CHIEF COMPLAINT: Tylenol toxicity

PRESENT ILLNESS: 28 y/o female transferred from [**Hospital 792**]hospital for
management of tylenol toxicity. Due to
right lower quadrant abdominal pain she took [**12-17**] Tylenol 325mg
every hour without relief approximately 22 tabs/24hrs on weds.
[**4-25**] after which she was admitted with symptoms of fatigue,
nausea, and vomiting. Initial investigations revealed an
elevated tylenol level and transaminases in the 200's that have
gradually risen to 5000's. In addition, total bilirubin on
admission was 3.0 and had trended to 1.7 at OSH. INR climbed to
a maximum of 2.2 and currently is 1.3. Renal function is normal
as is pH.  Symptomatically, mental status is clear with no
confusion or signs of encephalopathy. She denies having
abdominal, nausea, diarrhea.  She admits to heavy drinking (up
to 6 beers/daily for 5 years now) but stopped in early [**Month (only) 547**].
Does not report intravenous or intransal drug use.  She has
intermittent, nonspecific, right lower quadrant pain for at
least an year now. This hasn't been investigated, and has been
medicating herself with oral NSAIDS and tylenol. The pain
usually last for 2 hrs, is mild in
severity, and is without any particular exacerbating factors. It
occurs once a month and she denies any vaginal discharge,
hemturia, heamtochezia, melena, weight loss, nausea, vomiting in
the past. The pain was worse early this week, which prompted her
to takeincreasing doses of tylenol (up to 2 pills every 1 hr for
a day).She denies suicidal ideation.
.
She was admitted to the transplant service and currently her
LFT's, INR and t. bili are down trending. Liver has seen the
patient and are following.  She remains asymptomatic with no
signs of encephalopathy or confusion. She denies abdominal pain,
nausea, vomiting, fevers/chills.
.
She denies anxiety or depression.

MEDICAL HISTORY: Abdominal pain- for 1 year of unknown etiology
C section delivery approx. 6 years ago.

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Discharge
Physical Exam:
VS: 97.1 91/50 62 18 100% RA
GEN: AOx3, female NAD, oriented X3
HEENT:  PERRLA. MMM. no LAD. no JVD. neck supple. No cervical,
supraclavicular, or axillary LAD
Cards: RR S1/S2 normal. no murmurs/gallops/rubs.
Pulm: No dullness to percussion, CTAB no crackles or wheezes
Abd: BS+, soft, NT, no rebound/guarding, no HSM, no [**Doctor Last Name 515**]
sign
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: no rashes or bruising
Neuro: CNs II-XII intact. 5/5 strength in U/L extremities.
Sensation intact to LT, gait WNL. No asterxis

FAMILY HISTORY: Denies any history of liver disease
Unknown whether parents/siblings have Hepatitis B

SOCIAL HISTORY: drinks at least 6 beers daily for past 5 years (reports stopping
drinking in early [**Month (only) 547**]
Nonsmoker
c-section 6 yrs ago
child is with biological father
patient lives with boyfriend
parents live in [**Name (NI) 4565**], and are on vacation in [**Country **]
born in [**Country 5142**], moved in early childhood
Poisoning by aromatic analgesics, not elsewhere classified,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hepatitis, unspecified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Accidents occurring in unspecified place
Pois-arom analgesics NEC,Hpt B chrn wo cm wo dlta,Hepatitis NOS,Acc poison-arom analgesc,Accident in place NOS
Admission Date:  [**2159-4-27**]              Discharge Date:   [**2159-4-30**]

Date of Birth:  [**2130-10-12**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 13256**]
Chief Complaint:
Tylenol toxicity

