CHIEF COMPLAINT: tylenol OD

PRESENT ILLNESS: 19 Yr F. took 50 extra strength tylenols (25gm) on [**5-8**] night
(attempted suicide - b/c was "sad"
told her family about it but apparently did not come to the
hospital. Started vomiting [**5-8**]. Eventually presented to OSH
[**5-10**]. Tylenol level 48 hrs post ingestion was 27. INR 4.9. Given
11gms of NAC IV. transferred to [**Hospital1 **]-[**5-10**] night. INR 6.9,
transaminases [**Numeric Identifier 890**]. PH 7.38(post fluids)

MEDICAL HISTORY: Her past medical history is
significant for the suicide attempt and asthma.  She has no
known drug allergies and takes oral contraceptives and
albuterol medication.

MEDICATION ON ADMISSION: OCP, Albuterol IH PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: gen: wdwn young female, lethargic but arousable, comfortable in
bed
heent: anicteric sclera, jaundiced mucous membranes, mmm
cv: s1, s2 tachy but regular w/ no mrg appreciated
pulm: cta anteriorly
abd: naval piercing, hypoactive bs, soft, mild tender in ruq, no
rebound
extr: no edema
neuro: ?1-2 beat asterixis, no clonus

FAMILY HISTORY: depression

SOCIAL HISTORY: hairdresser, lives w/ mother in [**Name (NI) **]. Occasional etoh, no
ivda, smokes cigarettes, occasional [**Doctor Last Name 63683**]
Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Hepatitis, unspecified,Borderline personality disorder
Pois-arom analgesics NEC,Poison-analgesics,Hepatitis NOS,Borderline personality
Admission Date: [**2200-5-11**]        Discharge Date: [**2200-5-15**]

Date of Birth:  [**2180-7-30**]        Sex:  F

Service:  [**Last Name (un) **]


Briefly, this is a 19 year old female who had previous
suicide attempt who took multiple Tylenol tablets who was
evaluated at [**Hospital6 1597**] emergency room and was found
to be in significant liver failure who was transferred to the
medical service.  She was admitted to the [**Hospital Ward Name 332**] ICU at the
time.

PAST MEDICAL HISTORY:  Her past medical history is
significant for the suicide attempt and asthma.  She has no
known drug allergies and takes oral contraceptives and
albuterol medication.

PHYSICAL EXAMINATION:  At the time, she was afebrile.  Her
heart rate was 100.  Blood pressure was stable and
respiratory was 96% on room air.  She as jaundiced.  Her
lungs were clear.  Heart was regular.  Abdomen was soft and
nontender.  She had hyperactive bowel sounds and she had mild
right upper quadrant tenderness with no rebound or guarding.
Her extremities were warm and well perfused.

HOSPITAL COURSE:  The patient was admitted to the medical
service.  Her laboratory values on admission were consistent
with a white count of 15.9, hematocrit of 31.6, and platelet
count of 218.  Her chemistries were within normal limits.
However, bicarb was 16 and BUN and creatinine were 21.0.  Her
ALT was 12,595.  Her AST was 11,870.  Her alk phos was 97.
Her bili was 3.7.  Her amylase and lipase were also elevated.
She was admitted to the [**Hospital Ward Name 332**] ICU.

The hepatology service was consulted and the patient was
transferred to the [**Hospital Ward Name 517**] to the surgical ICU to the
transplant service.  The patient was resuscitated and given
IV Mucomyst both in the [**Hospital3 **] ER as well as continued
with an IV drip through her hospital course until [**2200-5-14**].  The patient's LFTs continue to rise to a transaminase
in the 13,000 range and a INR of 6.9.  This was treated with
10 mg of subcutaneous vitamin K and it began dropping.  Over
the next couple of days, her encephalopathy improved and the
patient was seen by psychiatry and social work.  After
complete work up for transplant was done, it was felt all the
patient's LFTs were improving and that she would likely be
able to avoid a transplant.  Over the next couple of days,
her LFTs improved and she was transferred to the floor.  Her
diet was slowly advanced.

