CHIEF COMPLAINT: Suicide attempt, tylenol ingestion

PRESENT ILLNESS: 30 y/o female w h/o depression, anxiety, and polysubstance
abuse, prior suicide attempt [**4-23**] with Tylenol and Lithium,
found to have suicide attempt with tylenol ingestion admitted to
OSH on [**9-18**].  Patient took approx 150 tabs of tylenol PM.  After
1 hour of this ingestion (per patient), she came to the ED and
was found to have a Tylenol level to 470.  In OSH ED, she was
given IV acetylcysteine gtt, unclear dosing.  Her LFT initially
was AST 67 ALT 257 which steadily climbed to AST 2550 ALT 1557
then today AST [**Numeric Identifier 7652**] ALT 4825.  Her INR also risen (1.2->3.1).
Her renal function is within normal limits still.  Her most
recent ABG is 7.39/30.7.  No evidence of hepatic encephalopathy.
 She has persistent nausea and abdominal pain.  At OSH, she had
elevated glucose up to 255, no history of DM.  Amylase and
lipase of 69 and 33 respectively.  Hepatitis panel (A and B
negative).  Hep C and HIV were pnding.  Denies SI.  Has been a
heavy alcohol user with no h/o withdrawal.
.
At OSH, she was given 21 hours of acetylcysteine and was d/c,
but her LFT continued to rise.  After discussion with poison
control, she was continued on her IV acetylcysteine (goal till
her AST/ALT down below 1000) and her tylenol level below 10.
She was transferred to [**Hospital1 18**] for further management of her
ingestion of tylenol.
.
Pt reports a long history of anxiety with panic attacks as well
as polysubstance abuse including oxycontin, heroine, cocaine,
and xanax.
.
On the floor, she was found to be alert and oriented without any
issues.
.
Review of systems:
(+) Per HPI

MEDICAL HISTORY: Past Medical History:
-Cellulitis
-Thrombocytosis
-h/o lithium/tylenol overdose in [**2123**]
-depression
-anxiety
-polysubstance abuse including IVDU, marijuana use, cocaine use

MEDICATION ON ADMISSION: Home Meds (stopped several months prior to admission):
- Quetiapine 50 mg Tablet Sig: 1-2 Tablets PO BID PRN anxiety,
insomnia.
- Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 99.6 BP: 118/66 P: 83 R: 18 O2: 99%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Father - History of substance abuse that developed in [**Country 3992**].
He had long period of sobriety until a few years ago when he was
put on opiates for pain control and developed addiction. Per
report, he fell and died following head trauma, which may have
been related to intoxication. No known suicides.
Mother - History of anxiety. (No official psychiatric
diagnoses.)

SOCIAL HISTORY: Patient currently lives alone. She previously lived with
husband, but he has been in jail since [**February 2123**]. They are also in
the midst of divorce proceedings. Fiance has been at bedside
during ICU stay. She has no children. Previously worked as a
crime analyst, but not currently. No tobacco. Drinks alcohol
(unsure of amount). Uses cocaine (intravenous), marijuana,
percocet.
Poisoning by aromatic analgesics, not elsewhere classified,Combinations of opioid type drug with any other drug dependence, continuous,Unspecified episodic mood disorder,Unspecified viral hepatitis C without hepatic coma,Abnormal coagulation profile,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics
Pois-arom analgesics NEC,Opioid/other dep-contin,Episodic mood disord NOS,Hpt C w/o hepat coma NOS,Abnrml coagultion prfile,Poison-analgesics
Admission Date:  [**2125-9-20**]              Discharge Date:   [**2125-9-25**]

Date of Birth:  [**2095-6-6**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**Known firstname 3574**]
Chief Complaint:
Suicide attempt, tylenol ingestion

