CHIEF COMPLAINT: "I drank too much."

PRESENT ILLNESS: 45yo M with a history of alcoholism who presents after 6 days of
alcohol binge drinking. Mr. [**Name13 (STitle) 84342**] recently returned from
[**Country 7192**] on [**2112-10-2**] where he had "many problems." Upon return,
he began to drink beer, rum, liquor, and rubbing alcohol
incessantly. He did not eat all week. During that time, he
described himself as "like crazy." According to family members,
he continued to demand more alcohol and was "getting worse," so
2 cousins brought him to the Emergency Department for evaluation
on [**2112-10-7**]. He had mild abdominal pain from "drinking too
much." Mr. [**Name13 (STitle) 84342**] reports being sober for 5 years, but his wife
denied that, saying that he has been hospitalized at [**Hospital 8**]
Hospital for alcoholism and has frequent relapses during which
he drinks for 1-2 weeks at time.

MEDICAL HISTORY: s/p ex-lap for gunshot wound

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98   92   140/93   18   96%RA
General: somewhat desheveled-appearing man with poor denition
lying in bed, excited to converse, NAD
Skin: no rashes
HEENT: normocephalic, atraumatic, injected conjunctivae, PERRLA,
moist mucous membranes, no oropharyngeal lesions, supple neck,
no cervical/supraclavicular LAD
Cardiac: RRR, normal S1, S2, no murmurs, rubs, gallops
Pulm: CTAB, good air entry to bases
Abd: well healed scar adjacent to midline, +bs, soft, nontender,
nondistended
Ext: warm, well perfused, strong dp/pt pulses, no edema, no
asterixis
Neuro: A+Ox3, CNII-XII intact, moves all 4 extremities to
command, no focal deficits

FAMILY HISTORY: Mother recently passed away in traffic accident in [**Country 7192**].
Did not know his father. [**Name (NI) **] multiple siblings in reportedly
good health. No other known alcoholics in family.

SOCIAL HISTORY: Lives at home with wife. Travels frequently between US and
[**Country 7192**] (spends winter months in [**Country 7192**]). Works in
landscaping (lawn-mowing) and as a janitor. Has 28yo married
son. [**Name (NI) **] been alcoholic since adulthood. Denies smoking history
or recreational drug use.
Pneumonitis due to inhalation of food or vomitus,Other and unspecified manifestations of thiamine deficiency,Unspecified protein-calorie malnutrition,Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, continuous,Dehydration,Tachycardia, unspecified,Contusion of face, scalp, and neck except eye(s),Unspecified fall,Accidents occurring in other specified places
Food/vomit pneumonitis,Thiamine defic NEC/NOS,Protein-cal malnutr NOS,Alcohol withdrawal,Ac alcohol intox-contin,Dehydration,Tachycardia NOS,Contusion face/scalp/nck,Fall NOS,Accident in place NEC
Admission Date:  [**2112-10-8**]              Discharge Date:   [**2112-10-12**]

Date of Birth:  [**2048-1-6**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
"I drank too much."

Major Surgical or Invasive Procedure:
Intubation
Lumbar puncture


History of Present Illness:
45yo M with a history of alcoholism who presents after 6 days of
alcohol binge drinking. Mr. [**Name13 (STitle) 84342**] recently returned from
[**Country 7192**] on [**2112-10-2**] where he had "many problems." Upon return,
he began to drink beer, rum, liquor, and rubbing alcohol
incessantly. He did not eat all week. During that time, he
described himself as "like crazy." According to family members,
he continued to demand more alcohol and was "getting worse," so
2 cousins brought him to the Emergency Department for evaluation
on [**2112-10-7**]. He had mild abdominal pain from "drinking too
much." Mr. [**Name13 (STitle) 84342**] reports being sober for 5 years, but his wife
denied that, saying that he has been hospitalized at [**Hospital 8**]
Hospital for alcoholism and has frequent relapses during which
he drinks for 1-2 weeks at time.

Past Medical History:
s/p ex-lap for gunshot wound

Social History:
Lives at home with wife. Travels frequently between US and
[**Country 7192**] (spends winter months in [**Country 7192**]). Works in
landscaping (lawn-mowing) and as a janitor. Has 28yo married
son. [**Name (NI) **] been alcoholic since adulthood. Denies smoking history
or recreational drug use.

