CHIEF COMPLAINT: Pt transfered to MICU after drug overdose.

PRESENT ILLNESS: 42 y/o male w/ hx of depression, recently diagnosed c HIV.Pt was
found  down today  at noon by family who called EMS. +AMS. Per
report took ~25 100mg Elavil tablets.  After talking to pt he
admits takling " a whole bottle of " Elavil and Percocet and has
been using crystal methadone over the last 2 days.

MEDICAL HISTORY: Depression
HIV + recently diagnosed
MRSA Pneumonia d/ced 2 weeks ago
S/P lumbar spine fusion
Chronic back pain

MEDICATION ON ADMISSION: Elavil 200 qd
Klonopin 0.5 tid
Seroquel 200 qd
Dufloxetine
Percocet
Fentanyl patch 75 mcg/h x 3 d

ALLERGIES: Ciprofloxacin Hcl

PHYSICAL EXAM: T 98.5 BP 160/80 HR 75 SpO2 95 % on RA

FAMILY HISTORY: unknown

SOCIAL HISTORY: Denies EtOH or tobacco.
Unemployed.
Poisoning by aromatic analgesics, not elsewhere classified,Cellulitis and abscess of face,Acute respiratory failure,Acidosis,Rhabdomyolysis,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified,Asymptomatic human immunodeficiency virus [HIV] infection status,Bipolar I disorder, most recent episode (or current) unspecified
Pois-arom analgesics NEC,Cellulitis of face,Acute respiratry failure,Acidosis,Rhabdomyolysis,Poison-analgesics,Depressive disorder NEC,Asymp hiv infectn status,Bipolor I current NOS
Admission Date:  [**2129-2-7**]              Discharge Date:   [**2129-2-24**]

Date of Birth:  [**2087-1-19**]             Sex:   M

Service: MEDICINE

Allergies:
Ciprofloxacin Hcl

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
Pt transfered to MICU after drug overdose.

Major Surgical or Invasive Procedure:
Left forearm and bilateral hand fasciotomies with closure.


History of Present Illness:
42 y/o male w/ hx of depression, recently diagnosed c HIV.Pt was
found  down today  at noon by family who called EMS. +AMS. Per
report took ~25 100mg Elavil tablets.  After talking to pt he
admits takling " a whole bottle of " Elavil and Percocet and has
been using crystal methadone over the last 2 days.

In [**Name (NI) **] pt was somnolent but responsive. HR 100-110, BP 160/100's,
Serum tox positive for amp, tylenol (tylenol levels of 175) and
tcas.  Given 2grams of charcoal PO and bicarb drip with 3 amps
NaHco3 in D5w. ecg QRS ~100sec.He was started on Mucomyst drip.
Xrays of LUE neg for fracture.

Past Medical History:
Depression
HIV + recently diagnosed
MRSA Pneumonia d/ced 2 weeks ago
S/P lumbar spine fusion
Chronic back pain

Social History:
Denies EtOH or tobacco.
Unemployed.

Family History:
unknown

Physical Exam:
T 98.5 BP 160/80 HR 75 SpO2 95 % on RA

Gen:nad,  somnolent
HEENT:noorla lesions. L maxillary area c  edematous and
erythematous , c isolated blisters and excoriations
Neck: cerviacal  collar
CHEST: cta bl, L side of chest  indurated  and erythematous
over L pectoral area
CVR:RRR no m/g/r
ABDOMEN:nt, nd, no signs of abdominal trauma.
EXT: L forearm  edematous and  tender to palpation.Pt has pain
upon passive and active ROM of fingers . Wrist c severely
decreased ROM.
Neuro:AO x 3
.


Pertinent Results:
..... 88
15.1>---<245
.....40.9
 N:82.1 L:14.3 M:3.3 E:0.3 Bas:0.1

.
143 | 107 | 18 .............AGap=11
----------------<203
4.2 | 25  | 1.3
CK: [**Numeric Identifier 8794**]  MB: 148  MBI: 1.0
Ca: 8.0 Mg: 2.1 P: 4.9 D
PT: 12.9  PTT: 21.5  INR: 1.1
.
ALT: 59 AP: 104 Tbili: 0.4 Alb: 4.2
AST: 136 LDH:  Dbili:  TProt:
[**Doctor First Name **]: 143 Lip:
.
Serum TOX:
Serum Acetmnphn 151.6  - Serum Tricyc Pos
Serum ASA, EtOH, [**Last Name (LF) 2238**], [**First Name3 (LF) **] Negative
.
Urine Tox:
.
Urine Benzos Pos
Urine Amphet Pos
Urine Barbs, Opiates, Cocaine, Mthdne Negative
.
U/A - o bact, 0-2 wbc, nl LE, nl Nitr.

