
school early and began attending [**Location (un) 42830**]in the
Fall of [**2126**], at which time her psychiatric problems began.
She left school in [**Month (only) 547**], at which time she went to live with
her aunt in [**Name (NI) 760**] where she could receive 24-hour care.
She moved back to [**Location (un) **] in [**Month (only) 956**], and is currently
doing data entry and taking courses for certification in this
field.  She denies any alcohol or drug use. 

### Response:
{'Hyposmolality and/or hyponatremia,Other convulsions,Bipolar I disorder, most recent episode (or current) unspecified,Mitral valve disorders'}