Family History:
Mother recently passed away in traffic accident in [**Country 7192**].
Did not know his father. [**Name (NI) **] multiple siblings in reportedly
good health. No other known alcoholics in family.

Physical Exam:
VS: 98   92   140/93   18   96%RA
General: somewhat desheveled-appearing man with poor denition
lying in bed, excited to converse, NAD
Skin: no rashes
HEENT: normocephalic, atraumatic, injected conjunctivae, PERRLA,
moist mucous membranes, no oropharyngeal lesions, supple neck,
no cervical/supraclavicular LAD
Cardiac: RRR, normal S1, S2, no murmurs, rubs, gallops
Pulm: CTAB, good air entry to bases
Abd: well healed scar adjacent to midline, +bs, soft, nontender,
nondistended
Ext: warm, well perfused, strong dp/pt pulses, no edema, no
asterixis
Neuro: A+Ox3, CNII-XII intact, moves all 4 extremities to
command, no focal deficits

Pertinent Results:
ADMISSION LABS [**2112-10-8**]:
BLOOD
[**2112-10-8**] 12:25AM WBC-8.6 Hgb-14.0 Hct-39.4* Plt Ct-198
[**2112-10-8**] 12:25AM Neuts-71.8* Lymphs-21.9 Monos-5.8 Eos-0.3
Baso-0.2
[**2112-10-8**] 12:25AM Glucose-144* UreaN-10 Creat-1.2 Na-135 K-3.4
Cl-97 HCO3-23 AnGap-18
[**2112-10-8**] 12:25AM ALT-116* AST-195* LD(LDH)-516* AlkPhos-66
TotBili-0.7
[**2112-10-8**] 12:25AM Lipase-81*
[**2112-10-8**] 09:35PM Calcium-8.1* Phos-2.0* Mg-2.3
[**2112-10-8**] 12:25AM Osmolal-313*
[**2112-10-8**] 07:05AM Ammonia-23
[**2112-10-8**] 12:25AM ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG
Barbitr-NEG Tricycl-NEG
[**2112-10-8**] 04:46AM Type-ART pO2-114* pCO2-39 pH-7.43 calTCO2-27
Base XS-2 Intubat-INTUBATED
[**2112-10-8**] 07:43AM Lactate-0.9

URINE
[**2112-10-8**] 02:30AM Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.008
[**2112-10-8**] 02:30AM Blood-MOD Nitrite-NEG Protein-30 Glucose-250
Ketone-150 Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG
[**2112-10-8**] 02:30AM RBC-0-2 WBC-0 Bacteri-RARE Yeast-NONE Epi-0-2
[**2112-10-8**] 02:30AM bnzodzp-NEG barbitr-NEG opiates-NEG cocaine-NEG
amphetm-NEG mthdone-NEG

CSF
[**2112-10-8**] 06:45AM WBC-1 RBC-208* Polys-8 Lymphs-48 Monos-44
[**2112-10-8**] 06:45AM WBC-7 RBC-2925* Polys-61 Lymphs-25 Monos-14
[**2112-10-8**] 06:45AM TotProt-30 Glucose-87
[**2112-10-8**] 09:14AM HERPES SIMPLEX VIRUS PCR-negative

LFTs:
[**2112-10-8**] 12:25AM ALT-116* AST-195* LD(LDH)-516* AlkPhos-66
TotBili-0.7
[**2112-10-8**] 09:35PM ALT-108* AST-189* LD(LDH)-523* AlkPhos-59
TotBili-0.7
[**2112-10-9**] 03:39AM ALT-104* AST-165* AlkPhos-57 TotBili-0.8
[**2112-10-10**] 06:14AM ALT-96* AST-96* LD(LDH)-371*
[**2112-10-11**] 06:52AM ALT-92* AST-70* LD(LDH)-313* TotBili-0.8

MICROBIOLOGY:
[**2112-10-8**] CSF gram stain, fluid Cx - negative
[**2112-10-8**] BCx - negative
[**2112-10-8**] MRSA screen - negative
[**2112-10-8**] Influenza DFA - negative
[**2112-10-8**] Sputum Cx - sparse growth
[**2112-10-9**] RPR - non-reactive

STUDIES:
[**2112-10-8**] EKG - Sinus tachycardia. Left axis deviation. There is
a late
transition with tiny R waves in the anterior leads consistent
with possible prior anterior myocardial infarction

[**2112-10-8**] CT abd/pelvis -
1. No acute intra-abdominal or pelvic trauma.
2. Bibasalar atelectasis-consolidation may represent aspiration.