Major Surgical or Invasive Procedure:
None

History of Present Illness:
30 y/o female w h/o depression, anxiety, and polysubstance
abuse, prior suicide attempt [**4-23**] with Tylenol and Lithium,
found to have suicide attempt with tylenol ingestion admitted to
OSH on [**9-18**].  Patient took approx 150 tabs of tylenol PM.  After
1 hour of this ingestion (per patient), she came to the ED and
was found to have a Tylenol level to 470.  In OSH ED, she was
given IV acetylcysteine gtt, unclear dosing.  Her LFT initially
was AST 67 ALT 257 which steadily climbed to AST 2550 ALT 1557
then today AST [**Numeric Identifier 7652**] ALT 4825.  Her INR also risen (1.2->3.1).
Her renal function is within normal limits still.  Her most
recent ABG is 7.39/30.7.  No evidence of hepatic encephalopathy.
 She has persistent nausea and abdominal pain.  At OSH, she had
elevated glucose up to 255, no history of DM.  Amylase and
lipase of 69 and 33 respectively.  Hepatitis panel (A and B
negative).  Hep C and HIV were pnding.  Denies SI.  Has been a
heavy alcohol user with no h/o withdrawal.
.
At OSH, she was given 21 hours of acetylcysteine and was d/c,
but her LFT continued to rise.  After discussion with poison
control, she was continued on her IV acetylcysteine (goal till
her AST/ALT down below 1000) and her tylenol level below 10.
She was transferred to [**Hospital1 18**] for further management of her
ingestion of tylenol.
.
Pt reports a long history of anxiety with panic attacks as well
as polysubstance abuse including oxycontin, heroine, cocaine,
and xanax.
.
On the floor, she was found to be alert and oriented without any
issues.
.
Review of systems:
(+) Per HPI

Past Medical History:
Past Medical History:
-Cellulitis
-Thrombocytosis
-h/o lithium/tylenol overdose in [**2123**]
-depression
-anxiety
-polysubstance abuse including IVDU, marijuana use, cocaine use

Social History:
Patient currently lives alone. She previously lived with
husband, but he has been in jail since [**February 2123**]. They are also in
the midst of divorce proceedings. Fiance has been at bedside
during ICU stay. She has no children. Previously worked as a
crime analyst, but not currently. No tobacco. Drinks alcohol
(unsure of amount). Uses cocaine (intravenous), marijuana,
percocet.

Family History:
Father - History of substance abuse that developed in [**Country 3992**].
He had long period of sobriety until a few years ago when he was
put on opiates for pain control and developed addiction. Per
report, he fell and died following head trauma, which may have
been related to intoxication. No known suicides.
Mother - History of anxiety. (No official psychiatric
diagnoses.)


