CHIEF COMPLAINT: heroin overdose

PRESENT ILLNESS: cc:[**CC Contact Info **].
hpi: 36 yo m w/ h/o hepatitis c who presents to the ICU
following overdose.  Patient reports that he began using heroine
last night when he noted some blurry vision then awoke in the
ED. Denies other preceding symptoms.  No headache/cp/sob/aura.
Unclear how long he was down for.  Wife found patient on floor
in bathroom -> called EMS.   again, after being clean for approx
2 years.   Triggered by splitup with wife.  Also states he has
been taking valium (from friend) over the last several days.
Denies recent illness.  Specifically no f/chills/rash/sore
throat/sob/cough/problems w/ urination. States that his daughter
has had several bouts of strep throat and that he and his wife
have been ill, most recently approx 1 mo ago characterized by
lethargy, and flu like symptoms.  Denies SI.
.
In ED, initial VSS stable, pt arousable and oriented.  Noted to
desat to 89% when his resp rate dropped to approx 7.  Given
Narcan 0.2 mg x2, followed by 0.4 mg x2, with improvment in rr.
Started on narcan drip, transferred to ICU for further
monitoring.

MEDICAL HISTORY: hepatitis c, x several years, acquired by needle sharing.  no
h/o jaundice/ruq pain/dk urine.
depression

MEDICATION ON ADMISSION: Prozac 20mg qday
Multivitamin 1 tab po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98.0, bp 122/65, hr 98, rr 12, 98% ra on narcan gtt
Easily arousable, well appearing male in NAD.
PERRL. anicteric
OP clr. MMM
neck supple.
Regular s1,s2. no m/r/g
LCA b/l
+bs. soft. nt. nd. no [**Doctor Last Name **] sign. liver 7cm in mcl. spleen
not palpable.
no le edema/clubbing/cyanosis
Alert and oriented x3.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: h/o IV heroin, previously clean for 2 years.
denies etoh.
+tobacco use
Poisoning by heroin,Opioid abuse, unspecified,Unspecified viral hepatitis C without hepatic coma,Hypovolemia,Accidental poisoning by heroin,Depressive disorder, not elsewhere classified,Unspecified nonpsychotic mental disorder
Poisoning-heroin,Opioid abuse-unspec,Hpt C w/o hepat coma NOS,Hypovolemia,Acc poison-heroin,Depressive disorder NEC,Nonpsychotic disord NOS
Admission Date:  [**2161-11-10**]              Discharge Date:   [**2161-11-12**]

Date of Birth:  [**2125-8-1**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3326**]
Chief Complaint:
heroin overdose

Major Surgical or Invasive Procedure:
No major surgical or invasive procedures.

History of Present Illness:
cc:[**CC Contact Info **].
hpi: 36 yo m w/ h/o hepatitis c who presents to the ICU
following overdose.  Patient reports that he began using heroine
last night when he noted some blurry vision then awoke in the
ED. Denies other preceding symptoms.  No headache/cp/sob/aura.
Unclear how long he was down for.  Wife found patient on floor
in bathroom -> called EMS.   again, after being clean for approx
2 years.   Triggered by splitup with wife.  Also states he has
been taking valium (from friend) over the last several days.
Denies recent illness.  Specifically no f/chills/rash/sore
throat/sob/cough/problems w/ urination. States that his daughter
has had several bouts of strep throat and that he and his wife
have been ill, most recently approx 1 mo ago characterized by
lethargy, and flu like symptoms.  Denies SI.
.
In ED, initial VSS stable, pt arousable and oriented.  Noted to
desat to 89% when his resp rate dropped to approx 7.  Given
Narcan 0.2 mg x2, followed by 0.4 mg x2, with improvment in rr.
Started on narcan drip, transferred to ICU for further
monitoring.

Past Medical History:
hepatitis c, x several years, acquired by needle sharing.  no
h/o jaundice/ruq pain/dk urine.
depression


Social History:
h/o IV heroin, previously clean for 2 years.
denies etoh.
+tobacco use

Family History:
Non-contributory

Physical Exam:
98.0, bp 122/65, hr 98, rr 12, 98% ra on narcan gtt
Easily arousable, well appearing male in NAD.
PERRL. anicteric
OP clr. MMM
neck supple.
Regular s1,s2. no m/r/g
LCA b/l
+bs. soft. nt. nd. no [**Doctor Last Name **] sign. liver 7cm in mcl. spleen
not palpable.
no le edema/clubbing/cyanosis
Alert and oriented x3.


Pertinent Results:
EKG:  100bpm, nl axis, nl intervals, no st-tw changes.

[**2161-11-10**]:
CHEST PORTABLE: Prior studies are not available for comparison.
The heart is normal in size. The mediastinal, hilar contours are
unremarkable. The pulmonary vasculature is normal. The lungs are
clear.

IMPRESSION: No acute intrathoracic process.

