CHIEF COMPLAINT: Altered Mental Status, Hypotension

PRESENT ILLNESS: 61 yoM with hx of EtoH abuse, Neck CA s/p trach and peg, found
down next to a number of bottles. Patient states that he isn't
clear on the events of the past 2 days, but denies injestions of
anything but alcohol. He also denies any fever,chill, SOB, CP,
N/V/D. He states he had some mild transient pain at PEG tube
site, w/o increased or unusual discharge. He also reports that
he has had a decreased amount of sputum from stoma. He denies
trauma or injury. He reports seizure x 1 15 years ago, but
unclear if this was in the setting of alcohol withdrawal. He
denies feeling jittery or anxious, denies hallucinations.

MEDICAL HISTORY: - EtOH Abuse: Pt apparently administers vodka and listerine via
PEG.
- s/p PEG and trach placement: ~2.5 years ago after "upper mouth
hemmorrhage" (he states that he does not have any cancer but did
receive chemo and radiation for "upper mouth cancer")
- Hypoglycemia seconday to poor nutrition
- Hyponatremia [**2-21**] alcohol abuse, poor intake, and dehydration
- h/o R open clavicle fracture infected with MRSA and
corynebacterium
- h/o pseudomonas in sputum on [**11-26**] (resistant to
ciprofloxacin)
- h/o PNA

MEDICATION ON ADMISSION: None

ALLERGIES: Aspirin

PHYSICAL EXAM: VITALS: T 97.0 HR 89 BP 106/59 RR 15 98% RA
GEN: NAD, wearning wool hat, disheveled
HEENT: NC, no trauma, no abraisons, no nystagmus
NECK: non-tender along stoma, no secretions
RESP: unlabored, clear bilaterally
CARD: RRR, no MRG
ABD: soft, no TTP, mildly erythematous at PEG site with a small
amount of opaque discharge but no purulence, warmth or swelling
EXTR: warm, no abraisons, no edema; slight tremor bilaterally
NEURO: Aox3, able to relate history and answer questions
appropriately

FAMILY HISTORY: Has no contact w/ his mother who has COPD and alzheimers.
Father deceased.  [**Name2 (NI) **] report, died in his son's arms with only
[**1-22**] of one lung from PNA.

SOCIAL HISTORY: - +EtOH Abuse
- + 1 ppd tob
- Homeless.
- Gets care at [**Location (un) 32163**].
- No HCP.
Hyposmolality and/or hyponatremia,Acute alcoholic intoxication in alcoholism, continuous,Anemia, unspecified,Tracheostomy status,Lack of housing,Personal history of malignant neoplasm of other sites
Hyposmolality,Ac alcohol intox-contin,Anemia NOS,Tracheostomy status,Lack of housing,Hx of malignancy NEC
Admission Date:  [**2139-11-13**]              Discharge Date:   [**2139-11-14**]

Date of Birth:  [**2078-8-10**]             Sex:   M

Service: MEDICINE

Allergies:
Aspirin

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
Altered Mental Status, Hypotension

Major Surgical or Invasive Procedure:
Cenral line placement - Right Femoral.


History of Present Illness:
61 yoM with hx of EtoH abuse, Neck CA s/p trach and peg, found
down next to a number of bottles. Patient states that he isn't
clear on the events of the past 2 days, but denies injestions of
anything but alcohol. He also denies any fever,chill, SOB, CP,
N/V/D. He states he had some mild transient pain at PEG tube
site, w/o increased or unusual discharge. He also reports that
he has had a decreased amount of sputum from stoma. He denies
trauma or injury. He reports seizure x 1 15 years ago, but
unclear if this was in the setting of alcohol withdrawal. He
denies feeling jittery or anxious, denies hallucinations.

In the ED, he was found to be able to nod yes/no to questions,
afebrile, hypotensive to systeolic 80 mmHg, received 1L and
improved to SBP 110s mmHg, FS 105. EtOH level 200 so concern for
other etiologies for change in MS. [**First Name (Titles) 32883**] [**Last Name (Titles) **] negative. Increased
purulence coming from trach site thus given Levaquin,
Ceftriaxone for possible PNA. CT Head no acute process. Very
poor access so R femoral triple lumen placed, BCx, UCx sent. At
time of transfer the pt exhibited SaO2= 95-98% RA.

Of note in [**2-26**] the pt was admitted to [**Hospital1 18**] and found to have
Na of 125 with an EtOH level was 141.

