CHIEF COMPLAINT: EtOH withdrawal

PRESENT ILLNESS: Mr. [**Known lastname 68181**] is a 25 year-old man with a history of alcoholism and
seizure disorder who presents with alcohol withdrawal and is
admitted to the [**Hospital Unit Name 153**] for management of tachycardia,
hypertension, and significant diazepam requirement.
.
He was last admitted for alcohol withdrawal in [**Month (only) **]/[**2190-7-15**]
and was cocaine positive at that time.  He was discharged with a
plan to follow-up at [**Hospital3 **] outpatient substance abuse
program.  He continued drinking, however, and notes that he has
been drinking approximately a quart of alcohol daily and two 40
oz beers.  He has also not been taking his seizure medications
for several days to weeks.  He had his last drink yesterday
morning and states that he had a generalized seizure a few hours
later.  It was witnessed by his boyfriend who states that he
lost consciousness for five to ten minutes, with tonic-clonic
motion and loss of bladder continence.  He has not had a seizure
since that time.  This morning, he presented to the ED for
evaluation, as he felt chest pain, general malaise, was
tremulous, and had visual hallucinations of seeing rats and
bugs.
.
In the ED, initial vs were: 98.6 120 150/100 18 99%ra.  He was
given valium 10 mg IV x 9, a banana bag, multivitamin, and
aspirin 325 mg. He was tachy to the 120s and hypertensive to
SBPs of 160, and there was concern for potential hemodynamic
instability, so ICU admission was requested.  Serum EtOH 19 and
tox screen otherwise negative.
.
On the floor, he is anxious and tremulous but denies
hallucinations.
.
Review of systems:
(+) Per HPI
(-) Denies headache, sinus tenderness, rhinorrhea or congestion.
Denies cough, shortness of breath, or wheezing. Denies chest
pressure, palpitations, or weakness. Denies nausea, vomiting,
diarrhea, constipation, abdominal pain, or changes in bowel
habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias. Denies rashes or skin changes.

MEDICAL HISTORY: - Alcoholism
- Hx. seizures (GTC) related to hx. of head injury (hit by bat
per
pt.); was on tegretol and neurontin for ppx, as well as
clonazepam for anxiety, but stopped all of these when he began
drinking again
- ?Hepatitis C

MEDICATION ON ADMISSION: Acetaminophen 650 mg PO/NG Q6H:PRN pain
Clonazepam 2 mg PO/NG QAM
Clonazepam 1 mg PO/NG QPM
Gabapentin 600 mg PO/NG Q8H
Multivitamins 1 TAB PO/NG DAILY
Nicotine Polacrilex 2 mg PO Q1H:PRN smoking cessation
Thiamine 100 mg PO/NG DAILY

ALLERGIES: Prozac / Haldol

PHYSICAL EXAM: Vitals: T: 96 BP: 147/100 P: 112 R: 18 O2: 98%RA
General: Alert, oriented, tremulous
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: clear on right, LLL rales
CV: tachy, no murmurs
Abdomen: soft, mildly tender diffusely, non-distended
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: 1-2 cm erythematous blanching papules scattered over
chest, back, arms, and legs

FAMILY HISTORY: He has no contact with his family and he works at Subway. He
rents a room with his friend.

SOCIAL HISTORY: He drinks approximately a quart of vodka daily and two 40 oz
beers daily and smokes.  He reports using cocaine on a single
ocassion (last use [**7-24**]) though some OMR notes report regular
cocaine use.  No IVDU.  He has no contact with his family and he
works at Subway. He lives with his boyfriend.
Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, continuous,Generalized convulsive epilepsy, without mention of intractable epilepsy,Tachycardia, unspecified,Rash and other nonspecific skin eruption,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified viral hepatitis C without hepatic coma
Alcohol withdrawal,Ac alcohol intox-contin,Gen cnv epil w/o intr ep,Tachycardia NOS,Nonspecif skin erupt NEC,Hx of past noncompliance,Hpt C w/o hepat coma NOS
Admission Date:  [**2190-9-15**]              Discharge Date:   [**2190-9-16**]

