CHIEF COMPLAINT: Coffee ground emesis.

PRESENT ILLNESS: This is a 34-year-old male with
a history of alcohol abuse and delirium tremens and
depression, who was admitted to the MICU after admission for
coffee ground emesis.  The patient had started drinking
alcohol again after a recent hiatus when he found that his
work was closing and began drinking six liters of wine a day
and had been vomiting four days prior to admission.  He came
to the Emergency Department and was found to have coffee
ground emesis with an NG lavage that cleared after one liter.
He was admitted to the Medical Intensive Care Unit.  His
hematocrit was 45 on admission and, after intravenous fluids,
was found to be 32.  The patient also had multiple
electrolyte abnormalities, including a mixed metabolic
acidosis that corrected after dextrose containing IV fluids.
The patient was then transferred from the Medical Intensive
Care Unit to the floor, after his hematocrit appeared to be
stable.  Upon transfer, the patient was found to be
asymptomatic without fevers, chills or headache.  No nausea,
vomiting or diarrhea.  No more episodes of hematemesis.  No
chest pain or shortness of breath.  No abdominal pain.

MEDICAL HISTORY: Alcohol abuse and history of delirium
tremens, depression.  History of a GI bleed in [**12-2**] and
found to be from a Dieulafoy's lesion.  Anxiety.
Polysubstance abuse.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for alcohol abuse and
polysubstance abuse.  Patient worked in a record store that
was recently found to be closing and will be without a job.
He is not married.
Hemorrhage of gastrointestinal tract, unspecified,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, unspecified,Gastroesophageal laceration-hemorrhage syndrome
Gastrointest hemorr NOS,Alcoh dep NEC/NOS-unspec,Drug abuse NEC-unspec,Mallory-weiss syndrome
Admission Date:  [**2114-4-25**]     Discharge Date:  [**2114-4-28**]

Date of Birth:   [**2079-7-15**]     Sex:  M

Patient left against medical advice on [**2114-4-28**].

Service:  [**Hospital 139**] Medical Service

CHIEF COMPLAINT:  Coffee ground emesis.

HISTORY OF PRESENT ILLNESS:  This is a 34-year-old male with
a history of alcohol abuse and delirium tremens and
depression, who was admitted to the MICU after admission for
coffee ground emesis.  The patient had started drinking
alcohol again after a recent hiatus when he found that his
work was closing and began drinking six liters of wine a day
and had been vomiting four days prior to admission.  He came
to the Emergency Department and was found to have coffee
ground emesis with an NG lavage that cleared after one liter.
He was admitted to the Medical Intensive Care Unit.  His
hematocrit was 45 on admission and, after intravenous fluids,
was found to be 32.  The patient also had multiple
electrolyte abnormalities, including a mixed metabolic
acidosis that corrected after dextrose containing IV fluids.
The patient was then transferred from the Medical Intensive
Care Unit to the floor, after his hematocrit appeared to be
stable.  Upon transfer, the patient was found to be
asymptomatic without fevers, chills or headache.  No nausea,
vomiting or diarrhea.  No more episodes of hematemesis.  No
chest pain or shortness of breath.  No abdominal pain.

PAST MEDICAL HISTORY:  Alcohol abuse and history of delirium
tremens, depression.  History of a GI bleed in [**12-2**] and
found to be from a Dieulafoy's lesion.  Anxiety.
Polysubstance abuse.

OUTPATIENT MEDICATIONS:  Effexor, 75 mg PO q d.  BuSpar, 50
mg PO b.i.d..  Seroquel, 25 mg PO q d.

MEDICATIONS ON TRANSFER TO THE FLOOR:  Diazepam, 10 mg PO
p.r.n..  Haldol, 1-5 mg IV q 4 p.r.n..  Quetiapine, 25 mg PO
q d.  BuSpar, 150 mg PO b.i.d..  Venlafaxine, 75 mg PO q d.
Ondansetron, 8 mg IV q 6 hours.  Folic acid, 1 mg IV q d.
Thiamine, 100 mg IV q d.  Subcutaneous heparin, 5,000 units
b.i.d..  Tylenol, p.r.n..

ALLERGIES:  Patient has no known drug allergies.

SOCIAL HISTORY:  Significant for alcohol abuse and
polysubstance abuse.  Patient worked in a record store that
was recently found to be closing and will be without a job.
He is not married.

EXAM UPON TRANSFER TO THE FLOOR FROM THE MICU:  Vital signs:
Afebrile, T-max 97, pulse 72-85, blood pressure
101-130/48-56, respirations 15-22.  Oxygen saturation 100% on
room air.  General: Patient has slurred speech, but answers
questions appropriately.  HEENT: PERRLA, anicteric sclerae.
Mucous membranes moist.  Benign oropharynx.  No jugular
venous distention.  Chest: Clear to auscultation bilaterally.
Heart: Regular rate and rhythm.  S1, S2.  No rubs, gallops or
murmurs.  Abdomen: Normoactive bowel sounds.  Nontender,
nondistended.  No organomegaly.  Extremities: No clubbing,
cyanosis or edema.  PT pulses 2+ bilaterally.  Neuro: No
focal deficits.  No asterixis or tremor.

