CHIEF COMPLAINT: transfer from OSH for EtOH DTs

PRESENT ILLNESS: Mr [**Known lastname 15499**] is a 43M w h/o depression, alcoholism, who was
originally admitted from home to [**Hospital3 1196**] on
[**2159-3-16**] w grand mal seizures likely [**3-12**] alcohol withdrawal
(last drink [**3-16**]), then was first transferred to [**Hospital1 **] for
detoxification under "Section 12" restriction, but subsequently
transferred to [**Hospital1 18**] w acute agitation/mental status changes
from delerium tremens. Treated in the MICU w valium (up to 450mg
IV valium on presentation) w taper as tolerated, as well as
haldol. Followed by SW and Psych. Transferred to medical floor.
Developed right upper extremity superficial vein thrombosis
causing hand swelling.
.
On arrival to floor, pt was AOx3, comfortable, though [**Doctor Last Name 11506**].

MEDICAL HISTORY: history of EtOH withdrawl seizures
EtOH abuse
? of HIV status

MEDICATION ON ADMISSION: none, received Ativan 2mg IV X2 and MIV/folate/vit B1 at OSH

ALLERGIES: Propoxyphene

PHYSICAL EXAM: VS: 97.1, 108/70, 95, 23 91% on RA
GENERAL: malnourished man in NAD
SKIN: warm and well perfused, no excoriations or lesions, no
rashes
HEENT: EOMI, PERRLA, anicteric sclera, pink conjunctiva, patent
nares, MMM, good dentition, nontender supple neck, no LAD,
normal JVP
CARDIAC: RRR, S1/S2, no mrg
LUNG: CTAB
ABDOMEN: nondistended, +BS, nontender in all quadrants, no
rebound/guarding, no hepatosplenomegaly
EXT: RUE swelling up to elbow, palpable pulses throughout
NEURO: AOx3 (though not sure about name of hospital), CN II-XII
intact, moves all 4 extremities

FAMILY HISTORY: sister with bipolar d/o, 15 y.o. daugther with
depression and s/p recent SA

SOCIAL HISTORY: Lives w mother. Separated from gf after 15 yrs. 2 daughters: 1
age 15 now in psych hospital s/p SA; 1 daughter died at age 10
from HIV/AIDS (from transfusion). Pt is on disability. Walks
with a cane at baseline. His ex-GF has restraining order against
him, and he was just recently in court for violating this.
Alcohol withdrawal delirium,Encephalopathy, unspecified,Other complications due to other vascular device, implant, and graft,Unspecified protein-calorie malnutrition,Hypovolemia,Dysthymic disorder,Drug-induced delirium
Delirium tremens,Encephalopathy NOS,Comp-oth vasc dev/graft,Protein-cal malnutr NOS,Hypovolemia,Dysthymic disorder,Drug-induced delirium
Admission Date:  [**2159-3-19**]              Discharge Date:   [**2159-3-24**]

Date of Birth:  [**2116-1-16**]             Sex:   M

Service: MEDICINE

Allergies:
Propoxyphene

Attending:[**First Name3 (LF) 5119**]
Chief Complaint:
transfer from OSH for EtOH DTs

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr [**Known lastname 15499**] is a 43M w h/o depression, alcoholism, who was
originally admitted from home to [**Hospital3 1196**] on
[**2159-3-16**] w grand mal seizures likely [**3-12**] alcohol withdrawal
(last drink [**3-16**]), then was first transferred to [**Hospital1 **] for
detoxification under "Section 12" restriction, but subsequently
transferred to [**Hospital1 18**] w acute agitation/mental status changes
from delerium tremens. Treated in the MICU w valium (up to 450mg
IV valium on presentation) w taper as tolerated, as well as
haldol. Followed by SW and Psych. Transferred to medical floor.
Developed right upper extremity superficial vein thrombosis
causing hand swelling.
.
On arrival to floor, pt was AOx3, comfortable, though [**Doctor Last Name 11506**].

Past Medical History:
history of EtOH withdrawl seizures
EtOH abuse
? of HIV status

Social History:
Lives w mother. Separated from gf after 15 yrs. 2 daughters: 1
age 15 now in psych hospital s/p SA; 1 daughter died at age 10
from HIV/AIDS (from transfusion). Pt is on disability. Walks
with a cane at baseline. His ex-GF has restraining order against
him, and he was just recently in court for violating this.