3. Fatty liver.

[**2112-10-8**] CT head -
No acute intracranial abnormality

[**2112-10-8**] CT C-spine -
No fracture or misalignment of the cervical spine. Evaluation
for
ligaments and cord is limited on CT and MRI is a better modality
to evaluate these structures

DISCHARGE LABS:
[**2112-10-10**] 06:14AM WBC-4.7 Hgb-14.1 Hct-41.1 Plt Ct-164
[**2112-10-10**] 06:14AM Glucose-102 UreaN-9 Creat-1.0 Na-138 K-3.8
Cl-101 HCO3-29 AnGap-12
[**2112-10-11**] 06:52AM ALT-92* AST-70* LD(LDH)-313* TotBili-0.8

Brief Hospital Course:
Mr. [**Name13 (STitle) 84342**] is a 64 year old man with h/o EtOH abuse for 50
years, presented to the hospital after 1 week of heavy drinking,
abdominal pain.

In the ED, Mr. [**Name13 (STitle) 84342**] was answering questions appropriately
initially, but then became febrile to 101, tachycardic to 130,
and progressively more delerious/agitated. He would initially
follow commands but was easily distracted and would try to get
out of bed. He did not have a tremor or focal neuro signs at any
time. Serum and urine tox were negative. Because of
distractability, he was intubated for CT head and LP. CT head
was negative and LP showed 200 RBCs, 1 wbc, glucose 87, protein
30. CT abdomen/pelvis for his abdominal pain showed bibasilar
consolidation, ED felt that he had likely aspirated
perintubation. He was given Ceftriaxone 2 grams for suspected
meningitis and levofloxacin for PNA as well as valium and a
banana bag. He remained hemodynamically stable, satting high 90s
on FiO2 48% and PEEP of 8. Blood cultures were drawn after Abx
administered.

In the MICU, he received acyclovir for possible HSV
encephalitis, levofloxacin/vancomycin for CAP. He was extubated
without difficulty. He was noted to be tachycardic, agitated,
and sweaty, so was given 75mg total of valium for suspected
withdrawal.

Upon arrival to the floor, Mr. [**Name13 (STitle) 84342**] was noted to be agitated
and easily distracted. He had increased energy and was seen
walking into other patients' rooms. He expressed great concern
about obtaining a letter for his employer about being in the
hospital for these missed days of work. Psychiatry evaluated the
patient and felt that he showed signs of mania. They were
uncomfortable sending him home on hospital day 3 without
contextualizing his behavior with his baseline. Upon further
evaluation, Mr. [**Name13 (STitle) 84342**] showed signs of Wernicke's
encephalopathy. He frequently confabulated stories to fit each
conversation. He exhibited bizarre behavior throughout his
hospitalization (exposing himself, lying on another patient's
empty bed, unable to report consistently his date of birth), but
his mental status improved overall. He was given IV thiamine
100mg for 5 days and discharged with PO MVI, thiamine, and
folate.

Medications on Admission:
None

Discharge Medications:
1. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnoses: Alcohol abuse, Wernicke's encephalopathy
Secondary diagnoses: malnutrition, dehydration

Discharge Condition:
Stable, baseline mental status


Discharge Instructions:
You were seen in the hospital for your alcohol abuse. Imaging of
your head showed no bleeding. Imaging of your abdomen showed a
fatty liver and possible signs of aspiration. Imaging of your
cervical spine showed no fracture. The labs did not indicate
that you had an infection, but you were given several
antibiotics to treat an infection that may not have showed up in
the labs. You were seen my Psychiatry who diagnosed you with
alcohol dependence and delirium secondary to alcohol dependence.
Due to your chronic alcohol abuse, you may have a condition
called "Wernicke's encephalopathy." There is no cure for this
condition. To stop this condition from getting worse, you should
stop drinking alcohol. Please continue to take a thiamine
supplement and eat healthy meals.

