CHIEF COMPLAINT: Drug overdose

PRESENT ILLNESS: Patient is a 33 year old woman who presented to the ED after OD
on lexapro, and risperidal, neurontin one bottle of [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 5261**]. Initially she was somnolent on exam and was intubated
for airway protection. She later self extubated. Tox screen was
positive for benzos, amphetamines and alcohol level was 101. She
received charcol via NGT and 3L of NS.
.
Patient reports that she has been depressed for several months.
She has a psychiatrist who prescribes Lexapro, risperidal and
neurontin for depression and mild bipolar disorder. She takes
the risperidal prn. Yesterday she smoked pot and got drunk and
while intoxicated decided to take 20-30 pills of each
medication. Ten minutes later she regreted it and called her
husband and best friend who brought her to the hospital. In the
ED she was initially very somnolent but is now only mildly
sleepy.

MEDICAL HISTORY: 1. Depression
2. Prior Suicide attempts per husband, pt denies
3. Bulemia

MEDICATION ON ADMISSION: Lexapro 40 mg po qday
Neurontin 200mg PO QHS
Risperdal 0.25 mg PO qd:PRN

ALLERGIES: Latex

PHYSICAL EXAM: VS: T 100.2 HR 108 BP 104/60 RR 11 O2 sat 94% RA
Gen: Well appearing, comfortable, sleepy but arousable.
HEENT: PERRL, EOMI, sclera anicteric, MM dry.
Neck: No LAD, JVD or thyromegly.
CV: RRR with no m/r/g
Lungs: CTA bilaterally
Abd: soft, NT, ND active BS, no hepatosplenomegly.
ext: No clubbing, cyanosis or edema.
Neuro: Sleepy but arousable. Oriented x 3. 5/5 strength in all
four extremities. PERRL.
.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married. Works in marketing. Smokes about 5 cigarettes a day.
Smokes marijuana about once a week. Drinks a glass of wine or
beer daily. Not sexually active. Has a 15 month old baby.
Toxic effect of ethyl alcohol,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Alcohol abuse, unspecified,Bipolar I disorder, most recent episode (or current) unspecified,Depressive disorder, not elsewhere classified,Bulimia nervosa
Toxic eff ethyl alcohol,Poison-psychotropic agt,Alcohol abuse-unspec,Bipolor I current NOS,Depressive disorder NEC,Bulimia nervosa
Admission Date:  [**2199-12-10**]              Discharge Date:   [**2199-12-11**]

Date of Birth:  [**2166-10-18**]             Sex:   F

Service: MEDICINE

Allergies:
Latex

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
Drug overdose

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Patient is a 33 year old woman who presented to the ED after OD
on lexapro, and risperidal, neurontin one bottle of [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 5261**]. Initially she was somnolent on exam and was intubated
for airway protection. She later self extubated. Tox screen was
positive for benzos, amphetamines and alcohol level was 101. She
received charcol via NGT and 3L of NS.
.
Patient reports that she has been depressed for several months.
She has a psychiatrist who prescribes Lexapro, risperidal and
neurontin for depression and mild bipolar disorder. She takes
the risperidal prn. Yesterday she smoked pot and got drunk and
while intoxicated decided to take 20-30 pills of each
medication. Ten minutes later she regreted it and called her
husband and best friend who brought her to the hospital. In the
ED she was initially very somnolent but is now only mildly
sleepy.


Past Medical History:
1. Depression
2. Prior Suicide attempts per husband, pt denies
3. Bulemia

Social History:
Married. Works in marketing. Smokes about 5 cigarettes a day.
Smokes marijuana about once a week. Drinks a glass of wine or
beer daily. Not sexually active. Has a 15 month old baby.

Family History:
non-contributory

Physical Exam:
VS: T 100.2 HR 108 BP 104/60 RR 11 O2 sat 94% RA
Gen: Well appearing, comfortable, sleepy but arousable.
HEENT: PERRL, EOMI, sclera anicteric, MM dry.
Neck: No LAD, JVD or thyromegly.
CV: RRR with no m/r/g
Lungs: CTA bilaterally
Abd: soft, NT, ND active BS, no hepatosplenomegly.
ext: No clubbing, cyanosis or edema.
Neuro: Sleepy but arousable. Oriented x 3. 5/5 strength in all
four extremities. PERRL.
.


