CHIEF COMPLAINT: Altered mental status

PRESENT ILLNESS: This is a 33 yo F, 2 months post-partum from NSVD, who presented
to an OSH ([**Hospital **] Hosp [**Telephone/Fax (1) **]) yesterday complaining of
dizziness, nausea, vomiting, tingling fingers and confusion. She
was brought to the OSH by her husband. As per the husband she
had told him that she felt "strange, and had never felt like
this before".
At the ED there she had no c/o HA, recent fever, trauma. Her
only recent complaint was feeling constantly dehydrated despite
drinking large amounts of water ([**5-2**]+L per day), tiredness,
"feeling overwhelmed" and occasional constipation.
Pregnancy was complicated by multiple visits to OB/L&D for
"false labor" and dehydration.
After arrival at the ED and placement in an exam room, she was
found on the floor unresponsive, having vomited and "twitching".
 During her stay in the ED she was occasionally alert & awake,
but agitated and combative.
Pertinent findings on physical exam were: afebrile, with supple
neck, no signs of trauma, agitation as above, nonfocal neuro
exam, downgoing babinskis.
Initial sodium was 120, K=3.4, bicarb 20, BUN=9, Cr=0.8, Hct=35,
WBC 10.6, FS=103.
Initial Head CT was read as suboptimal exam [**12-26**] motion artifact,
suggestion of diffuse decrease in ventricular size & cortical
sulci, [**Month (only) **] grey-white differentiation, no focal parenchymal
findings, ? cerebral edema.
In the ED she received 3mg Ativan IV, Compazine 10mg IV, 1L NS.
She was transferred to the ICU where she was started on
hypertonic saline (total of 284mL of 3% saline). She was
evaluated by renal and neurology.
Neuro interventions included LP w/ normal opening pressure
(170mm), neg CSF(prot 29, glucose 70, wbc 1).
Other relevant findings/interventions were blood cx (NGTD), Mg
repletion (3g total), dexamethasone 10mg. (see below for full
summary of labs etc).
Prior to transfer she had a MRI brain that was read as (resident
read) 1. diffuse sulcal inc. flair signal ? artifact vs diffuse
SAH vs meningitis. 2. inc cortical signal - but no ev for acute
infarct/global ischemia 3. no shift - films did not accompany
the patient.

MEDICAL HISTORY: 1. psychiatric admission age 13 2. Interstitial cystitis, 3.
pelvic pain, 4. endometriosis, 5. H/O UTIs
PSxHx: Left bunionectomy

MEDICATION ON ADMISSION: vitamins, no herbals, no other OTCs

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: PE: VS:

FAMILY HISTORY: father w/ epilepsy, maternal GM w/ schizophrenia

SOCIAL HISTORY: married, lives with husband & son, employed as psych RN
Hyposmolality and/or hyponatremia,Other convulsions
Hyposmolality,Convulsions NEC
Admission Date:  [**2130-5-27**]              Discharge Date:   [**2130-5-30**]

Date of Birth:  [**2096-10-8**]             Sex:   F

Service: MED

Allergies:
Sulfa (Sulfonamides)

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Altered mental status


Major Surgical or Invasive Procedure:
none


History of Present Illness:
This is a 33 yo F, 2 months post-partum from NSVD, who presented
to an OSH ([**Hospital **] Hosp [**Telephone/Fax (1) **]) yesterday complaining of
dizziness, nausea, vomiting, tingling fingers and confusion. She
was brought to the OSH by her husband. As per the husband she
had told him that she felt "strange, and had never felt like
this before".
At the ED there she had no c/o HA, recent fever, trauma. Her
only recent complaint was feeling constantly dehydrated despite
drinking large amounts of water ([**5-2**]+L per day), tiredness,
"feeling overwhelmed" and occasional constipation.
Pregnancy was complicated by multiple visits to OB/L&D for
"false labor" and dehydration.
After arrival at the ED and placement in an exam room, she was
found on the floor unresponsive, having vomited and "twitching".
 During her stay in the ED she was occasionally alert & awake,
but agitated and combative.
Pertinent findings on physical exam were: afebrile, with supple
neck, no signs of trauma, agitation as above, nonfocal neuro
exam, downgoing babinskis.
Initial sodium was 120, K=3.4, bicarb 20, BUN=9, Cr=0.8, Hct=35,
WBC 10.6, FS=103.
Initial Head CT was read as suboptimal exam [**12-26**] motion artifact,
suggestion of diffuse decrease in ventricular size & cortical
sulci, [**Month (only) **] grey-white differentiation, no focal parenchymal
findings, ? cerebral edema.
In the ED she received 3mg Ativan IV, Compazine 10mg IV, 1L NS.
She was transferred to the ICU where she was started on
hypertonic saline (total of 284mL of 3% saline). She was
evaluated by renal and neurology.
Neuro interventions included LP w/ normal opening pressure
(170mm), neg CSF(prot 29, glucose 70, wbc 1).
Other relevant findings/interventions were blood cx (NGTD), Mg
repletion (3g total), dexamethasone 10mg. (see below for full
summary of labs etc).
Prior to transfer she had a MRI brain that was read as (resident
read) 1. diffuse sulcal inc. flair signal ? artifact vs diffuse
SAH vs meningitis. 2. inc cortical signal - but no ev for acute
infarct/global ischemia 3. no shift - films did not accompany
the patient.