Physical Exam:
Vitals: T: 99.6 BP: 118/66 P: 83 R: 18 O2: 99%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
Admission Labs:
[**2125-9-20**] 08:14PM BLOOD WBC-10.2# RBC-4.44# Hgb-13.0 Hct-37.7#
MCV-85 MCH-29.3 MCHC-34.5 RDW-15.4 Plt Ct-264#
[**2125-9-20**] 08:14PM BLOOD Neuts-79.4* Lymphs-17.7* Monos-1.1*
Eos-1.2 Baso-0.7
[**2125-9-20**] 08:14PM BLOOD PT-30.2* PTT-37.1* INR(PT)-3.0*
[**2125-9-20**] 08:14PM BLOOD Glucose-208* UreaN-6 Creat-0.6 Na-136
K-4.4 Cl-106 HCO3-22 AnGap-12
[**2125-9-20**] 08:14PM BLOOD ALT-5241* AST-5074* AlkPhos-164*
Amylase-23 TotBili-4.0*
[**2125-9-20**] 08:14PM BLOOD Lipase-30
[**2125-9-20**] 08:14PM BLOOD Albumin-3.6 Calcium-8.9 Phos-1.0*# Mg-1.9
Iron-63 Cholest-136
[**2125-9-20**] 08:14PM BLOOD calTIBC-302 Ferritn-3675* TRF-232
[**2125-9-20**] 08:14PM BLOOD Triglyc-103 HDL-43 CHOL/HD-3.2 LDLcalc-72
[**2125-9-20**] 08:14PM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HAV
Ab-POSITIVE IgM HAV-NEGATIVE
[**2125-9-21**] 04:19AM BLOOD HIV Ab-NEGATIVE
[**2125-9-20**] 08:14PM BLOOD Lithium-LESS THAN
[**2125-9-20**] 08:14PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2125-9-20**] 08:14PM BLOOD HCV Ab-POSITIVE*
[**2125-9-20**] 08:29PM BLOOD Type-[**Last Name (un) **] pO2-116* pCO2-37 pH-7.39
calTCO2-23 Base XS--1 Comment-GREEN TOP
[**2125-9-20**] 08:29PM BLOOD Lactate-2.7*
.
Discharge Labs:
[**2125-9-24**] 05:45AM BLOOD WBC-6.0 RBC-3.98* Hgb-11.6* Hct-34.5*
MCV-87 MCH-29.2 MCHC-33.7 RDW-16.5* Plt Ct-313
[**2125-9-24**] 05:45AM BLOOD PT-13.4 PTT-30.7 INR(PT)-1.1
[**2125-9-24**] 05:45AM BLOOD Glucose-106* UreaN-9 Creat-0.6 Na-139
K-3.7 Cl-106 HCO3-26 AnGap-11
[**2125-9-24**] 05:45AM BLOOD ALT-1172* AST-83* LD(LDH)-133
AlkPhos-117* TotBili-1.7*
[**2125-9-24**] 05:45AM BLOOD Calcium-8.7 Phos-3.6 Mg-1.6
.
Microbiology:
HCV VIRAL LOAD ([**2125-9-24**]): HCV RNA detected, less than 43 IU/mL.

[**Doctor Last Name **]-[**Doctor Last Name **] VIRUS VCA-IgG AB (Final [**2125-9-24**]): POSITIVE BY EIA.

[**Doctor Last Name **]-[**Doctor Last Name **] VIRUS EBNA IgG AB (Final [**2125-9-24**]): POSITIVE BY
EIA.
[**Doctor Last Name **]-[**Doctor Last Name **] VIRUS VCA-IgM AB (Final [**2125-9-24**]): NEGATIVE <1:10
BY IFA.
CMV IgG ANTIBODY (Final [**2125-9-21**]): NEGATIVE FOR CMV IgG ANTIBODY
BY EIA.
CMV IgM ANTIBODY (Final [**2125-9-21**]): NEGATIVE FOR CMV IgM ANTIBODY
BY EIA.
VARICELLA-ZOSTER IgG SEROLOGY (Final [**2125-9-21**]): POSITIVE BY EIA.

Rubella IgG/IgM Antibody ([**2125-9-21**]): POSITIVE by Latex
Agglutination.
RAPID PLASMA REAGIN TEST (Final [**2125-9-21**]): NONREACTIVE.
.
CXR [**2125-9-20**]: Heart size is top normal, most likely within normal
limits and the study is slightly exaggerated by the portable
technique of the study. Mediastinum is unremarkable. Lungs are
clear but note is made that external devices are projecting over
the right hemithorax, precluding detailed evaluation of that
examination. There is no pleural effusion or pneumothorax.
.
Pending:
HBcAb, HBc IgM