Brief Hospital Course:
A&P:  42 yo man c history of depression admitted after being
found down after drug overdose (Tylenol, TCA and amphetamines)
noted to have compartment syndrome left arm and taken to OR for
decompression.
.
# Toxicology (tylenol and anticholinergic overdose): On
admission, the patient had elevated Tylenol levels with elevated
ALT/AST but INR and Tbili normal.  He also had elevated CKs.  He
was tachycardic and had EKG changes concerning for possible
prolonged qtc.  He was given charcoal and started on NaHCO3 and
Mucomyst in ED.  He was maintained on IVF and N-Acetylcysteine
in the ICU.  Daily ECGs were done and showed resolution of ECG
changes on day 2. His LFTs also trended down and had largely
resolved by his transfer from the ICU. Once on the floor he was
medically stable from the standpoint of his overdose.
.
# Compartment syndrome - On initial exam in the MICU, pt noted
to have swelling and decreased pulses in L Arm. An emergent
orthopedics consult was obtained. Orthopedics took patient to OR
for fasciotomy for compartment syndrome of l arm and b/l
hands.The patient also underwent bediside hand fasciotomies by
plastics on [**2-8**] and [**2-9**]. He underwent a repeat surgery for
washout and closure of dorsal fasciotomies on [**2-10**]. Volar
fasciotomies were closed on [**2-22**]. Throughout his course in the
hospital the patient underwent a two week course of IV
vancomycin for his wounds. At the time of discharge the
patient's wounds were stable and were being following daily by
orhthopedics. He is to have continued dry sterile dressings
changed by ortho while he is on the psychiatric service.
.
# Rhabdomyolisis - On admission the patient had a urine dipstick
+ for large amount of  blood but with only 2 rbc also increased
CK upto ~30K.  He was given aggressive volume initially. His
creatinine remained stable and CKs trended down.
.
#Respiratory failue/assistance - Patient was intuabed prior to
OR procedure on day of admission and was unable to be extubated
immediately post operative. He was maintained on minimal
ventilatory support and was ultimately successfully extubated on
[**2-10**].
.
#Psych: Due to the patient's active suicidality he was watched
by a 1:1 sitter while in-house. Following extubation he was
placed benzodiazpenes for anxiety and was started on lamictal
for his bipolar disaorder. The patient is to be transferred to
psychiatry for further evaluation following his admission on
medicine.
.
#HIV: currently not on HAART or OI prophylaxis; will f/u with
his outpt ID physician
.
#Prophylaxis: The pt was maintained on a PPI and Heparin sc
throughout admission.
.
#FEN: Once extubated the pt was placed on aregular diet
throughout admission.
.
#Comm-This was through his parents who were involved w/ his
care.


Medications on Admission:
Elavil 200 qd
Klonopin 0.5 tid
Seroquel 200 qd
Dufloxetine
Percocet
Fentanyl patch 75 mcg/h x 3 d

Discharge Medications:
1. Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
2. Fentanyl 75 mcg/hr Patch 72HR Sig: One (1) Patch 72HR
Transdermal Q72H (every 72 hours).
3. Quetiapine 25 mg Tablet Sig: Two (2) Tablet PO BID (2 times a
day).
4. Clonidine 0.1 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QWED (every Wednesday).
5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO TID (3
times a day).
8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed for fever.
10. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
11. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical  QID
(4 times a day) as needed.
12. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
13. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for anxiety.
14. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4
hours) as needed for pain.
15. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).

16. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
[**Hospital1 **] (2 times a day) as needed for itching.
17. Morphine 15 mg Tablet Sig: One (1) Tablet PO Q4-6H (every 4
to 6 hours) as needed for pain.
18. Lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] 4

Discharge Diagnosis:
major depression with suicide attempt
b/l compartment syndrome
HIV


Discharge Condition:
Fair


Discharge Instructions:
Please take all medications as directed.  If you experience
fever (temp>100.5), increased pain, drainage from you wounds, or
any other symptoms of concern to you, please call your doctor.

Followup Instructions:
Please call your PCP: [**Name10 (NameIs) 8795**],[**Name11 (NameIs) **] [**Name Initial (NameIs) **]. [**Telephone/Fax (1) 8796**] for
followup within 1-2 weeks.

Orthopedics: Please call Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 1228**] for a
followup appointment in 2 weeks.


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Poisoning by aromatic analgesics, not elsewhere classified,Cellulitis and abscess of face,Acute respiratory failure,Acidosis,Rhabdomyolysis,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified,Asymptomatic human immunodeficiency virus [HIV] infection status,Bipolar I disorder, most recent episode (or current) unspecified'}


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: Pt transfered to MICU after drug overdose.

PRESENT ILLNESS: 42 y/o male w/ hx of depression, recently diagnosed c HIV.Pt was
found  down today  at noon by family who called EMS. +AMS. Per
report took ~25 100mg Elavil tablets.  After talking to pt he
admits takling " a whole bottle of " Elavil and Percocet and has
been using crystal methadone over the last 2 days.

MEDICAL HISTORY: Depression
HIV + recently diagnosed
MRSA Pneumonia d/ced 2 weeks ago
S/P lumbar spine fusion
Chronic back pain

MEDICATION ON ADMISSION: Elavil 200 qd
Klonopin 0.5 tid
Seroquel 200 qd
Dufloxetine
Percocet
Fentanyl patch 75 mcg/h x 3 d

ALLERGIES: Ciprofloxacin Hcl

PHYSICAL EXAM: T 98.5 BP 160/80 HR 75 SpO2 95 % on RA

FAMILY HISTORY: unknown

SOCIAL HISTORY: Denies EtOH or tobacco.
Unemployed. 

### Response:
{'Poisoning by aromatic analgesics, not elsewhere classified,Cellulitis and abscess of face,Acute respiratory failure,Acidosis,Rhabdomyolysis,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Depressive disorder, not elsewhere classified,Asymptomatic human immunodeficiency virus [HIV] infection status,Bipolar I disorder, most recent episode (or current) unspecified'}
