CHIEF COMPLAINT: over dose

PRESENT ILLNESS: This is a 33 year old woman with history of previous overdose on
lexapro, risperdal, neurontin in [**11-30**] who presents to the ED
obtunded after presumed overdose. On her previous admission, she
had been intubated but then self extubated, and discharged to an
overngight psych program. Her psychopharmacologist was Dr.
[**Last Name (STitle) 94957**].
.
According to her husband she has been under a lot of stress with
her 15 month old baby and resuming her job. She was sober for a
short period, but then resumed drinking alcohol and he has found
her drunk more often. Yesterday, she went out until about 6 pm,
then came home and seemed upset. She went out again without her
husband from 8 until 1 am, and then came home and slept on the
couch. She was found by him at 6 am, unresponsive but breathing,
clutching a picture of her son's footprints and surrounded by
empty bottles.
.
In the ED she was intubated for airway protection and sedated
with versed/fentanyl. She was found with empty bottles of
lamictal and zoloft, and tox screen was positive for cocaine and
amphetamines, so she received 25g activated charcoal. She got 5
liters of fluid in the ED. She was transferred to the MICU for
supportive care.
.

MEDICAL HISTORY: Depression
Prior overdose at [**Hospital1 18**] [**11-30**]
Bulemia

MEDICATION ON ADMISSION: lamictal
seroquel prn
zoloft

ALLERGIES: Latex

PHYSICAL EXAM: EXAM ON ADMISSION TO MICU

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married. Works in marketing. Smokes about 5 cigarettes a day.
Smokes marijuana occaionally. No previous known cocaine use.
Drinks daily.Has a 15 month old baby
Poisoning by aromatic analgesics, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Cocaine abuse, unspecified,Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Poisoning by other and unspecified anticonvulsants,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified
Pois-arom analgesics NEC,Food/vomit pneumonitis,Cocaine abuse-unspec,Poison-antipsychotic NEC,Pois-anticonvul NEC/NOS,Poison-analgesics,Depressive disorder NEC
Admission Date:  [**2200-5-7**]              Discharge Date:   [**2200-5-9**]

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

Service: MEDICINE

Allergies:
Latex

Attending:[**First Name3 (LF) 898**]
Chief Complaint:
over dose

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
This is a 33 year old woman with history of previous overdose on
lexapro, risperdal, neurontin in [**11-30**] who presents to the ED
obtunded after presumed overdose. On her previous admission, she
had been intubated but then self extubated, and discharged to an
overngight psych program. Her psychopharmacologist was Dr.
[**Last Name (STitle) 94957**].
.
According to her husband she has been under a lot of stress with
her 15 month old baby and resuming her job. She was sober for a
short period, but then resumed drinking alcohol and he has found
her drunk more often. Yesterday, she went out until about 6 pm,
then came home and seemed upset. She went out again without her
husband from 8 until 1 am, and then came home and slept on the
couch. She was found by him at 6 am, unresponsive but breathing,
clutching a picture of her son's footprints and surrounded by
empty bottles.
.
In the ED she was intubated for airway protection and sedated
with versed/fentanyl. She was found with empty bottles of
lamictal and zoloft, and tox screen was positive for cocaine and
amphetamines, so she received 25g activated charcoal. She got 5
liters of fluid in the ED. She was transferred to the MICU for
supportive care.
.


Past Medical History:
Depression
Prior overdose at [**Hospital1 18**] [**11-30**]
Bulemia


Social History:
Married. Works in marketing. Smokes about 5 cigarettes a day.
Smokes marijuana occaionally. No previous known cocaine use.
Drinks daily.Has a 15 month old baby


Family History:
non-contributory

Physical Exam:
EXAM ON ADMISSION TO MICU

VS: T 96 BP 106/41 P115 R14 O2 100% on AC 500x14 10% peep 5
Gen: Intubated, sedated
HEENT: OP clear with ETT in place. Pupils 3 mm, reactive
bilaterally.
Neck: Neck large, no JVP
Resp: CTA bilaterally
CV: RRR nl s1s2 no MGR
Abd: soft, NTND +BS
Ext: trace edema. 2+ DP bilaterally
Neuro: not responsive to pain. No spontaneous movements.