Family History:
sister with bipolar d/o, 15 y.o. daugther with
depression and s/p recent SA


Physical Exam:
VS: 97.1, 108/70, 95, 23 91% on RA
GENERAL: malnourished man in NAD
SKIN: warm and well perfused, no excoriations or lesions, no
rashes
HEENT: EOMI, PERRLA, anicteric sclera, pink conjunctiva, patent
nares, MMM, good dentition, nontender supple neck, no LAD,
normal JVP
CARDIAC: RRR, S1/S2, no mrg
LUNG: CTAB
ABDOMEN: nondistended, +BS, nontender in all quadrants, no
rebound/guarding, no hepatosplenomegaly
EXT: RUE swelling up to elbow, palpable pulses throughout
NEURO: AOx3 (though not sure about name of hospital), CN II-XII
intact, moves all 4 extremities


Pertinent Results:
HEMATOLOGY:
.
[**2159-3-19**] 02:45PM BLOOD WBC-8.5 RBC-4.01* Hgb-13.7* Hct-39.3*
MCV-98 MCH-34.2* MCHC-34.9 RDW-14.6 Plt Ct-180
[**2159-3-19**] 02:45PM BLOOD Neuts-80.2* Lymphs-14.4* Monos-3.3
Eos-1.9 Baso-0.2
[**2159-3-19**] 02:45PM BLOOD PT-12.7 PTT-23.3 INR(PT)-1.1
.
CHEMISTRY:
[**2159-3-19**] 02:45PM BLOOD Glucose-91 UreaN-11 Creat-0.8 Na-140
K-4.3 Cl-102 HCO3-25 AnGap-17
[**2159-3-19**] 02:45PM BLOOD ALT-75* AST-95* AlkPhos-105 TotBili-0.9
[**2159-3-20**] 05:15AM BLOOD ALT-62* AST-83* CK(CPK)-1739* AlkPhos-81
TotBili-0.9
[**2159-3-20**] 11:24PM BLOOD CK(CPK)-1020*
[**2159-3-21**] 04:45AM BLOOD ALT-42* AST-45* LD(LDH)-285* CK(CPK)-637*
AlkPhos-59 TotBili-0.4
[**2159-3-19**] 09:53PM BLOOD Albumin-4.4 Calcium-8.9 Phos-3.3 Mg-1.2*
.
TOX:
[**2159-3-19**] 02:45PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2159-3-19**] 02:30PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG
.
MICRO:
C. diff negative
.
RADIOLOGY:
CXR:
FINDINGS: No previous images. The heart is normal in size and
configuration. There is some indistinctness of pulmonary
vessels, raising the possibility of elevated pulmonary venous
pressure. No acute focal pneumonia or pleural effusion.
.
HEAD CT:
IMPRESSION: No intracranial hemorrhage or edema.
.
RIGHT HAND X-RAY:
IMPRESSION: No fracture.
.
RUE U/S:
IMPRESSION: Occlusive thrombus in the mid to distal right
basilic vein.

Brief Hospital Course:
Mr [**Known lastname 15499**] is a 43 year old male with history of EtOH seizures
p/w EtOH withdrawl with resolving DTs.

# DT: Last drink was 7 days prior to admission and his
adrenergic symptoms consisting of disorientation, tachycardia,
hypertension, agitation & diaphoresis. This is consistent with
DT. Patient received MVI/Thiamine/Folate in ED and in the unit.
CT head negative. Patient was code purpled for getting agitated
after not being allowed to smoke. Placed on high-dose nicotine
patch.
Received high doses of valium for CIWA > 10 (up to 450mg IV on
the first day!), but weaned quickly once symptoms improved,
especially since signs/symptoms of benzo intoxication were noted
(confusion, nystagmus). Continued on haldol PRN for agitation.
EKG monitored for QTc prolongation. Psych/SW on-board
throughout. Pt wanted to go home, had capacity to make decision
per psych. Discharged home w plan for detoxification and
outpatient followup.
.
# R hand superficial vein thrombosis: Possibly related to periph
IV. Hand is warm, well purfused, good cap refill, palpable
radial pulse. Evaluated by plastic and vascular surgery.
Improved clinically day by day, so no intervention.