Major Surgical or Invasive Procedure:
none


History of Present Illness:
28 y/o female transferred from [**Hospital 792**]hospital for
management of tylenol toxicity. Due to
right lower quadrant abdominal pain she took [**12-17**] Tylenol 325mg
every hour without relief approximately 22 tabs/24hrs on weds.
[**4-25**] after which she was admitted with symptoms of fatigue,
nausea, and vomiting. Initial investigations revealed an
elevated tylenol level and transaminases in the 200's that have
gradually risen to 5000's. In addition, total bilirubin on
admission was 3.0 and had trended to 1.7 at OSH. INR climbed to
a maximum of 2.2 and currently is 1.3. Renal function is normal
as is pH.  Symptomatically, mental status is clear with no
confusion or signs of encephalopathy. She denies having
abdominal, nausea, diarrhea.  She admits to heavy drinking (up
to 6 beers/daily for 5 years now) but stopped in early [**Month (only) 547**].
Does not report intravenous or intransal drug use.  She has
intermittent, nonspecific, right lower quadrant pain for at
least an year now. This hasn't been investigated, and has been
medicating herself with oral NSAIDS and tylenol. The pain
usually last for 2 hrs, is mild in
severity, and is without any particular exacerbating factors. It
occurs once a month and she denies any vaginal discharge,
hemturia, heamtochezia, melena, weight loss, nausea, vomiting in
the past. The pain was worse early this week, which prompted her
to takeincreasing doses of tylenol (up to 2 pills every 1 hr for
a day).She denies suicidal ideation.
.
She was admitted to the transplant service and currently her
LFT's, INR and t. bili are down trending. Liver has seen the
patient and are following.  She remains asymptomatic with no
signs of encephalopathy or confusion. She denies abdominal pain,
nausea, vomiting, fevers/chills.
.
She denies anxiety or depression.

.
On transfer her vitals are: 97.7 92/60 80 18 100% RA

Review of Systems:
(+) Per HPI
(-) Review of Systems: GEN: No fever, chills, night sweats,
recent weight loss or gain. HEENT: No headache, sinus
tenderness, rhinorrhea or congestion. CV: No chest pain or
tightness, palpitations. PULM: No cough, shortness of breath, or
wheezing. GI: No  diarrhea, constipation or abdominal pain. No
recent change in bowel habits, no hematochezia or melena. GUI:
No dysuria or change in bladder habits. MSK:  No arthritis,
arthralgias, or myalgias. DERM: No rashes or skin breakdown.
NEURO: No numbness/tingling in extremities. PSYCH: No feelings
of depression or anxiety. All other review of systems negative.


Past Medical History:
Abdominal pain- for 1 year of unknown etiology
C section delivery approx. 6 years ago.


Social History:
drinks at least 6 beers daily for past 5 years (reports stopping
drinking in early [**Month (only) 547**]
Nonsmoker
c-section 6 yrs ago
child is with biological father
patient lives with boyfriend
parents live in [**Name (NI) 4565**], and are on vacation in [**Country **]
born in [**Country 5142**], moved in early childhood


Family History:
Denies any history of liver disease
Unknown whether parents/siblings have Hepatitis B


Physical Exam:
Discharge
Physical Exam:
VS: 97.1 91/50 62 18 100% RA
GEN: AOx3, female NAD, oriented X3
HEENT:  PERRLA. MMM. no LAD. no JVD. neck supple. No cervical,
supraclavicular, or axillary LAD
Cards: RR S1/S2 normal. no murmurs/gallops/rubs.
Pulm: No dullness to percussion, CTAB no crackles or wheezes
Abd: BS+, soft, NT, no rebound/guarding, no HSM, no [**Doctor Last Name 515**]
sign
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: no rashes or bruising
Neuro: CNs II-XII intact. 5/5 strength in U/L extremities.
Sensation intact to LT, gait WNL. No asterxis