Past Medical History:
1. psychiatric admission age 13 2. Interstitial cystitis, 3.
pelvic pain, 4. endometriosis, 5. H/O UTIs
PSxHx: Left bunionectomy

Social History:
married, lives with husband & son, employed as psych RN


Family History:
father w/ epilepsy, maternal GM w/ schizophrenia

Physical Exam:
PE: VS:

Gen: awake, does not respond to commands, agitated - saying
"please help me"
HEENT: PERRLA, pupils 4->3 w/ light, EOMI grossly intact, neck
supple, FROM
LUNGS: CTA B, no wheezes, ronchi, rales
CARD: RRR, 2/6 SEM best @ base, no radiation
ABD: soft, ND, NT, NABS
EXT: warm, no c/c/e
NEURO: alert, not responsive to commands, CN 2-12 grossly
intact, MAEW, B LE reflexes [**1-25**]+, no clonus. did not assess
gait.


Pertinent Results:
[**2130-5-27**] 06:24PM   GLUCOSE-109* UREA N-6 CREAT-0.6 SODIUM-131*
POTASSIUM-3.6 CHLORIDE-97 TOTAL CO2-25 ANION GAP-13
[**2130-5-27**] 06:25PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2130-5-27**] 06:24PM   WBC-12.8* RBC-3.89* HGB-12.3 HCT-34.1* MCV-88
MCH-31.7 MCHC-36.2* RDW-12.5

Brief Hospital Course:
1. Altered mental status - The initial differential included new
onset seizure disorder, hyponatremia (alone, or by possibly
lowering seizure threshold), central demyelinating process
secondary to rapid correction of hyponatremia, toxic metabolic
syndromes, or other exogenous toxic ingestion, brain structural
lesions (poss. causing seizures), endocrine disorders.  The
normal LP at OSH helps eliminate meningitis.  Her CT at the
outside hospital had shown question of cerebral edema, the MRI
showed diffuse increase in sucal flair signal.  She was
transfered from [**Hospital1 **] ICU to the MICU at [**Hospital1 18**].  Her tox
screen was negative except for positive opiods.  She regained
mental status and was transferred to the floor.  On the floor
and MRV was obtained to rule out venous thrombosis causing
increased ICP leading to her nausea, vomiting, and altered
mental status.  The MRV was normal.  Neurology was involved in
her evaluation and felt she was safe to discharge home with
instructions on restricting free water intake.

2. Hyponatremia - Her hyponatremia seemed to be somewhat chronic
in nature, although this may represent acute exacerbation.  She
states that she had been told to drink a lot of fluid because
she was breast feeding.  Prior to coming into the hospital she
was drinking 6-7 liters of water a day.  She was placed on a
free water restriction while in the hospital and her Na was
checked every 6, then every 12 hours.  Once her free water was
restricted her Na remained normal for the duration of her
hospital admission.  She met with a nutritionist while in the
hospital to get advice on maintaining apropriate PO intake and
avoiding another occurance of this in the future.

3. Psych - She was evaluated by psychology while she was in the
hospital.  She is to follow up with her psychologist and
counselor as an outpatient.

4.  Prophylaxis - She was maintained on normal diet for the
course of her hospital stay.  She was initially treated with
Heparin SC but these were stopped once she was ambulating on her
own.