Pertinent Results:
EKG: long QTC, over [**1-27**] RR interval merging into P wave. No ST/T
wave changes

[**2200-5-7**] 06:35AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-0.2 PH-5.0
LEUK-NEG
[**2200-5-7**] 06:35AM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.025
[**2200-5-7**] 06:35AM   PLT COUNT-188
[**2200-5-7**] 06:35AM   NEUTS-62.9 LYMPHS-31.1 MONOS-3.8 EOS-2.1
BASOS-0.2
[**2200-5-7**] 06:35AM   WBC-7.9# RBC-4.45 HGB-12.3 HCT-37.4 MCV-84
MCH-27.7 MCHC-33.0 RDW-14.3
[**2200-5-7**] 06:35AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-POS amphetmn-POS mthdone-NEG
[**2200-5-7**] 06:35AM   ASA-NEG ETHANOL-NEG ACETMNPHN-224.8*
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2200-5-7**] 06:35AM   ALT(SGPT)-13 AST(SGOT)-17 ALK PHOS-91 TOT
BILI-0.3
[**2200-5-7**] 06:35AM   GLUCOSE-144* UREA N-10 CREAT-0.9 SODIUM-138
POTASSIUM-3.6 CHLORIDE-101 TOTAL CO2-25 ANION GAP-16
[**2200-5-7**] 08:02AM   LACTATE-2.3*
[**2200-5-7**] 10:50AM   ACETMNPHN-146.9*
[**2200-5-7**] 12:02PM   LACTATE-3.0*

Brief Hospital Course:
A/P: 33 year old woman with history of drug overdose presents
following repeat overdose. Initially admitted to ICU for airway
protection/intubation/somnolence, but was extubated and
transferred to the medical floor within 24 hours of admission.
Doing well.
.
#) Drug overdose - poly-ingestion with tylenol (level 225
initially, but now zero), seroquel, lamictal, and zoloft. In
addition, she tested positive for cocaine/amphetamines.
Supportive care continued during hospitalization. Received
activated charcoal in ED.
.
--RE: Tylenol overdose - timing of ingestion unclear but likely
at or after 1 am on day of admission. We continued treatment
with N-acetylcysteine 6000 mg q4 hr x 12 doses. She was
initially to have the 17 dose protocol, but given normal LFTs,
INR, and zero tylenol level, further treatment was d/c'd.
.
---RE: ?Seroquel overdose - most common effects are CNS
depression, delirium, tachycardia and hypotension, ECG changes
(QTc and QRS prolongation, PVCs), hypokalemia, and
rhabdomyolysis. Patient had several of these effects but had
polysubstance ingestion so unclear if solely seroquel effect.
Repeat EKG's ok, no events on telemetry, bp stable, CK slightly
elevated but with normal renal function, sinus tachycardia
resolved after transfer to floor. Continued IV hydration but now
taking good PO.
.
---RE: ?lamotrigine overdose - effects include somnolence,
ataxia, nystagmus, hypokalemia, seizures, nausea, vomiting, dry
mouth with thick secretions, tachycardia, confusion, agitation,
rash, slurred speech, tremor, and blurred vision. As above, BP
stable, repleting K, continued hydration, EKG with stable
intervals.
.
--RE: ?sertraline overdose - difficult to have toxicity unless
doses extremely high. Most common signs/symptoms include
somnolence, nausea and vomiting, tachycardia, dizziness,
agitation and tremor. Continued supportive care.