Pertinent Results:
Admission Labs

[**2159-4-27**] 10:11PM   TYPE-ART PO2-131* PCO2-36 PH-7.46* TOTAL
CO2-26 BASE XS-2
[**2159-4-27**] 10:11PM   GLUCOSE-96 LACTATE-1.0
[**2159-4-27**] 10:11PM   freeCa-1.18
[**2159-4-27**] 08:59PM   GLUCOSE-87 UREA N-4* CREAT-0.4 SODIUM-141
POTASSIUM-4.0 CHLORIDE-105 TOTAL CO2-27 ANION GAP-13
[**2159-4-27**] 08:59PM   estGFR-Using this
[**2159-4-27**] 08:59PM   ALT(SGPT)-5292* AST(SGOT)-2106* LD(LDH)-732*
ALK PHOS-38 AMYLASE-41 TOT BILI-1.2 DIR BILI-0.4* INDIR BIL-0.8
[**2159-4-27**] 08:59PM   GGT-33
[**2159-4-27**] 08:59PM   ALBUMIN-3.9 CALCIUM-8.7 PHOSPHATE-3.0
MAGNESIUM-1.6
[**2159-4-27**] 08:59PM   HBsAg-POSITIVE* HBc Ab-POSITIVE IgM
HBc-NEGATIVE IgM HAV-NEGATIVE
[**2159-4-27**] 08:59PM   HCV Ab-NEGATIVE
[**2159-4-27**] 08:59PM   WBC-5.3 RBC-4.67 HGB-13.0 HCT-39.1 MCV-84
MCH-27.8 MCHC-33.2 RDW-13.4
[**2159-4-27**] 08:59PM   NEUTS-65.5 LYMPHS-24.9 MONOS-3.1 EOS-5.6*
BASOS-0.9
[**2159-4-27**] 08:59PM   PLT COUNT-170
[**2159-4-27**] 08:59PM   PT-17.0* PTT-30.3 INR(PT)-1.5*
[**2159-4-27**] 08:59PM   FIBRINOGE-322
.
Discharge Labs

[**2159-4-30**] 07:20AM BLOOD WBC-3.5* RBC-4.32 Hgb-11.9* Hct-36.2
MCV-84 MCH-27.7 MCHC-33.0 RDW-13.9 Plt Ct-209
[**2159-4-29**] 05:15PM BLOOD WBC-4.0 RBC-4.32 Hgb-12.1 Hct-36.5 MCV-85
MCH-27.9 MCHC-33.1 RDW-13.8 Plt Ct-204
[**2159-4-29**] 03:01AM BLOOD WBC-3.4* RBC-4.21 Hgb-11.9* Hct-35.0*
MCV-83 MCH-28.3 MCHC-34.0 RDW-13.8 Plt Ct-195
[**2159-4-27**] 08:59PM BLOOD Neuts-65.5 Lymphs-24.9 Monos-3.1 Eos-5.6*
Baso-0.9
[**2159-4-30**] 07:20AM BLOOD Plt Ct-209
[**2159-4-30**] 07:20AM BLOOD PT-13.1 PTT-25.0 INR(PT)-1.1
[**2159-4-29**] 05:15PM BLOOD Plt Ct-204
[**2159-4-29**] 05:15PM BLOOD PT-14.4* PTT-25.6 INR(PT)-1.2*
[**2159-4-30**] 07:20AM BLOOD Glucose-83 UreaN-5* Creat-0.6 Na-140
K-4.4 Cl-105 HCO3-29 AnGap-10
[**2159-4-29**] 05:15PM BLOOD Glucose-97 UreaN-4* Creat-0.6 Na-141
K-4.1 Cl-106 HCO3-28 AnGap-11
[**2159-4-29**] 03:01AM BLOOD Glucose-118* UreaN-4* Creat-0.5 Na-140
K-3.5 Cl-107 HCO3-26 AnGap-11
[**2159-4-30**] 07:20AM BLOOD ALT-2474* AST-188* AlkPhos-42 TotBili-0.5
[**2159-4-29**] 05:15PM BLOOD ALT-2891* AST-290* LD(LDH)-169 AlkPhos-40
TotBili-0.6
[**2159-4-29**] 03:01AM BLOOD ALT-3070* AST-437* AlkPhos-34*
TotBili-0.6
[**2159-4-28**] 08:21PM BLOOD ALT-3394* AST-620* AlkPhos-32*
[**2159-4-28**] 11:19AM BLOOD ALT-4040* AST-994* AlkPhos-39 TotBili-0.9
DirBili-0.3 IndBili-0.6
[**2159-4-28**] 03:36AM BLOOD ALT-4653* AST-1455* AlkPhos-37
TotBili-1.2
[**2159-4-30**] 07:20AM BLOOD Albumin-3.8 Calcium-9.5 Phos-5.2*# Mg-1.9
[**2159-4-29**] 05:15PM BLOOD Albumin-4.0 Calcium-9.2 Phos-3.1 Mg-1.9
[**2159-4-29**] 03:01AM BLOOD Albumin-3.8 Calcium-8.5 Phos-3.7 Mg-2.0
[**2159-4-29**] 05:15PM BLOOD TSH-1.4
[**2159-4-27**] 08:59PM BLOOD HBsAg-POSITIVE* HBcAb-POSITIVE IgM
HBc-NEGATIVE IgM HAV-NEGATIVE
[**2159-4-29**] 05:15PM BLOOD Acetmnp-NEG
[**2159-4-28**] 11:19AM BLOOD EDTA Ho-HOLD
[**2159-4-27**] 10:11PM BLOOD Type-ART pO2-131* pCO2-36 pH-7.46*
calTCO2-26 Base XS-2
[**2159-4-27**] 10:11PM BLOOD Glucose-96 Lactate-1.0
[**2159-4-27**] 10:11PM BLOOD freeCa-1.18
[**2159-4-30**] 07:20AM BLOOD HEPATITIS Be ANTIGEN-PND
[**2159-4-27**] 08:59PM BLOOD HERPES SIMPLEX (HSV) 2, IGG-Test Name
[**2159-4-27**] 08:59PM BLOOD HERPES SIMPLEX (HSV) 1, IGG-Test
[**2159-4-27**] 08:59PM BLOOD CERULOPLASMIN-Test
.
Reports
Liver US
IMPRESSION:
1. Echogenic liver compatible with fatty infiltration, however
other forms of ore advanced liver disease such as significant
hepatic fibrosis/cirrhosis cannot be excluded.
2. Doppler assessment of the hepatic vasculature shows patency
and
appropriate directionality of flow.
.