Past Medical History:
- EtOH Abuse: Pt apparently administers vodka and listerine via
PEG.
- s/p PEG and trach placement: ~2.5 years ago after "upper mouth
hemmorrhage" (he states that he does not have any cancer but did
receive chemo and radiation for "upper mouth cancer")
- Hypoglycemia seconday to poor nutrition
- Hyponatremia [**2-21**] alcohol abuse, poor intake, and dehydration
- h/o R open clavicle fracture infected with MRSA and
corynebacterium
- h/o pseudomonas in sputum on [**11-26**] (resistant to
ciprofloxacin)
- h/o PNA

Social History:
- +EtOH Abuse
- + 1 ppd tob
- Homeless.
- Gets care at [**Location (un) 32163**].
- No HCP.

Family History:
Has no contact w/ his mother who has COPD and alzheimers.
Father deceased.  [**Name2 (NI) **] report, died in his son's arms with only
[**1-22**] of one lung from PNA.


Physical Exam:
VITALS: T 97.0 HR 89 BP 106/59 RR 15 98% RA
GEN: NAD, wearning wool hat, disheveled
HEENT: NC, no trauma, no abraisons, no nystagmus
NECK: non-tender along stoma, no secretions
RESP: unlabored, clear bilaterally
CARD: RRR, no MRG
ABD: soft, no TTP, mildly erythematous at PEG site with a small
amount of opaque discharge but no purulence, warmth or swelling
EXTR: warm, no abraisons, no edema; slight tremor bilaterally
NEURO: Aox3, able to relate history and answer questions
appropriately

Pertinent Results:
[**2139-11-13**] 07:53PM   WBC-6.6 RBC-3.47* HGB-11.7* HCT-32.5* MCV-94#
MCH-33.8*# MCHC-36.1* RDW-17.3*

[**2139-11-13**] 07:53PM   NEUTS-75.6* LYMPHS-17.4* MONOS-5.1 EOS-1.4
BASOS-0.5

[**2139-11-13**] 07:53PM   GLUCOSE-73 UREA N-7 CREAT-0.5 SODIUM-127*
POTASSIUM-4.0 CHLORIDE-86* TOTAL CO2-33* ANION GAP-12

[**2139-11-13**] 07:53PM   ALT(SGPT)-24 AST(SGOT)-55* LD(LDH)-513* ALK
PHOS-96 TOT BILI-0.5

[**2139-11-13**] 07:53PM   ALBUMIN-3.4 CALCIUM-8.7 PHOSPHATE-1.7*#
MAGNESIUM-1.6

[**2139-11-13**] 08:05PM   LACTATE-2.5*

[**2139-11-13**] 07:53PM   PT-12.8 PTT-29.8 INR(PT)-1.1

[**2139-11-13**] 09:40PM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-1 PH-8.0 LEUK-NEG

[**2139-11-13**] 09:40PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.005

CHEST (PORTABLE AP) Study Date of [**2139-11-13**] 8:04 PM
1. No pneumonia.
2. Suggestion of left lung nodular density. Further evaluation
with CT is
recommended on a non-emergent basis. This finding was entered
into the
radiology critical results reporting database on [**2139-11-14**].

CT HEAD W/O CONTRAST Study Date of [**2139-11-13**] 9:36 PM
1. No acute intracranial process.
2. Stable areas of encephalomalacia in bifrontal lobes.
The study and the report were reviewed by the staff radiologist.



Brief Hospital Course:
61 yoM with hx of EtoH abuse, Neck CA s/p trach and peg, found
down next to a number of bottles.

# Acute Change in MS:  Mentating well upon admission.  Likely
[**2-21**] to ETOh and hyponatremia. The patient's Etoh level is 212,
which is not severely elevated but it appears as though on past
admission that he has presented with similar AMS, Etoh levels
and hyponatremia. His [**Month/Day (2) **] screen was negative. He did not have
an acidosis to suggest methanol or ethanol ingestion.  In terms
of infection, he has no fever, to leukocytosis, neg UA, no PNA
on CXR. CT head negative.  Did not develop further etiology
beyond fatigue and EtoH intoxication.  Discharged once improved
to baseline.

# Hyponatermia: Pt initially hypotensive on arrival to ED, thus
etiology may Hypovolemic hypotonic, however may be an element of
euvolemic hypotonic hyponatremia.
Given NS and discharged home once improved.

# Possible PNA: Pt received dose of Ceftriaxone and Levaquin
empirically in E.D for sputum production; however, pt reports
that sputum has acutally decreased. Pt afebrile without
tachycardia and leukocytosis. CXR is w/o evidence PNA.  Thus,
antibiotics were discontinued upon arrival in MICU.