Pertinent Results:
[**2199-12-9**] 10:30PM BLOOD WBC-6.8 RBC-4.36 Hgb-12.7 Hct-36.9 MCV-85
MCH-29.1 MCHC-34.4 RDW-13.3 Plt Ct-169
[**2199-12-11**] 04:49AM BLOOD WBC-4.5 RBC-3.74* Hgb-11.1* Hct-32.6*
MCV-87 MCH-29.8 MCHC-34.2 RDW-14.6 Plt Ct-138*
[**2199-12-9**] 10:30PM BLOOD Neuts-62.4 Lymphs-29.4 Monos-2.5 Eos-5.2*
Baso-0.5
[**2199-12-9**] 10:30PM BLOOD PT-11.9 PTT-24.0 INR(PT)-0.9
[**2199-12-11**] 04:49AM BLOOD Plt Ct-138*
[**2199-12-9**] 10:30PM BLOOD Glucose-110* UreaN-7 Creat-0.8 Na-138
K-3.2* Cl-99 HCO3-25 AnGap-17
[**2199-12-11**] 04:49AM BLOOD Glucose-112* UreaN-5* Creat-0.6 Na-139
K-3.4 Cl-107 HCO3-25 AnGap-10
[**2199-12-9**] 10:30PM BLOOD ALT-13 AST-19 AlkPhos-97 Amylase-32
TotBili-0.2
[**2199-12-9**] 10:30PM BLOOD Lipase-41
[**2199-12-9**] 10:30PM BLOOD Albumin-4.6 Calcium-9.0 Phos-3.1 Mg-1.8
[**2199-12-11**] 04:49AM BLOOD Calcium-8.3* Phos-2.4* Mg-1.8
[**2199-12-9**] 10:30PM BLOOD ASA-NEG Ethanol-101* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2199-12-9**] 10:36PM BLOOD Lactate-3.2*
[**2199-12-10**] 12:35AM BLOOD freeCa-1.11*
[**2199-12-10**] 12:35AM BLOOD Type-ART FiO2-21 pO2-82* pCO2-43 pH-7.38
calHCO3-26 Base XS-0 Intubat-NOT INTUBA
.
[**2199-12-9**]
AP UPRIGHT PORTABLE CHEST X-RAY: There has been interval removal
of an endotracheal tube. A nasogastric tube remains in unchanged
position with the tip below the hemidiaphragms. The proximal
side port remains at the gastroesophageal junction. The cardiac
silhouette, mediastinal and hilar contours are normal. The
pulmonary vasculature is normal. Both lungs are clear without
consolidations or effusions. The surrounding soft tissues are
unremarkable.
.
AP UPRIGHT PORTABLE CHEST X-RAY: An endotracheal tube terminates
above the level of the clavicles. A nasogastric tube descends
below the diaphragm. The proximal side port is at the level of
the gastroesophageal junction. The mediastinum is prominent,
most likely related to patient positioning. There are low lung
volumes bilaterally without consolidations or effusions. The
surrounding soft tissue and osseous structures are unremarkable.


Brief Hospital Course:
33 year old woman with history of depression and bulimia
presents with mental status changes resulting in inability to
protect her airway after overdose on Risperdal, lexapro and
alcohol in attempt to commit suicide.
.
Suicide attempt: Toxicology was consulted in the ED and
suggested charcoal. ECG showed initial QTc of 461 and then QTc
of 434. Bicarbonate was not given due to normal QRS. Given her
poor mental status, it was felt that should could not protect
her airway and she was intubated but then self-extubated and was
subsequently able to protect her own airway. Her urine tox
screen was positive for benzos and amphetamines and her blood
alcohol level was 101. She was transferred to the ICU for close
monitoring given her mental status. Patient was monitored for
benzodiazepine and alcohol withdrawal on CIWA scale and was
awake and interactive by the following day and was provided with
a 1:1 sitter. Psychiatry was consulted and thought it best to
hold psych meds until contacting her outpatient psychiatrist.
The Psychiatry team did not feel that she needed an inpatient
psychiatric admission but would rather benefit from a partial
hospital arrangement. Supportive care was continued and her
outpatient psychiatrist recommended restarting her outpatient
regimen. Arrangements were made for her to start a hospital
program at [**Hospital 3671**] Hospital in [**Hospital1 **], MA the day after
discharge. She was given 2 days worth of her medications and was
discharged under the supervision of her husband. She was told to
call her psychopharmacologist Dr. [**Last Name (STitle) 94957**] [**Name (STitle) 2678**] to set up an
appointment.
.