5.  Breast feeding - She was initially interested in continuing
to breast feed.  We obtained a pump for her but told her to
discard all milk until the Ativan had washed from her system.
She later decided that she was not interested in breast feeding
as she was nervous it had contributed to her initial
hyponatremia.

6.  Nausea - She was having trouble with nausea during her
hospital admission.  She was treated with Zofran and Compazine
while in the hospital.  We tested a urine HCG which was
negative.

Medications on Admission:
vitamins, no herbals, no other OTCs

Discharge Medications:
1. Reglan 10 mg Tablet Sig: One (1) Tablet PO every six (6)
hours as needed for nausea.
Disp:*40 Tablet(s)* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
1.  Hyponatremia


Discharge Condition:
good

Discharge Instructions:
Return to emergency room if you feel any symptoms similar to
those that preceeded your current admission (severe
lightheadedness, nausea, finger tingling)
Limit free water intake to 1500 ml per day.


Followup Instructions:
Please call PCP [**Last Name (NamePattern4) **]. [**Last Name (STitle) 22799**] at [**Telephone/Fax (1) 57852**] in 1 week
Follow up with Dr. [**First Name (STitle) **] (psychiatrist) and [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) 35041**]
(therapist) next week.
{'Hyposmolality and/or hyponatremia,Other convulsions'}


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: Altered mental status

PRESENT ILLNESS: This is a 33 yo F, 2 months post-partum from NSVD, who presented
to an OSH ([**Hospital **] Hosp [**Telephone/Fax (1) **]) yesterday complaining of
dizziness, nausea, vomiting, tingling fingers and confusion. She
was brought to the OSH by her husband. As per the husband she
had told him that she felt "strange, and had never felt like
this before".
At the ED there she had no c/o HA, recent fever, trauma. Her
only recent complaint was feeling constantly dehydrated despite
drinking large amounts of water ([**5-2**]+L per day), tiredness,
"feeling overwhelmed" and occasional constipation.
Pregnancy was complicated by multiple visits to OB/L&D for
"false labor" and dehydration.
After arrival at the ED and placement in an exam room, she was
found on the floor unresponsive, having vomited and "twitching".
 During her stay in the ED she was occasionally alert & awake,
but agitated and combative.
Pertinent findings on physical exam were: afebrile, with supple
neck, no signs of trauma, agitation as above, nonfocal neuro
exam, downgoing babinskis.
Initial sodium was 120, K=3.4, bicarb 20, BUN=9, Cr=0.8, Hct=35,
WBC 10.6, FS=103.
Initial Head CT was read as suboptimal exam [**12-26**] motion artifact,
suggestion of diffuse decrease in ventricular size & cortical
sulci, [**Month (only) **] grey-white differentiation, no focal parenchymal
findings, ? cerebral edema.
In the ED she received 3mg Ativan IV, Compazine 10mg IV, 1L NS.
She was transferred to the ICU where she was started on
hypertonic saline (total of 284mL of 3% saline). She was
evaluated by renal and neurology.
Neuro interventions included LP w/ normal opening pressure
(170mm), neg CSF(prot 29, glucose 70, wbc 1).
Other relevant findings/interventions were blood cx (NGTD), Mg
repletion (3g total), dexamethasone 10mg. (see below for full
summary of labs etc).
Prior to transfer she had a MRI brain that was read as (resident
read) 1. diffuse sulcal inc. flair signal ? artifact vs diffuse
SAH vs meningitis. 2. inc cortical signal - but no ev for acute
infarct/global ischemia 3. no shift - films did not accompany
the patient.

MEDICAL HISTORY: 1. psychiatric admission age 13 2. Interstitial cystitis, 3.
pelvic pain, 4. endometriosis, 5. H/O UTIs
PSxHx: Left bunionectomy

MEDICATION ON ADMISSION: vitamins, no herbals, no other OTCs

ALLERGIES: Sulfa (Sulfonamides)

PHYSICAL EXAM: PE: VS:

FAMILY HISTORY: father w/ epilepsy, maternal GM w/ schizophrenia

SOCIAL HISTORY: married, lives with husband & son, employed as psych RN 

### Response:
{'Hyposmolality and/or hyponatremia,Other convulsions'}