Date of Birth:  [**2165-3-8**]             Sex:   M

Service: MEDICINE

Allergies:
Prozac / Haldol

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
EtOH withdrawal

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 68181**] is a 25 year-old man with a history of alcoholism and
seizure disorder who presents with alcohol withdrawal and is
admitted to the [**Hospital Unit Name 153**] for management of tachycardia,
hypertension, and significant diazepam requirement.
.
He was last admitted for alcohol withdrawal in [**Month (only) **]/[**2190-7-15**]
and was cocaine positive at that time.  He was discharged with a
plan to follow-up at [**Hospital3 **] outpatient substance abuse
program.  He continued drinking, however, and notes that he has
been drinking approximately a quart of alcohol daily and two 40
oz beers.  He has also not been taking his seizure medications
for several days to weeks.  He had his last drink yesterday
morning and states that he had a generalized seizure a few hours
later.  It was witnessed by his boyfriend who states that he
lost consciousness for five to ten minutes, with tonic-clonic
motion and loss of bladder continence.  He has not had a seizure
since that time.  This morning, he presented to the ED for
evaluation, as he felt chest pain, general malaise, was
tremulous, and had visual hallucinations of seeing rats and
bugs.
.
In the ED, initial vs were: 98.6 120 150/100 18 99%ra.  He was
given valium 10 mg IV x 9, a banana bag, multivitamin, and
aspirin 325 mg. He was tachy to the 120s and hypertensive to
SBPs of 160, and there was concern for potential hemodynamic
instability, so ICU admission was requested.  Serum EtOH 19 and
tox screen otherwise negative.
.
On the floor, he is anxious and tremulous but denies
hallucinations.
.
Review of systems:
(+) Per HPI
(-) Denies headache, sinus tenderness, rhinorrhea or congestion.
Denies cough, shortness of breath, or wheezing. Denies chest
pressure, palpitations, or weakness. Denies nausea, vomiting,
diarrhea, constipation, abdominal pain, or changes in bowel
habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias. Denies rashes or skin changes.

Past Medical History:
- Alcoholism
- Hx. seizures (GTC) related to hx. of head injury (hit by bat
per
pt.); was on tegretol and neurontin for ppx, as well as
clonazepam for anxiety, but stopped all of these when he began
drinking again
- ?Hepatitis C


Social History:
He drinks approximately a quart of vodka daily and two 40 oz
beers daily and smokes.  He reports using cocaine on a single
ocassion (last use [**7-24**]) though some OMR notes report regular
cocaine use.  No IVDU.  He has no contact with his family and he
works at Subway. He lives with his boyfriend.

Family History:
He has no contact with his family and he works at Subway. He
rents a room with his friend.

Physical Exam:
Vitals: T: 96 BP: 147/100 P: 112 R: 18 O2: 98%RA
General: Alert, oriented, tremulous
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: clear on right, LLL rales
CV: tachy, no murmurs
Abdomen: soft, mildly tender diffusely, non-distended
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: 1-2 cm erythematous blanching papules scattered over
chest, back, arms, and legs

Pertinent Results:
[**2190-9-15**] 06:55AM   WBC-6.1 RBC-4.53* HGB-13.9* HCT-42.4 MCV-93
MCH-30.7 MCHC-32.8 RDW-16.4*
[**2190-9-15**] 06:55AM   NEUTS-74.0* LYMPHS-19.2 MONOS-5.6 EOS-0.2
BASOS-0.9
[**2190-9-15**] 06:55AM   PLT COUNT-200
[**2190-9-15**] 06:55AM   ASA-NEG ETHANOL-19* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2190-9-15**] 06:55AM   GLUCOSE-128* UREA N-14 CREAT-0.7 SODIUM-139
POTASSIUM-4.1 CHLORIDE-96 TOTAL CO2-24 ANION GAP-23*
[**2190-9-15**] 09:45AM URINE  RBC-0-2 WBC-0-2 BACTERIA-FEW YEAST-NONE
EPI-0-2
[**2190-9-15**] 09:45AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-25
GLUCOSE-1000 KETONE-50 BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2190-9-15**] 09:45AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.018
[**2190-9-15**] 11:38AM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2190-9-15**] 11:38AM URINE  HOURS-RANDOM

Hepatitis Panels:
[**2190-9-15**] 06:55AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE
HBcAb-NEGATIVE
[**2190-9-15**] 06:55AM BLOOD HCV Ab-POSITIVE*

Discharge Labs: [**2190-9-16**]
CBC: BLOOD WBC-2.6*# RBC-4.52* Hgb-14.4 Hct-43.0 MCV-95 MCH-31.8
MCHC-33.5 RDW-16.1* Plt Ct-141* Neuts-59 Bands-0 Lymphs-24
Monos-15* Eos-1 Baso-1 Atyps-0 Metas-0 Myelos-0
Blood Smear: Hypochr-NORMAL Anisocy-1+ Poiklo-1+ Macrocy-1+
Microcy-NORMAL Polychr-OCCASIONAL Ovalocy-1+
Chem: Glucose-129* UreaN-16 Creat-0.9 Na-139 K-4.3 Cl-101
HCO3-30 AnGap-12
Calcium-9.5 Phos-3.7# Mg-2.2