Brief Hospital Course:
30yo female with h/o polysubstance abuse, previous suicide
attempt in [**2123**] (lithium and tylenol OD) requiring ICU admission
and subsequent inpatient psych admission, who presented to OSH
after ingestion of 150 Tylenol PM in setting of marijuana and
percocet use, and cocaine use the day prior. Patient was
transferred to ICU at [**Hospital1 18**] for further evaluation and
management of tylenol overdose.
.
# Tylenol ingestion: The patient's transaminases, AlkPhos,
Tbili, and INR continued to trend down since admission.  Pt was
seen by hepatology, toxicology, and psych.  Hepatology reassured
with her downtrending LFTs. Patient not a transplant candidate
at this time given recent substance abuse.  Toxicology felt that
since the pt's NAC was stopped for a period of 10 hrs at the
OSH, it should be restarted here for 21 hr protocol (which was
done).  NAC was d/c'ed on [**2125-9-21**].  Psych evaluated the pt, and
given her SI, they determined she would need to go for inpatient
psych treatment once medically stable.  The patient did not
develop any signs of encephalopathy or cerebral edema. She did
not develop any acute kidney injury. A RUQ US was negative for
any acute pathology (as per hepatology). The patient was
transferred to the general medicine floor, with all of her labs
continuing to trend down.  The patient remained hemodynamically
stable, asymptomatic, and was medically cleared for transfer to
inpatient psych.
.
# Suicide attempt: Patient's suicide attempt with tylenol
ingestion was in setting of marijuana and percocet use, as well
as IV cocaine use the day prior.  She also had a previous
suicide attempt in [**2123**]. Patient seen and evaluated by psych,
who felt patient will need inpatient psych treatment once
medically stable.  Patient has been on 1:1 sitter, and at time
of discharge from medical floor denies any further suicidal
ideation.
.
# Depression and Anxiety: Patient previously on fluoxetine as
outpatient, but stopped taking this medication several months
ago.  She will need to get appropriate outpatient follow-up
after inpatient psych treatment, with proper dosage of her home
psych meds.
.
# HCV Ab Positive - Patient has h/o IVDU, and HCV Ab noted to be
positive on this admission.  Patient aware of result.  HCV viral
load was less than 43 IU/mL on testing.  Patient HAV Ab
positive, but HAV IgM negative, indicating previous
exposure/vaccine for HAV.  HepBsAg negative, and patient may
benefit from Hep B vaccine as outpatient.  Also ordered HepB
core Ab and HepB core IgM, which will be pending at time of
discharge.  If HBV core Ab and IgM negative, patient should
receive Hep B vaccine.  Patient should follow-up with her PCP,
[**Name10 (NameIs) **] have repeat LFT testing and viral load testing.  If any
abnormalities, she may be referred to hepatology as needed.

Medications on Admission:
Home Meds (stopped several months prior to admission):
- Quetiapine 50 mg Tablet Sig: 1-2 Tablets PO BID PRN anxiety,
insomnia.
- Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY

Medications on transfer:
Albuterol 1 puff inhaled q2h prn sob
D5 1/2 NS with 40 KCl 150ml/h
Pepcid 20mg po bid
D50 prn hypoglycemia
Glucagon 1mg IM prn hypoglycemia
Glucose 4g 2 tabs prn hypoglycemia
Novolog ISS
Acetylcysteine 100mg/kg

Discharge Medications:
None

Discharge Disposition:
Extended Care

Facility:
[**Hospital 1680**] Hospital - [**Location (un) 538**]

Discharge Diagnosis:
Primary Diagnosis:
1. Tylenol overdose
2. Suicide attempt

Secondary Diagnosis:
1. Depression
2. Anxiety

Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted to the ICU after ingesting a large amount of
tylenol.  This amount was toxic and caused significant injury to
your liver.  We monitored your liver function, and all of your
lab values and symptoms continued to improve during your
hospital course.  You were seen by the liver team, who were
encouraged by the improvement in your lab values.  You were also
seen by psychiatry, who felt that you would benefit from going
to an inpatient psychiatry treatment center once you were
medically stable.
.
One of your blood tests showed you have been exposed to the
Hepatitis C virus. You will need to follow-up with the liver
doctors as [**Name5 (PTitle) **] outpatient for further evaluation.  You should
also be vaccinated against the Hepatitis B vaccine, and your PCP
can help coordinate this vaccination.