After transfer to the floor, her diet was advanced to regular
diet.  Her LFTs continued to drop.  Her bilirubin was noted
to be rising, all her LFTs were normalizing which was
consistent with liver injury.  On the day of discharge, her
bilirubin began dropping which again was consistent with the
previous injury to the liver.  Her Tylenol levels continued
to drop slowly throughout the course of her hospital stay and
were undetectable by hospital day 3.  Her Mucomyst was
stopped as stated previously on [**2200-5-14**].  Psychiatry
evaluated the patient again on [**2199-5-14**] and felt that a
transfer to a psychiatric facility would be needed.
Therefore, evaluation was done by psychiatric case management
and was found to be sufficient.  Patient was transferred to
the psychiatric facility on [**2200-5-15**] tolerating her
regular diet.  Her Mucomyst had been stopped and her LFTs
were normal.  The patient was discharged in stable condition.
She was having some mild vaginal discharge and was given
topical creams for that.  Physical therapy saw the patient
and felt there was no need for further following from a
physical therapy standpoint.  The patient was discharged on
[**2200-5-15**] with the stated medications.  The patient was
instructed to follow up with her primary care physician and
continue having LFTs checked routinely for the next couple of
days until LFTs return to normal and then also to follow up
with her primary care physician [**Last Name (NamePattern4) **] 2 weeks' time for repeat
LFT check.  The patient has also been told that she will need
close psychiatric follow up and counseling for this suicide
attempt.  The patient was discharged in stable condition.



                        [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) **], [**MD Number(1) 3432**]

Dictated By:[**Doctor Last Name 11225**]
MEDQUIST36
D:  [**2200-5-15**] 13:52:04
T:  [**2200-5-15**] 17:46:00
Job#:  [**Job Number 67356**]


Admission Date:  [**2200-5-11**]              Discharge Date:   [**2200-5-15**]

Date of Birth:  [**2180-7-30**]             Sex:   F

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 668**]
Chief Complaint:
tylenol OD

Major Surgical or Invasive Procedure:
none


History of Present Illness:
19 Yr F. took 50 extra strength tylenols (25gm) on [**5-8**] night
(attempted suicide - b/c was "sad"
told her family about it but apparently did not come to the
hospital. Started vomiting [**5-8**]. Eventually presented to OSH
[**5-10**]. Tylenol level 48 hrs post ingestion was 27. INR 4.9. Given
11gms of NAC IV. transferred to [**Hospital1 **]-[**5-10**] night. INR 6.9,
transaminases [**Numeric Identifier 890**]. PH 7.38(post fluids)


Past Medical History:
prior suicide attempt several years ago with ibuprofen od,
asthma

Social History:
hairdresser, lives w/ mother in [**Name (NI) **]. Occasional etoh, no
ivda, smokes cigarettes, occasional [**Doctor Last Name 63683**]

Family History:
depression

Physical Exam:
gen: wdwn young female, lethargic but arousable, comfortable in
bed
heent: anicteric sclera, jaundiced mucous membranes, mmm
cv: s1, s2 tachy but regular w/ no mrg appreciated
pulm: cta anteriorly
abd: naval piercing, hypoactive bs, soft, mild tender in ruq, no
rebound
extr: no edema
neuro: ?1-2 beat asterixis, no clonus