Medications on Admission:
none, received Ativan 2mg IV X2 and MIV/folate/vit B1 at OSH

Discharge Medications:
1. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily): Not to be used if smoking.
Disp:*30 Patch 24 hr(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
alcohol withdrawal
.
anxiety
depression


Discharge Condition:
stable


Discharge Instructions:
You were transferred to our hospital for alcohol withdrawal. We
treated you with medications and supportive measures. We
recommend that you follow up very closely with your physicians
and get help with your alcohol problem.
.
Please see your primary care doctor to discuss starting a new
antidepressant medication and finding a new outpatient
psychiatrist.
.
We did not change your medications.
.
Should you have any concerning symptoms, please call your
physicians immediately.

Followup Instructions:
Please call your primary care physician ([**Telephone/Fax (1) 26318**]) for
followup within one week of your discharge.
.
We recommend that you go back to [**Hospital 36149**] Hospital for alcohol
detoxification.


                             [**First Name7 (NamePattern1) 1569**] [**Initial (NamePattern1) **] [**Name8 (MD) **] MD [**MD Number(2) 5122**]

Completed by:[**2159-3-24**]
{'Alcohol withdrawal delirium,Encephalopathy, unspecified,Other complications due to other vascular device, implant, and graft,Unspecified protein-calorie malnutrition,Hypovolemia,Dysthymic disorder,Drug-induced delirium'}


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: transfer from OSH for EtOH DTs

PRESENT ILLNESS: Mr [**Known lastname 15499**] is a 43M w h/o depression, alcoholism, who was
originally admitted from home to [**Hospital3 1196**] on
[**2159-3-16**] w grand mal seizures likely [**3-12**] alcohol withdrawal
(last drink [**3-16**]), then was first transferred to [**Hospital1 **] for
detoxification under "Section 12" restriction, but subsequently
transferred to [**Hospital1 18**] w acute agitation/mental status changes
from delerium tremens. Treated in the MICU w valium (up to 450mg
IV valium on presentation) w taper as tolerated, as well as
haldol. Followed by SW and Psych. Transferred to medical floor.
Developed right upper extremity superficial vein thrombosis
causing hand swelling.
.
On arrival to floor, pt was AOx3, comfortable, though [**Doctor Last Name 11506**].

MEDICAL HISTORY: history of EtOH withdrawl seizures
EtOH abuse
? of HIV status

MEDICATION ON ADMISSION: none, received Ativan 2mg IV X2 and MIV/folate/vit B1 at OSH

ALLERGIES: Propoxyphene

PHYSICAL EXAM: VS: 97.1, 108/70, 95, 23 91% on RA
GENERAL: malnourished man in NAD
SKIN: warm and well perfused, no excoriations or lesions, no
rashes
HEENT: EOMI, PERRLA, anicteric sclera, pink conjunctiva, patent
nares, MMM, good dentition, nontender supple neck, no LAD,
normal JVP
CARDIAC: RRR, S1/S2, no mrg
LUNG: CTAB
ABDOMEN: nondistended, +BS, nontender in all quadrants, no
rebound/guarding, no hepatosplenomegaly
EXT: RUE swelling up to elbow, palpable pulses throughout
NEURO: AOx3 (though not sure about name of hospital), CN II-XII
intact, moves all 4 extremities

FAMILY HISTORY: sister with bipolar d/o, 15 y.o. daugther with
depression and s/p recent SA

SOCIAL HISTORY: Lives w mother. Separated from gf after 15 yrs. 2 daughters: 1
age 15 now in psych hospital s/p SA; 1 daughter died at age 10
from HIV/AIDS (from transfusion). Pt is on disability. Walks
with a cane at baseline. His ex-GF has restraining order against
him, and he was just recently in court for violating this. 

### Response:
{'Alcohol withdrawal delirium,Encephalopathy, unspecified,Other complications due to other vascular device, implant, and graft,Unspecified protein-calorie malnutrition,Hypovolemia,Dysthymic disorder,Drug-induced delirium'}