Brief Hospital Course:
Assessment and Plan:
Mr. [**Known lastname 68181**] is a 25 year-old man with a history of alcoholism and
seizure disorder who presents with alcohol withdrawal and is
admitted to the [**Hospital Unit Name 153**] for management of tachycardia and
significant diazepam requirement.
.
# Alcoholism/withdrawal:
History of alcoholism with multiple admissions for withdrawal.
Has attempted detox in past but unsuccessful.  Also has history
of seizures in setting of withdrawal. Pt was put on CIWA scale
w/diazepam 10mg q1hr. Tox screen came back with positive serum
alcohol and urine benzos. Pt unwilling to enter detox program at
this time. However, pt did establish contact with [**Name (NI) 778**] clinic
and set up appointment for clinic intake and physician f/u at
that clinc. Requiring Q3 diazepam into morning of [**9-16**] but none
throughout morning. Pt not significantly symptomatic with
resolution of tachycardia. Somewhat anxious without home
clonazepam which had been held since giving diazepam but eager
to go home and stating ready to go home. Pt d/ced home with
instructions not to drink and f/u with [**Hospital1 778**] as he had
scheduled.
.
# Seizure disorder:  No evidence of seizure activity while in
hospital. Was on gabapentin in past but has not been taking
medications for days to weeks. Restart gabapentin in house. At
time of discharge was given 20 day scripts for clonazepam and
gabapentin to get him to his [**Hospital1 778**] appointments.
.
# ?Hepatitis C:  No history of documented hepatitis in OMR but
patient states he is hep C positive, contracted from tattoo, no
history of IVDU. Hepatitis serologies showed HCV Ab positing and
HBV ab negative to surface and core. HBV SA also negative.
.
# Rash:  unclear etiology - likely tinea corpis although Cculd
represent autoimmune condition.  Boyfriend does not have similar
symptoms. Pt given script for ketoconazole cream at time of d/c.
Instructed that if he wanted he could find shampoo with
ketoconazole in it and use this instead of the cream if he
wished.


Medications on Admission:
Acetaminophen 650 mg PO/NG Q6H:PRN pain
Clonazepam 2 mg PO/NG QAM
Clonazepam 1 mg PO/NG QPM
Gabapentin 600 mg PO/NG Q8H
Multivitamins 1 TAB PO/NG DAILY
Nicotine Polacrilex 2 mg PO Q1H:PRN smoking cessation
Thiamine 100 mg PO/NG DAILY

Discharge Medications:
1. Gabapentin 600 mg Tablet Sig: One (1) Tablet PO three times a
day for 20 days.
Disp:*60 Tablet(s)* Refills:*0*
2. Clonazepam 1 mg Tablet Sig: 1-2 Tablets PO 2 tablets in the
AM, 1 tablet in the PM for 20 days: Please take as you were
previously:
-2 tablets in AM
-1 tablet in PM.
Disp:*30 Tablet(s)* Refills:*0*
3. Ketoconazole 2 % Cream Sig: One (1)  Topical once a day for 7
days.
Disp:*1 1* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
1) Alcohol Withdrawal

Secondary Diagnosis:
1) Seizure disorder


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


Discharge Instructions:
Mr. [**Known lastname 68181**], you were admitted to the hospital due to alcohol
withdrawal and were monitored in the ICU with medications to
treat your withdrawal. When you showed improvement, had
scheduled clinic follow-up at [**Hospital 778**] clinic, and felt able to go
home safely, you were discharged to home.
.
You were discharged with prescriptions for 20 days for the
following medications:
-Clonazepam 2mg by mouth every morning and 1mg by mouth every
evening
-Gabapentin 600mg by mouth three times each day
-Ketoconazole Cream 2% apply to your rash once each day for 7
days (as an alternative you can find a shampoo that contains 2%
Ketoconazole and apply this to the rash for 7 days).
.
You should keep your follow-up intake appointments with [**Hospital 778**]
clinic on [**9-22**] and your follow-up with a physician that is
scheduled for 2 weeks afterward.
.
You should refrain from alcohol use upon discharge. Because of
your history of becoming sick from withdrawal, and because you
have a history of seizures that increase your risk for
withdrawal seizures, it would be best for your current and
long-term health to refrain from alcohol use.