Pertinent Results:
[**2200-5-11**] 12:50AM BLOOD WBC-15.8* RBC-4.31* Hgb-13.0* Hct-36.1*
MCV-84 MCH-30.3 MCHC-36.1* RDW-12.9 Plt Ct-236
[**2200-5-11**] 02:54PM BLOOD WBC-10.9 RBC-4.06* Hgb-11.9* Hct-33.2*
MCV-82 MCH-29.3 MCHC-35.9* RDW-13.2 Plt Ct-215
[**2200-5-14**] 05:47AM BLOOD WBC-8.8 RBC-3.93* Hgb-11.7* Hct-32.9*
MCV-84 MCH-29.9 MCHC-35.7* RDW-13.8 Plt Ct-237
[**2200-5-11**] 12:50AM BLOOD Neuts-94.6* Lymphs-2.9* Monos-2.5 Eos-0
Baso-0
[**2200-5-11**] 12:50AM BLOOD PT-56.8* PTT-45.2* INR(PT)-6.9*
[**2200-5-11**] 06:37PM BLOOD PT-40.7* PTT-34.5 INR(PT)-4.6*
[**2200-5-12**] 09:50AM BLOOD PT-33.6* PTT-31.0 INR(PT)-3.6*
[**2200-5-14**] 05:47AM BLOOD PT-17.9* PTT-26.3 INR(PT)-1.7*
[**2200-5-11**] 06:37PM BLOOD Fibrino-134*
[**2200-5-14**] 05:47AM BLOOD Fibrino-152
[**2200-5-11**] 12:50AM BLOOD Glucose-108* UreaN-20 Creat-1.0 Na-139
K-4.5 Cl-104 HCO3-16* AnGap-24
[**2200-5-11**] 02:54PM BLOOD Glucose-130* UreaN-14 Creat-0.9 Na-141
K-3.6 Cl-109* HCO3-23 AnGap-13
[**2200-5-12**] 09:50AM BLOOD Glucose-97 UreaN-9 Creat-0.6 Na-142
K-3.2* Cl-110* HCO3-24 AnGap-11
[**2200-5-14**] 05:47AM BLOOD Glucose-92 UreaN-7 Creat-0.5 Na-139
K-3.1* Cl-106 HCO3-25 AnGap-11
[**2200-5-11**] 12:50AM BLOOD ALT-[**Numeric Identifier **]* AST-[**Numeric Identifier **]* AlkPhos-97
Amylase-192* TotBili-3.7*
[**2200-5-11**] 02:54PM BLOOD ALT-9903* AST-6678* AlkPhos-98
TotBili-3.3*
[**2200-5-12**] 09:50AM BLOOD ALT-6480* AST-2481* LD(LDH)-394*
AlkPhos-93 Amylase-75 TotBili-3.4*
[**2200-5-14**] 05:47AM BLOOD ALT-2536* AST-291* AlkPhos-80 Amylase-75
TotBili-6.0*
[**2200-5-11**] 12:50AM BLOOD Lipase-430*
[**2200-5-11**] 09:24PM BLOOD Lipase-126*
[**2200-5-14**] 05:47AM BLOOD Lipase-72*
[**2200-5-11**] 12:50AM BLOOD Albumin-3.9 Calcium-7.9* Phos-2.5*
Mg-2.5*
[**2200-5-11**] 06:37PM BLOOD Albumin-3.5 Calcium-8.7 Phos-1.4* Mg-2.2
[**2200-5-14**] 05:47AM BLOOD Albumin-2.5* Calcium-7.8* Phos-1.6*
Mg-1.7
[**2200-5-11**] 12:50AM BLOOD Acetone-NEGATIVE
[**2200-5-11**] 01:05PM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE
HBcAb-NEGATIVE HAV Ab-NEGATIVE IgM HBc-NEGATIVE IgM HAV-NEGATIVE
[**2200-5-11**] 01:06PM BLOOD HIV Ab-NEGATIVE
[**2200-5-11**] 12:50AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-24.8
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2200-5-11**] 06:37PM BLOOD Acetmnp-8.9
[**2200-5-12**] 02:18AM BLOOD Acetmnp-NEG
[**2200-5-11**] 01:05PM BLOOD HERPES SIMPLEX (HSV) 1, IGG-Test
[**2200-5-11**] 12:50AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.023
[**2200-5-11**] 12:50AM URINE Blood-LGE Nitrite-NEG Protein-100
Glucose-NEG Ketone-150 Bilirub-NEG Urobiln-4* pH-6.5 Leuks-NEG
[**2200-5-11**] 12:50AM URINE RBC-21-50* WBC-0 Bacteri-MOD Yeast-NONE
Epi-[**2-23**]
[**2200-5-11**] 12:50AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG

RADIOLOGY  Final Report

CTA ABD W&W/O C & RECONS  [**2200-5-11**] 5:24 PM

CTA ABD W&W/O C & RECONS; CT PELVIS W/CONTRAST

Reason: need volume studies and 3-D reconstruction with vessels
for
Field of view: 36 Contrast: OPTIRAY

[**Hospital 93**] MEDICAL CONDITION:
19 year old woman with tylenol overdose - now pre-transplant
REASON FOR THIS EXAMINATION:
need volume studies and 3-D reconstruction with vessels for
planning for transplant surgery
CONTRAINDICATIONS for IV CONTRAST: None.

CTA OF LIVER

INDICATION: Patient with acute liver decompensation secondary to
partially small overdose. For evaluation of loco-regional
anatomy.

TECHNIQUE: Axial multidetector CT acquisitions of the abdomen
and pelvis were acquired before, during, and after the
administration of intravenous contrast.

CONTRAST: Non-ionic contrast was used due to the large injection
rate necessary.

COMPARISON: None.

MULTIPLANAR REFORMATS:

The images were exported to an offline workstation for
interactive interrogation and analysis. Generated images were
invaluable to evaluate the surgical arterial and venous anatomy.

REPORT:

CT LUNG BASES:

There is bibasilar atelectasis with small effusions identified.

