CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 15-year-old female
transferred here from [**Doctor Last Name **] [**Location (un) 8641**] Academy where she is a
resident in [**Location (un) 3844**].  She was brought to the [**Hospital1 1444**] Medical Intensive Care Unit
for a Tylenol overdose.

MEDICAL HISTORY: Depression (previously on Paxil but
self-discontinued).

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died five years ago of lung cancer.
Mother lives in [**Country 10181**].

SOCIAL HISTORY: No tobacco.  No alcohol.  A student in
[**Location (un) 8641**], [**Location (un) 3844**].
Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified
Pois-arom analgesics NEC,Poison-analgesics,Depressive disorder NEC
Admission Date:  [**2153-3-2**]     Discharge Date:  [**2153-3-5**]

Date of Birth:   [**2136-3-13**]     Sex:  F

Service:  Medicine, [**Hospital1 **] Firm

HISTORY OF PRESENT ILLNESS:  This is a 15-year-old female
transferred here from [**Doctor Last Name **] [**Location (un) 8641**] Academy where she is a
resident in [**Location (un) 3844**].  She was brought to the [**Hospital1 1444**] Medical Intensive Care Unit
for a Tylenol overdose.

The patient had been found on the floor by her classmates at
about 2:30 p.m. on the day of admission with Tylenol bottles
near her.  She had consumed approximately 150 tablets of
500-mg each.

She was brought to the hospital in [**Location (un) 8641**] where she underwent
an nasogastric lavage productive of pink sludge and pills.
She received charcoal and sorbitol times two.  At the outside
hospital, her acetaminophen level two hours after ingestion
was 232.  Three and a half hours after ingestion
acetaminophen was 337.

The patient was then transferred to the Medical Intensive
Care Unit at this hospital.

PAST MEDICAL HISTORY:  Depression (previously on Paxil but
self-discontinued).

MEDICATIONS ON ADMISSION:  None.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  No tobacco.  No alcohol.  A student in
[**Location (un) 8641**], [**Location (un) 3844**].

FAMILY HISTORY:  Father died five years ago of lung cancer.
Mother lives in [**Country 10181**].

PHYSICAL EXAMINATION ON PRESENTATION:  Temperature was 36.2,
heart rate was 68, blood pressure was 108/58, pulse oximetry
was 75.  In general, shivering and moaning.  Small volume
charcoal emesis.  Lying in bed awake.  Head, eyes, ears,
nose, and throat examination revealed normocephalic and
atraumatic.  Pupils were equal, round, and reactive to light.
Extraocular movements were intact.  Sclerae were anicteric.
Subunguially, a charcoal stained tongue.  The neck was
supple.  Full range of motion.  Jugular venous distention was
flat.  Trachea was midline.  No lymphadenopathy.  Thyroid was
not palpable.  Heart was regular.  Normal first heart sounds
and second heart sounds.  No third heart sounds or fourth
heart sounds.  No murmurs, rubs, or gallops.  Point of
maximal impulse was not displaced.  The lungs were clear to
auscultation bilaterally.   The abdomen was stable, normal
bowel sounds, and soft.  Mildly tender to deep palpation.
Extremities were cool and pale.  No rash.  No cyanosis or
edema.  Neurologic examination revealed alert and awake.  Did
not cooperate with examination.  On motor examination, moved
all four extremities.  The patient would not cooperate with
sensory or cerebellar examination.  Deep tendon reflexes were
2+ throughout.  Cranial nerves II, III, IV, and VI, V, VII,
IX, X, and XII were intact.

PERTINENT LABORATORY VALUES ON PRESENTATION:  Initial
laboratory studies revealed arterial blood gas with pH of
7.42, carbon dioxide was 38.5, oxygen was 243 on full face
mask.  Sodium was 140, potassium was 3.6, chloride was 100,
bicarbonate was 24, blood urea nitrogen was 13, creatinine
was 0.8, and blood glucose was 100.  White blood cell count
was 8.6, hematocrit was 36.2, and platelets were 295.  Total
bilirubin was 0.3, AST was 16, ALT was 19, alkaline
phosphatase was 52.  Total protein was 1.8.  INR was 1.1.
Acetaminophen level in this hospital was less than 200.

PERTINENT RADIOLOGY/IMAGING:  Electrocardiogram revealed a
sinus rhythm at 64 beats per minute.  P-R interval was less
than 0.2.  QRS interval was less than 0.12.  QTc was 405.
Axis was 120 and 150.  No Q waves.  No ST-T wave changes.

INITIAL ASSESSMENT:  This is a 17-year-old female with an
acetaminophen overdose.

HOSPITAL COURSE BY ISSUE/SYSTEM:   MEDICAL INTENSIVE CARE
UNIT COURSE:  In the Medical Intensive Care Unit, the patient
received an initial loading dose of 7 g of Mucomyst p.o.
followed by 3.5 g p.o. q.4h.  The patient also received
Reglan/Zofran regularly so she could tolerate the Mucomyst
doses.

She was evaluated by the Toxicology Service in the Medical
Intensive Care Unit who recommended the above treatment.

The patient was initially uncomfortable, with nausea and
moaning, but soon felt no abdominal pain and no nausea.  The
patient had her liver function tests monitored q.4h. with no
significant rise in her liver function tests or INR.   The
patient had a follow-up acetaminophen level which was 0; at
which point the Mucomyst and the liver function tests checks
were stopped.  The patient briefly had a central line placed
while in the Medical Intensive Care Unit which was pulled
when she came to the floor.

The patient was evaluated by the Psychiatry Service when she
came to the floor, and they felt that once she had been
medically cleared it would be most appropriate for her to go
to an inpatient psychiatry stay for further psychiatric
evaluation.  The patient had been on a one-to-one sitter and
suicide precautions at all times throughout her hospital
course.

DISCHARGE DIAGNOSES:   Tylenol overdose.

MEDICATIONS ON DISCHARGE:  Reglan 10 mg p.o. q.i.d. as
needed.

CONDITION AT DISCHARGE:  Condition on discharge was good.

DISCHARGE STATUS:  Discharged to [**Hospital3 1280**] Inpatient
Psychiatric [**Hospital1 **].





                          [**First Name11 (Name Pattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **], M.D.  [**MD Number(1) 16316**]

Dictated By:[**Name8 (MD) 8279**]

MEDQUIST36

D:  [**2153-3-5**]  19:55
T:  [**2153-3-6**]  15:47
JOB#:  [**Job Number 49006**]
{'Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified'}


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: 

PRESENT ILLNESS: This is a 15-year-old female
transferred here from [**Doctor Last Name **] [**Location (un) 8641**] Academy where she is a
resident in [**Location (un) 3844**].  She was brought to the [**Hospital1 1444**] Medical Intensive Care Unit
for a Tylenol overdose.

MEDICAL HISTORY: Depression (previously on Paxil but
self-discontinued).

MEDICATION ON ADMISSION: None.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Father died five years ago of lung cancer.
Mother lives in [**Country 10181**].

SOCIAL HISTORY: No tobacco.  No alcohol.  A student in
[**Location (un) 8641**], [**Location (un) 3844**]. 

### Response:
{'Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified'}