The following additions were made to your medications:
1. Please take a multivitamin, folate, and thiamine daily to
supplement your diet and keep you healthy
2. Please take Famotidine daily to help with your abdominal pain

If you have any signs of confusion, strange behavior, belly
pain, headache, difficulty remembering, chest pain, or shortness
of breath, please seek care immediately in the Emergency
Department.

Followup Instructions:
Please follow up at [**Hospital **] Health Center, located at [**Hospital1 84343**] [**Location (un) 686**], [**Numeric Identifier 12201**].
Provider: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Date/Time: [**2112-10-24**] 9am
Phone: [**Age over 90 7976**]
You can try calling the number for an earlier appointment.

Here are some other resources that may be helpful for you:
Latino Health Insurance Program
Contact: [**Name (NI) 20752**] [**Last Name (NamePattern1) **]
Phone: [**Telephone/Fax (1) 84344**] 2
She can help you get health insurance.

Substance Abuse Hotline
1-[**Telephone/Fax (1) 60237**]
Call this number if you ever feel like you need help with your
alcohol use. They can help you find ways to stop drinking
alcohol.


                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]
{'Pneumonitis due to inhalation of food or vomitus,Other and unspecified manifestations of thiamine deficiency,Unspecified protein-calorie malnutrition,Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, continuous,Dehydration,Tachycardia, unspecified,Contusion of face, scalp, and neck except eye(s),Unspecified fall,Accidents occurring in other specified places'}


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: "I drank too much."

PRESENT ILLNESS: 45yo M with a history of alcoholism who presents after 6 days of
alcohol binge drinking. Mr. [**Name13 (STitle) 84342**] recently returned from
[**Country 7192**] on [**2112-10-2**] where he had "many problems." Upon return,
he began to drink beer, rum, liquor, and rubbing alcohol
incessantly. He did not eat all week. During that time, he
described himself as "like crazy." According to family members,
he continued to demand more alcohol and was "getting worse," so
2 cousins brought him to the Emergency Department for evaluation
on [**2112-10-7**]. He had mild abdominal pain from "drinking too
much." Mr. [**Name13 (STitle) 84342**] reports being sober for 5 years, but his wife
denied that, saying that he has been hospitalized at [**Hospital 8**]
Hospital for alcoholism and has frequent relapses during which
he drinks for 1-2 weeks at time.

MEDICAL HISTORY: s/p ex-lap for gunshot wound

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98   92   140/93   18   96%RA
General: somewhat desheveled-appearing man with poor denition
lying in bed, excited to converse, NAD
Skin: no rashes
HEENT: normocephalic, atraumatic, injected conjunctivae, PERRLA,
moist mucous membranes, no oropharyngeal lesions, supple neck,
no cervical/supraclavicular LAD
Cardiac: RRR, normal S1, S2, no murmurs, rubs, gallops
Pulm: CTAB, good air entry to bases
Abd: well healed scar adjacent to midline, +bs, soft, nontender,
nondistended
Ext: warm, well perfused, strong dp/pt pulses, no edema, no
asterixis
Neuro: A+Ox3, CNII-XII intact, moves all 4 extremities to
command, no focal deficits

FAMILY HISTORY: Mother recently passed away in traffic accident in [**Country 7192**].
Did not know his father. [**Name (NI) **] multiple siblings in reportedly
good health. No other known alcoholics in family.

SOCIAL HISTORY: Lives at home with wife. Travels frequently between US and
[**Country 7192**] (spends winter months in [**Country 7192**]). Works in
landscaping (lawn-mowing) and as a janitor. Has 28yo married
son. [**Name (NI) **] been alcoholic since adulthood. Denies smoking history
or recreational drug use. 

### Response:
{'Pneumonitis due to inhalation of food or vomitus,Other and unspecified manifestations of thiamine deficiency,Unspecified protein-calorie malnutrition,Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, continuous,Dehydration,Tachycardia, unspecified,Contusion of face, scalp, and neck except eye(s),Unspecified fall,Accidents occurring in other specified places'}