--RE: cocaine/amphetamine use - No signs of stimulant overdose
on admission, given her lethargy/somnolence. No signs of
withdrawal from these substances during admission.
.
--RE: Etoh use/abuse: daily alcohol. No signs of withdrawal
during hospitalization. Maintained on CIWA but did not require
any valium.
.
#) depression/suicide attempt - psychiatry followed patient
during admission. Patient cannot leave AMA as she is sectioned.
Maintained 1:1 sitter for safety. Will be transferred to [**Hospital1 **] 4
on discharge.
.
#) fevers: pt with low grade temps in ICU to max 100.6 with
?aspiration pna on cxr, likely from pneumonitis vs atelectasis.
U/a repeat w/o evidence for infection. Had mild hypoxia s/p
extubation but now with normal sats. Denies dyspnea or cough.
Repeat CXR showed right lower lobe pneumonia. Started on PO
levaquin for 7 days (day one = [**5-9**]).
.
#) etoh use: drinks daily. was on ciwa w/ valium but no signs of
withdrawal during this admission.
.
#) proph - PPI (change to PO), SQ Heparin until she was
ambulatory
.
#) FEN - was NPO but restarted regular diet given improvement in
mental status. Lytes required repletion on few occasions. would
check lytes on [**5-10**] and replete prn.
.
#) Comm - Spoke with patient and mother on several occasions.
Husband [**Name (NI) **] 617-[**Telephone/Fax (1) 94961**] cell [**Telephone/Fax (1) 94962**] home
.
#) Code status - Full
.
#) Access - peripheral IV's
.
#) dispo: supportive care, transfer to [**Hospital1 **] 4

Medications on Admission:
lamictal
seroquel prn
zoloft


Discharge Medications:
1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 6 days: to total 7 days of treatment.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
polysubstance overdose
aspiration pneumonia


Discharge Condition:
stable


Discharge Instructions:
You are being discharged to an inpatient treatment program for
your depression

Followup Instructions:
Follow up with your primary care doctor once you are done with
your treamtent program.



Completed by:[**2200-5-9**]
{'Poisoning by aromatic analgesics, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Cocaine abuse, unspecified,Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Poisoning by other and unspecified anticonvulsants,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: over dose

PRESENT ILLNESS: This is a 33 year old woman with history of previous overdose on
lexapro, risperdal, neurontin in [**11-30**] who presents to the ED
obtunded after presumed overdose. On her previous admission, she
had been intubated but then self extubated, and discharged to an
overngight psych program. Her psychopharmacologist was Dr.
[**Last Name (STitle) 94957**].
.
According to her husband she has been under a lot of stress with
her 15 month old baby and resuming her job. She was sober for a
short period, but then resumed drinking alcohol and he has found
her drunk more often. Yesterday, she went out until about 6 pm,
then came home and seemed upset. She went out again without her
husband from 8 until 1 am, and then came home and slept on the
couch. She was found by him at 6 am, unresponsive but breathing,
clutching a picture of her son's footprints and surrounded by
empty bottles.
.
In the ED she was intubated for airway protection and sedated
with versed/fentanyl. She was found with empty bottles of
lamictal and zoloft, and tox screen was positive for cocaine and
amphetamines, so she received 25g activated charcoal. She got 5
liters of fluid in the ED. She was transferred to the MICU for
supportive care.
.

MEDICAL HISTORY: Depression
Prior overdose at [**Hospital1 18**] [**11-30**]
Bulemia

MEDICATION ON ADMISSION: lamictal
seroquel prn
zoloft

ALLERGIES: Latex

PHYSICAL EXAM: EXAM ON ADMISSION TO MICU

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: Married. Works in marketing. Smokes about 5 cigarettes a day.
Smokes marijuana occaionally. No previous known cocaine use.
Drinks daily.Has a 15 month old baby 

### Response:
{'Poisoning by aromatic analgesics, not elsewhere classified,Pneumonitis due to inhalation of food or vomitus,Cocaine abuse, unspecified,Poisoning by other antipsychotics, neuroleptics, and major tranquilizers,Poisoning by other and unspecified anticonvulsants,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified'}