LABS ON TRANSFER TO THE FLOOR:  Showed a white count of 10
which was down from 28,000 on admission, hematocrit of 32.2
which was down from 45 on admission, MCV of 89, platelets
207.  Coags show a PTT of 26, an INR of 0.9.  Electrolytes
with a sodium of 140, potassium 2.4, chloride 106,
bicarbonate of 24, BUN of 7, creatinine of 0.8.

On admission, the patient had significant electrolyte
abnormalities, including sodium of 130, potassium of 5.3,
chloride of 96, bicarbonate of 19, BUN of 17, and creatinine
of 1.3, and all of these corrected after IV fluid hydration.

ALT 27, AST 23, alkaline phosphatase 72, total bilirubin 1.9,
amylase 110, lipase 23, lactate dehydrogenase 209.  Alcohol
level on admission was 208.  Patient had a urinalysis on
admission with 250 of glucose, 15 of ketones, no red or white
cells.  Calcium 8.1, phosphorus 3.2, magnesium 2.1, upon
transfer to the floor.

Chest x-ray is negative for any acute or chronic processes.

HOSPITAL COURSE:  This is a 34-year-old male with a history
of alcohol abuse and Dieulafoy's lesion with a recent alcohol
binge admitted with upper GI bleed with coffee ground emesis.
The patient left against medical advice after being
transferred to the floor.  This was before he had the
opportunity of an EGD.

1.  Upper GI bleed:  Differential diagnosis [**Doctor First Name **]-[**Doctor Last Name **]
tear after alcohol binge and vomiting or recurrent
Dieulafoy's lesion or ulcer.  His hematocrit drifted down
from 45 to 32 and stabilized at 34 for 48 hours.  No sign of
active bleeding when the patient left against medical advice.

2.  Fluids, electrolytes, and nutrition:  Patient had
multiple electrolyte and acid based abnormalities on
admission secondary to vomiting, alcohol binge.  These
stabilized after IV fluids.


3.  Heme:  Hematocrit stabilized at low 30's times 48 hours
before leaving.  Initial leukocytosis from stress of GI bleed
resolved.

4.  Psych:  Patient has a history of alcohol abuse and
depression.  No current signs of withdrawal upon transfer to
the floor, although the patient was given up to 40 mg of
diazepam in the MICU for a question of alcohol withdrawal.
He will continue on his Seroquel, Effexor, and BuSpar for his
depression and anxiety disorder.

DISPOSITION:  The patient left against medical advice after
being transferred to the floor.  He was told that the risks
of leaving prior to the EGD study to determine and possibly
treat the cause of his bleed was possibly a risk of
re-bleeding with the concomitant chance of bleeding to death.
The patient understood this.  Psychiatry saw the patient
prior to leaving and determined that he was competent to
understand the risks of leaving against medical advice and
make this decision.  The patient said that he had a
prescription for Protonix at home and was encouraged to fill
this after leaving.  He was also encouraged to follow-up with
his primary care doctor as soon as possible.






                          [**First Name4 (NamePattern1) **] [**First Name8 (NamePattern2) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 12494**]

Dictated By:[**Last Name (NamePattern1) **]

MEDQUIST36

D:  [**2114-4-30**]  10:33
T:  [**2114-5-1**]  08:35
JOB#: [**Job Number 34397**]
{'Hemorrhage of gastrointestinal tract, unspecified,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, unspecified,Gastroesophageal laceration-hemorrhage syndrome'}


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: Coffee ground emesis.

PRESENT ILLNESS: This is a 34-year-old male with
a history of alcohol abuse and delirium tremens and
depression, who was admitted to the MICU after admission for
coffee ground emesis.  The patient had started drinking
alcohol again after a recent hiatus when he found that his
work was closing and began drinking six liters of wine a day
and had been vomiting four days prior to admission.  He came
to the Emergency Department and was found to have coffee
ground emesis with an NG lavage that cleared after one liter.
He was admitted to the Medical Intensive Care Unit.  His
hematocrit was 45 on admission and, after intravenous fluids,
was found to be 32.  The patient also had multiple
electrolyte abnormalities, including a mixed metabolic
acidosis that corrected after dextrose containing IV fluids.
The patient was then transferred from the Medical Intensive
Care Unit to the floor, after his hematocrit appeared to be
stable.  Upon transfer, the patient was found to be
asymptomatic without fevers, chills or headache.  No nausea,
vomiting or diarrhea.  No more episodes of hematemesis.  No
chest pain or shortness of breath.  No abdominal pain.

MEDICAL HISTORY: Alcohol abuse and history of delirium
tremens, depression.  History of a GI bleed in [**12-2**] and
found to be from a Dieulafoy's lesion.  Anxiety.
Polysubstance abuse.

MEDICATION ON ADMISSION: 

ALLERGIES: Patient has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: Significant for alcohol abuse and
polysubstance abuse.  Patient worked in a record store that
was recently found to be closing and will be without a job.
He is not married. 

### Response:
{'Hemorrhage of gastrointestinal tract, unspecified,Other and unspecified alcohol dependence, unspecified,Other, mixed, or unspecified drug abuse, unspecified,Gastroesophageal laceration-hemorrhage syndrome'}