CT OF ABDOMEN AND PELVIS:

The liver appears hyperdense throughout consistent with a
nonspecific metabolic insult. In the arterial phase imaging,
there is a vague peripheral rim of hyperenhancement rounding the
inferomedial aspect of segment IVb and to a lesser extent
segment III. This is perfusional in nature. No intrahepatic
lesions identified.

The gallbladder appears normal and there is no evidence of
gallstones. Small amount of fluid is identified surrounding the
gallbladder fossa and there is also a trace of perihepatic
ascites as well as some free fluid in the pelvis. This may
reflect underlying hepatic decompensation. No intra- or extra-
hepatic biliary dilatation is seen. Normal pancreas. A splenule
is identified in the distal pancreas. Spleen is normal. A
further splenule is identified adjacent to the superior aspect
of the left kidney. Both kidneys appear normal in size, shape,
and attenuation and show good uptake and excretion of contrast.
Both adrenals are normal.

CT OF PELVIS:

There is some free fluid identified within the pelvis as
described. The ureters appear normal. Normal bladder. Normal
uterus.

CT BONES:

No suspicious lytic or sclerotic lesion is identified.

CT ANGIOGRAPHY:

There is conventional arterial anatomy, with both left and right
hepatic arteries being coming off the proper hepatic artery
without evidence of accessory supply. Similarly, there is
conventional portal venous anatomy and conventional hepatic
venous anatomy. No vascular variant is seen.

CONCLUSION

Hypodense liver lesion which is non-specific.

Normal Vascular Anatomy


Brief Hospital Course:
Patient was admitted to the MICU, acetylcysteine continued, 1x1
sitter employed, lytes and labs monitored Q4hr, social work
aboard. hepatology consulted - serologies and titers were sent.
transplant [**Doctor First Name **] consulted and transferred to the SICU, pre-tx
w/u initiated. CT ab did not show pancreatitis. Patient was
initially kept NPO. Pscyh was consulted, stated needed psych
hospitalization once patient is medically cleared and is not
getting transplanted.  Once it was foudn out that the patient
wound not be eligible for a transplant due to multiple suicide
attempts, clears were started late on HD2 and then advanced to
regular diet on HD3. mucomyst was continued until HD4 at which
point it was stopped. Labs were trended for 4 days, and as per
results section of this report, all values demonstrate a
downward progression towards normal levels. On HD5 patient is
medically and clinically stable for transfer to a psych
unit/facility. She had been on the floor for 2 1/2 days,
tolerating regular diet and ambulating. Laboratory values are
reaching normal levels and she is at no risk for bleeding or any
other acute complications.

Medications on Admission:
 OCP, Albuterol IH PRN

Discharge Medications:
1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
2. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
3. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1)
Tablet, Chewable PO QID (4 times a day) as needed.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
tylenol OD


Discharge Condition:
good


Completed by:[**2200-5-15**]
{'Poisoning by aromatic analgesics, not elsewhere classified,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Hepatitis, unspecified,Borderline personality disorder'}


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: tylenol OD

PRESENT ILLNESS: 19 Yr F. took 50 extra strength tylenols (25gm) on [**5-8**] night
(attempted suicide - b/c was "sad"
told her family about it but apparently did not come to the
hospital. Started vomiting [**5-8**]. Eventually presented to OSH
[**5-10**]. Tylenol level 48 hrs post ingestion was 27. INR 4.9. Given
11gms of NAC IV. transferred to [**Hospital1 **]-[**5-10**] night. INR 6.9,
transaminases [**Numeric Identifier 890**]. PH 7.38(post fluids)

MEDICAL HISTORY: Her past medical history is
significant for the suicide attempt and asthma.  She has no
known drug allergies and takes oral contraceptives and
albuterol medication.

MEDICATION ON ADMISSION: OCP, Albuterol IH PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: gen: wdwn young female, lethargic but arousable, comfortable in
bed
heent: anicteric sclera, jaundiced mucous membranes, mmm
cv: s1, s2 tachy but regular w/ no mrg appreciated
pulm: cta anteriorly
abd: naval piercing, hypoactive bs, soft, mild tender in ruq, no
rebound
extr: no edema
neuro: ?1-2 beat asterixis, no clonus

FAMILY HISTORY: depression

SOCIAL HISTORY: hairdresser, lives w/ mother in [**Name (NI) **]. Occasional etoh, no
ivda, smokes cigarettes, occasional [**Doctor Last Name 63683**] 

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