# EtoH Abuse: Pt with prior hx of admissions for EtOH abuse.
EtOH level obtained on admission.  Was maintained on a CIWA
scale during stay but did not require any benzodiazepines.

# Anemia: Hct 32 at baseline

# ? Lung nodule:  This finding was reported on final report of
CXR as above after patient was discharged.  Given that patient
is homeless, and has no contact information, we were unable to
call him about this finding.  Thus, will plan to contact [**Name (NI) 89924**] Inn on the upcoming Monday to discuss follow-up with
regular providers.


Medications on Admission:
None

Discharge Medications:
1. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Multivitamins     Tablet, Chewable Sig: One (1) Tablet,
Chewable PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary: Confusion, loss of consciousness, alcohol intoxication
Secondary: Acohol abuse, tobacco use


Discharge Condition:
Hemodynamically stable and afebrile.


Discharge Instructions:
You were admitted when found unconcious in a public park.  This
was likely due to drinking alcohol and having poor sleep for
several days prior.  You were monitored for signs of alcohol
withdrawal but you didn't have any.  Once improved and safe, you
were discharged for further recovery.

Take all medications as prescribed.

For you health and safety, you need to stop drinking alcohol.
Alcohol consumption at your current level is life threatening.

Return to the ED or seek medical advice if you have fever,
chills, difficulty breathing, abdominal pain, blacking out or
any other symptom which is concerning to you.

Followup Instructions:
Please follow-up with your regular provider [**Last Name (NamePattern4) **] 1 week to discuss
strategies to stopping alcohol consumption.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]
{'Hyposmolality and/or hyponatremia,Acute alcoholic intoxication in alcoholism, continuous,Anemia, unspecified,Tracheostomy status,Lack of housing,Personal history of malignant neoplasm of other sites'}


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, Hypotension

PRESENT ILLNESS: 61 yoM with hx of EtoH abuse, Neck CA s/p trach and peg, found
down next to a number of bottles. Patient states that he isn't
clear on the events of the past 2 days, but denies injestions of
anything but alcohol. He also denies any fever,chill, SOB, CP,
N/V/D. He states he had some mild transient pain at PEG tube
site, w/o increased or unusual discharge. He also reports that
he has had a decreased amount of sputum from stoma. He denies
trauma or injury. He reports seizure x 1 15 years ago, but
unclear if this was in the setting of alcohol withdrawal. He
denies feeling jittery or anxious, denies hallucinations.

MEDICAL HISTORY: - EtOH Abuse: Pt apparently administers vodka and listerine via
PEG.
- s/p PEG and trach placement: ~2.5 years ago after "upper mouth
hemmorrhage" (he states that he does not have any cancer but did
receive chemo and radiation for "upper mouth cancer")
- Hypoglycemia seconday to poor nutrition
- Hyponatremia [**2-21**] alcohol abuse, poor intake, and dehydration
- h/o R open clavicle fracture infected with MRSA and
corynebacterium
- h/o pseudomonas in sputum on [**11-26**] (resistant to
ciprofloxacin)
- h/o PNA

MEDICATION ON ADMISSION: None

ALLERGIES: Aspirin

PHYSICAL EXAM: VITALS: T 97.0 HR 89 BP 106/59 RR 15 98% RA
GEN: NAD, wearning wool hat, disheveled
HEENT: NC, no trauma, no abraisons, no nystagmus
NECK: non-tender along stoma, no secretions
RESP: unlabored, clear bilaterally
CARD: RRR, no MRG
ABD: soft, no TTP, mildly erythematous at PEG site with a small
amount of opaque discharge but no purulence, warmth or swelling
EXTR: warm, no abraisons, no edema; slight tremor bilaterally
NEURO: Aox3, able to relate history and answer questions
appropriately

FAMILY HISTORY: Has no contact w/ his mother who has COPD and alzheimers.
Father deceased.  [**Name2 (NI) **] report, died in his son's arms with only
[**1-22**] of one lung from PNA.

SOCIAL HISTORY: - +EtOH Abuse
- + 1 ppd tob
- Homeless.
- Gets care at [**Location (un) 32163**].
- No HCP. 

### Response:
{'Hyposmolality and/or hyponatremia,Acute alcoholic intoxication in alcoholism, continuous,Anemia, unspecified,Tracheostomy status,Lack of housing,Personal history of malignant neoplasm of other sites'}