Followup Instructions:
You will be discharged from the general medicine service to an
inpatient psychiatric service.  Following your discharge from
inpatient psychiatry, you should follow-up with a psychiatrist
as an outpatient for ongoing evaluation and treatment of your
previous depression, anxiety, and suicidal ideation. You should
also follow up with your PCP.
{'Poisoning by aromatic analgesics, not elsewhere classified,Combinations of opioid type drug with any other drug dependence, continuous,Unspecified episodic mood disorder,Unspecified viral hepatitis C without hepatic coma,Abnormal coagulation profile,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics'}


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, tylenol ingestion

PRESENT ILLNESS: 30 y/o female w h/o depression, anxiety, and polysubstance
abuse, prior suicide attempt [**4-23**] with Tylenol and Lithium,
found to have suicide attempt with tylenol ingestion admitted to
OSH on [**9-18**].  Patient took approx 150 tabs of tylenol PM.  After
1 hour of this ingestion (per patient), she came to the ED and
was found to have a Tylenol level to 470.  In OSH ED, she was
given IV acetylcysteine gtt, unclear dosing.  Her LFT initially
was AST 67 ALT 257 which steadily climbed to AST 2550 ALT 1557
then today AST [**Numeric Identifier 7652**] ALT 4825.  Her INR also risen (1.2->3.1).
Her renal function is within normal limits still.  Her most
recent ABG is 7.39/30.7.  No evidence of hepatic encephalopathy.
 She has persistent nausea and abdominal pain.  At OSH, she had
elevated glucose up to 255, no history of DM.  Amylase and
lipase of 69 and 33 respectively.  Hepatitis panel (A and B
negative).  Hep C and HIV were pnding.  Denies SI.  Has been a
heavy alcohol user with no h/o withdrawal.
.
At OSH, she was given 21 hours of acetylcysteine and was d/c,
but her LFT continued to rise.  After discussion with poison
control, she was continued on her IV acetylcysteine (goal till
her AST/ALT down below 1000) and her tylenol level below 10.
She was transferred to [**Hospital1 18**] for further management of her
ingestion of tylenol.
.
Pt reports a long history of anxiety with panic attacks as well
as polysubstance abuse including oxycontin, heroine, cocaine,
and xanax.
.
On the floor, she was found to be alert and oriented without any
issues.
.
Review of systems:
(+) Per HPI

MEDICAL HISTORY: Past Medical History:
-Cellulitis
-Thrombocytosis
-h/o lithium/tylenol overdose in [**2123**]
-depression
-anxiety
-polysubstance abuse including IVDU, marijuana use, cocaine use

MEDICATION ON ADMISSION: Home Meds (stopped several months prior to admission):
- Quetiapine 50 mg Tablet Sig: 1-2 Tablets PO BID PRN anxiety,
insomnia.
- Fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 99.6 BP: 118/66 P: 83 R: 18 O2: 99%
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Father - History of substance abuse that developed in [**Country 3992**].
He had long period of sobriety until a few years ago when he was
put on opiates for pain control and developed addiction. Per
report, he fell and died following head trauma, which may have
been related to intoxication. No known suicides.
Mother - History of anxiety. (No official psychiatric
diagnoses.)

SOCIAL HISTORY: Patient currently lives alone. She previously lived with
husband, but he has been in jail since [**February 2123**]. They are also in
the midst of divorce proceedings. Fiance has been at bedside
during ICU stay. She has no children. Previously worked as a
crime analyst, but not currently. No tobacco. Drinks alcohol
(unsure of amount). Uses cocaine (intravenous), marijuana,
percocet. 

### Response:
{'Poisoning by aromatic analgesics, not elsewhere classified,Combinations of opioid type drug with any other drug dependence, continuous,Unspecified episodic mood disorder,Unspecified viral hepatitis C without hepatic coma,Abnormal coagulation profile,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics'}