[**2161-11-10**] 11:53PM URINE  bnzodzpn-POS barbitrt-NEG opiates-POS
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2161-11-10**] 10:20PM   GLUCOSE-349* UREA N-20 CREAT-1.4* SODIUM-141
POTASSIUM-4.7 CHLORIDE-99 TOTAL CO2-27 ANION GAP-20
ASA-NEG ETHANOL-NEG ACETMNPHN-NEG bnzodzpn-POS barbitrt-NEG
tricyclic-NEG
WBC-13.9* RBC-4.44* HGB-14.4 HCT-40.6 MCV-92 MCH-32.4*
MCHC-35.4* RDW-13.1
NEUTS-90.2* BANDS-0 LYMPHS-7.9* MONOS-1.3* EOS-0.2 BASOS-0.3

Brief Hospital Course:
Impression: 36 yo m w/ history of IV drug use, recent heroin
use, found down, low respiratory rate in ED, improved w/ narcan.
.
1) heroin overdose-
Pt was administered narcan in the ED with immediate response.
He was transferred to the [**Hospital Unit Name 153**] for further observation,
monitoring of vital signs.  He was maintained on a narcan drip
which was titrated off.  The pt's vital signs remained stable
with good oxygenation.  On arrival to [**Hospital Unit Name 153**], he was mentating
normally, appropriate in conversation.  No suspicion for
infectious etiologies (i.e. meningitis- elev wbcc likely [**3-4**]
demargination).  A social work consult was placed and psychiatry
evaluated the patient as well.  He was discharged from the ICU
in stable condition.
.
2) Hepatitis c- little history known by patient
LFTs were checked to rule out a hepatic component to his change
in mental status.  He had only mildly elevated AST and ALT, with
a normal total bilirubin.
.
3) [**Name (NI) 20191**] unclear etiology. It was not documented if pt
received D50 on presentation to ED.  However, his glucose was
elevated on both his chem 7 and urine.  An AM fasting glucose
was checked, and it was within normal limits.  His HgbA1C was
normal.
.
4) Elevated anion gap- mild at 15, then closed.  This was
thought likely secondary to ketones if patient was down for some
time (although not noted in urine). Also concern for ingestion,
although patient denies.  The gap was re-checked on AM labs and
was normal.
.
5) Depression- We continued his prozac.  Psychiatry was involved
in the care of this pt.  He will need to follow up as an
outpatient.
.
6) Benzodiazepine use-
He did not require a CIWA scale after he was titrated off narcan
gtt.
.
7) full code

Medications on Admission:
Prozac 20mg qday
Multivitamin 1 tab po qd

Discharge Medications:
1. Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
Disp:*30 Capsule(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
1. Heroin overdose
2. Depression with suicidal ideations
3. Benzodiazepine use


Discharge Condition:
Stable.


Discharge Instructions:
If you develop shortness of breath, chest pain, confusion,
headache, vision changes, please call your PCP or go to the
emergency room. If you develop suicidal or homicidal thoughts,
please go to the emergency room.

Followup Instructions:
Please follow-up with your PCP [**Last Name (NamePattern4) **] [**2-1**] weeks.



Completed by:[**2161-11-27**]
{'Poisoning by heroin,Opioid abuse, unspecified,Unspecified viral hepatitis C without hepatic coma,Hypovolemia,Accidental poisoning by heroin,Depressive disorder, not elsewhere classified,Unspecified nonpsychotic mental disorder'}


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: heroin overdose

PRESENT ILLNESS: cc:[**CC Contact Info **].
hpi: 36 yo m w/ h/o hepatitis c who presents to the ICU
following overdose.  Patient reports that he began using heroine
last night when he noted some blurry vision then awoke in the
ED. Denies other preceding symptoms.  No headache/cp/sob/aura.
Unclear how long he was down for.  Wife found patient on floor
in bathroom -> called EMS.   again, after being clean for approx
2 years.   Triggered by splitup with wife.  Also states he has
been taking valium (from friend) over the last several days.
Denies recent illness.  Specifically no f/chills/rash/sore
throat/sob/cough/problems w/ urination. States that his daughter
has had several bouts of strep throat and that he and his wife
have been ill, most recently approx 1 mo ago characterized by
lethargy, and flu like symptoms.  Denies SI.
.
In ED, initial VSS stable, pt arousable and oriented.  Noted to
desat to 89% when his resp rate dropped to approx 7.  Given
Narcan 0.2 mg x2, followed by 0.4 mg x2, with improvment in rr.
Started on narcan drip, transferred to ICU for further
monitoring.

MEDICAL HISTORY: hepatitis c, x several years, acquired by needle sharing.  no
h/o jaundice/ruq pain/dk urine.
depression

MEDICATION ON ADMISSION: Prozac 20mg qday
Multivitamin 1 tab po qd

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98.0, bp 122/65, hr 98, rr 12, 98% ra on narcan gtt
Easily arousable, well appearing male in NAD.
PERRL. anicteric
OP clr. MMM
neck supple.
Regular s1,s2. no m/r/g
LCA b/l
+bs. soft. nt. nd. no [**Doctor Last Name **] sign. liver 7cm in mcl. spleen
not palpable.
no le edema/clubbing/cyanosis
Alert and oriented x3.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: h/o IV heroin, previously clean for 2 years.
denies etoh.
+tobacco use 

### Response:
{'Poisoning by heroin,Opioid abuse, unspecified,Unspecified viral hepatitis C without hepatic coma,Hypovolemia,Accidental poisoning by heroin,Depressive disorder, not elsewhere classified,Unspecified nonpsychotic mental disorder'}