Followup Instructions:
Follow up with [**Hospital 778**] clinic as you have already scheduled. It
is very important for your health that you keep these
appointments as the clinic at [**Hospital1 778**] will be able to offer you
resources and care that will greatly improve your long-term
health.


                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]
{'Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, continuous,Generalized convulsive epilepsy, without mention of intractable epilepsy,Tachycardia, unspecified,Rash and other nonspecific skin eruption,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified viral hepatitis C without hepatic coma'}


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: EtOH withdrawal

PRESENT ILLNESS: Mr. [**Known lastname 68181**] is a 25 year-old man with a history of alcoholism and
seizure disorder who presents with alcohol withdrawal and is
admitted to the [**Hospital Unit Name 153**] for management of tachycardia,
hypertension, and significant diazepam requirement.
.
He was last admitted for alcohol withdrawal in [**Month (only) **]/[**2190-7-15**]
and was cocaine positive at that time.  He was discharged with a
plan to follow-up at [**Hospital3 **] outpatient substance abuse
program.  He continued drinking, however, and notes that he has
been drinking approximately a quart of alcohol daily and two 40
oz beers.  He has also not been taking his seizure medications
for several days to weeks.  He had his last drink yesterday
morning and states that he had a generalized seizure a few hours
later.  It was witnessed by his boyfriend who states that he
lost consciousness for five to ten minutes, with tonic-clonic
motion and loss of bladder continence.  He has not had a seizure
since that time.  This morning, he presented to the ED for
evaluation, as he felt chest pain, general malaise, was
tremulous, and had visual hallucinations of seeing rats and
bugs.
.
In the ED, initial vs were: 98.6 120 150/100 18 99%ra.  He was
given valium 10 mg IV x 9, a banana bag, multivitamin, and
aspirin 325 mg. He was tachy to the 120s and hypertensive to
SBPs of 160, and there was concern for potential hemodynamic
instability, so ICU admission was requested.  Serum EtOH 19 and
tox screen otherwise negative.
.
On the floor, he is anxious and tremulous but denies
hallucinations.
.
Review of systems:
(+) Per HPI
(-) Denies headache, sinus tenderness, rhinorrhea or congestion.
Denies cough, shortness of breath, or wheezing. Denies chest
pressure, palpitations, or weakness. Denies nausea, vomiting,
diarrhea, constipation, abdominal pain, or changes in bowel
habits. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias. Denies rashes or skin changes.

MEDICAL HISTORY: - Alcoholism
- Hx. seizures (GTC) related to hx. of head injury (hit by bat
per
pt.); was on tegretol and neurontin for ppx, as well as
clonazepam for anxiety, but stopped all of these when he began
drinking again
- ?Hepatitis C

MEDICATION ON ADMISSION: Acetaminophen 650 mg PO/NG Q6H:PRN pain
Clonazepam 2 mg PO/NG QAM
Clonazepam 1 mg PO/NG QPM
Gabapentin 600 mg PO/NG Q8H
Multivitamins 1 TAB PO/NG DAILY
Nicotine Polacrilex 2 mg PO Q1H:PRN smoking cessation
Thiamine 100 mg PO/NG DAILY

ALLERGIES: Prozac / Haldol

PHYSICAL EXAM: Vitals: T: 96 BP: 147/100 P: 112 R: 18 O2: 98%RA
General: Alert, oriented, tremulous
HEENT: Sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: clear on right, LLL rales
CV: tachy, no murmurs
Abdomen: soft, mildly tender diffusely, non-distended
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: 1-2 cm erythematous blanching papules scattered over
chest, back, arms, and legs

FAMILY HISTORY: He has no contact with his family and he works at Subway. He
rents a room with his friend.

SOCIAL HISTORY: He drinks approximately a quart of vodka daily and two 40 oz
beers daily and smokes.  He reports using cocaine on a single
ocassion (last use [**7-24**]) though some OMR notes report regular
cocaine use.  No IVDU.  He has no contact with his family and he
works at Subway. He lives with his boyfriend. 

### Response:
{'Alcohol withdrawal,Acute alcoholic intoxication in alcoholism, continuous,Generalized convulsive epilepsy, without mention of intractable epilepsy,Tachycardia, unspecified,Rash and other nonspecific skin eruption,Personal history of noncompliance with medical treatment, presenting hazards to health,Unspecified viral hepatitis C without hepatic coma'}