Medications on Admission:
Lexapro 40 mg po qday
Neurontin 200mg PO QHS
Risperdal 0.25 mg PO qd:PRN

Discharge Medications:
1. Lexapro 20 mg Tablet Sig: Two (2) Tablet PO once a day for 2
days.
Disp:*4 Tablet(s)* Refills:*0*
2. Neurontin 100 mg Capsule Sig: Two (2) Capsule PO at bedtime
for 2 days.
Disp:*4 Capsule(s)* Refills:*0*
3. Risperdal 0.25 mg Tablet Sig: One (1) Tablet PO once a day as
needed for 2 days.
Disp:*4 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary
1. Suicide attempt
2. Drug overdose
2. Depression
Secondary
1. Bulemia
2. Alcohol abuse


Discharge Condition:
No SI/HI. Alert, awake and oriented. Will return home under the
supervision of her husband.


Discharge Instructions:
You will be starting a program at [**Hospital 3671**] hospital tomorrow.

Take all of your medicaions as directed.

Keep all of your follow up appointments.

Followup Instructions:
You have an appointment at [**Hospital 3671**] Hospital Thursday, [**12-12**], [**2199**]. The hospital is located at [**Street Address(2) 94958**]. in [**Hospital1 **],
MA. You are scheduled to meet in the Thoreau Unit ([**Location (un) 442**]) at
8:30 am. The phone number is [**Telephone/Fax (1) 94959**].

You should call Dr. [**Last Name (STitle) **] for an appointment [**Last Name (STitle) 2678**] at
[**Telephone/Fax (1) 94960**].
{'Toxic effect of ethyl alcohol,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Alcohol abuse, unspecified,Bipolar I disorder, most recent episode (or current) unspecified,Depressive disorder, not elsewhere classified,Bulimia nervosa'}


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: Drug overdose

PRESENT ILLNESS: Patient is a 33 year old woman who presented to the ED after OD
on lexapro, and risperidal, neurontin one bottle of [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 5261**]. Initially she was somnolent on exam and was intubated
for airway protection. She later self extubated. Tox screen was
positive for benzos, amphetamines and alcohol level was 101. She
received charcol via NGT and 3L of NS.
.
Patient reports that she has been depressed for several months.
She has a psychiatrist who prescribes Lexapro, risperidal and
neurontin for depression and mild bipolar disorder. She takes
the risperidal prn. Yesterday she smoked pot and got drunk and
while intoxicated decided to take 20-30 pills of each
medication. Ten minutes later she regreted it and called her
husband and best friend who brought her to the hospital. In the
ED she was initially very somnolent but is now only mildly
sleepy.

MEDICAL HISTORY: 1. Depression
2. Prior Suicide attempts per husband, pt denies
3. Bulemia

MEDICATION ON ADMISSION: Lexapro 40 mg po qday
Neurontin 200mg PO QHS
Risperdal 0.25 mg PO qd:PRN

ALLERGIES: Latex

PHYSICAL EXAM: VS: T 100.2 HR 108 BP 104/60 RR 11 O2 sat 94% RA
Gen: Well appearing, comfortable, sleepy but arousable.
HEENT: PERRL, EOMI, sclera anicteric, MM dry.
Neck: No LAD, JVD or thyromegly.
CV: RRR with no m/r/g
Lungs: CTA bilaterally
Abd: soft, NT, ND active BS, no hepatosplenomegly.
ext: No clubbing, cyanosis or edema.
Neuro: Sleepy but arousable. Oriented x 3. 5/5 strength in all
four extremities. PERRL.
.

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married. Works in marketing. Smokes about 5 cigarettes a day.
Smokes marijuana about once a week. Drinks a glass of wine or
beer daily. Not sexually active. Has a 15 month old baby. 

### Response:
{'Toxic effect of ethyl alcohol,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Alcohol abuse, unspecified,Bipolar I disorder, most recent episode (or current) unspecified,Depressive disorder, not elsewhere classified,Bulimia nervosa'}