Brief Hospital Course:
28 y/o female admitted for management of Tylenol toxicity with
evidence of acute liver damage  including a elevated INR and
elevated transaminase.
.
#Acute Liver injury: There were no signs of encephalopathy,
renal failure, or metabolic acidosis. She did initially have
significantly elevated transaminase, total bilirubin and INR
which downtrended with 48 hours of IV NAC. After serum Tylenol
levels were undetectable on tests NAC was discontinued.  She has
history of heavy alcohol drinking, but no evidence clinically of
having cirrhosis, though cannot be excluded on abdominal
ultrasound with diffuse fatty infiltration. She was found to be
hepatitis B surface antigen positive which was new per the
patient.She was hepatitis C negative and the following test were
pending at the time of discharge:HIV, CMV IgM/IgG, HSV titer,
EBV panel, rubella,Serum caeruloplasmin and copper and urinary
copper-pending, hepatitis B e antigen/antibody pending.  It was
explained to her the importance of following up with a liver
clinic and informing her family to get tested.
.
---------------
Outpatient follow up
follow up pending labs above especially Hepatitis B e
antigen/antibody considering Hepatitis B surface antigen
positivity.

Medications on Admission:
none

Discharge Medications:
none

Discharge Disposition:
Home

Discharge Diagnosis:
Acute Liver Injury- Tylenol Toxicity
Chronic hepatitis B


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
It was a pleasure to care for you as your doctor.
.
You were brought to the hospital with tylenol poisoning and
liver injury. After several days of treatment and observation
your liver recovered and you were determined stable for
discharge. You were also found to have a chronic hepatitis B.
.
Please do not drink alcohol or take tylenol as they can damage
your liver.
.
Please follow up with the appointments below:

Followup Instructions:
Department: LIVER CENTER
When: MONDAY [**2159-6-4**] at 10:10 AM
With: [**Name6 (MD) 1382**] [**Name8 (MD) 1383**], MD [**Telephone/Fax (1) 2422**]
Building: LM [**Hospital Unit Name **] [**Location (un) 858**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: [**Hospital3 249**]
When: WEDNESDAY [**2159-6-13**] at 3:00 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 18835**] your new physician in [**Name9 (PRE) 191**] and Dr. [**Last Name (STitle) 18835**] works
closely with Dr. [**First Name8 (NamePattern2) 2426**] [**Last Name (NamePattern1) **], [**First Name3 (LF) **] both will be involved in
your care.  For insurance purposes please indicate Dr. [**First Name8 (NamePattern2) 2426**]
[**Last Name (NamePattern1) **] as your Primary Care Physician

Department: OBSTETRICS AND GYNECOLOGY
When: TUESDAY [**2159-6-5**] at 8:30 AM
With: [**First Name8 (NamePattern2) **] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 21122**], MD [**Telephone/Fax (1) 2664**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Poisoning by aromatic analgesics, not elsewhere classified,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hepatitis, unspecified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Accidents occurring in unspecified place'}


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 toxicity

PRESENT ILLNESS: 28 y/o female transferred from [**Hospital 792**]hospital for
management of tylenol toxicity. Due to
right lower quadrant abdominal pain she took [**12-17**] Tylenol 325mg
every hour without relief approximately 22 tabs/24hrs on weds.
[**4-25**] after which she was admitted with symptoms of fatigue,
nausea, and vomiting. Initial investigations revealed an
elevated tylenol level and transaminases in the 200's that have
gradually risen to 5000's. In addition, total bilirubin on
admission was 3.0 and had trended to 1.7 at OSH. INR climbed to
a maximum of 2.2 and currently is 1.3. Renal function is normal
as is pH.  Symptomatically, mental status is clear with no
confusion or signs of encephalopathy. She denies having
abdominal, nausea, diarrhea.  She admits to heavy drinking (up
to 6 beers/daily for 5 years now) but stopped in early [**Month (only) 547**].
Does not report intravenous or intransal drug use.  She has
intermittent, nonspecific, right lower quadrant pain for at
least an year now. This hasn't been investigated, and has been
medicating herself with oral NSAIDS and tylenol. The pain
usually last for 2 hrs, is mild in
severity, and is without any particular exacerbating factors. It
occurs once a month and she denies any vaginal discharge,
hemturia, heamtochezia, melena, weight loss, nausea, vomiting in
the past. The pain was worse early this week, which prompted her
to takeincreasing doses of tylenol (up to 2 pills every 1 hr for
a day).She denies suicidal ideation.
.
She was admitted to the transplant service and currently her
LFT's, INR and t. bili are down trending. Liver has seen the
patient and are following.  She remains asymptomatic with no
signs of encephalopathy or confusion. She denies abdominal pain,
nausea, vomiting, fevers/chills.
.
She denies anxiety or depression.

MEDICAL HISTORY: Abdominal pain- for 1 year of unknown etiology
C section delivery approx. 6 years ago.

MEDICATION ON ADMISSION: none

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Discharge
Physical Exam:
VS: 97.1 91/50 62 18 100% RA
GEN: AOx3, female NAD, oriented X3
HEENT:  PERRLA. MMM. no LAD. no JVD. neck supple. No cervical,
supraclavicular, or axillary LAD
Cards: RR S1/S2 normal. no murmurs/gallops/rubs.
Pulm: No dullness to percussion, CTAB no crackles or wheezes
Abd: BS+, soft, NT, no rebound/guarding, no HSM, no [**Doctor Last Name 515**]
sign
Extremities: wwp, no edema. DPs, PTs 2+.
Skin: no rashes or bruising
Neuro: CNs II-XII intact. 5/5 strength in U/L extremities.
Sensation intact to LT, gait WNL. No asterxis

FAMILY HISTORY: Denies any history of liver disease
Unknown whether parents/siblings have Hepatitis B

SOCIAL HISTORY: drinks at least 6 beers daily for past 5 years (reports stopping
drinking in early [**Month (only) 547**]
Nonsmoker
c-section 6 yrs ago
child is with biological father
patient lives with boyfriend
parents live in [**Name (NI) 4565**], and are on vacation in [**Country **]
born in [**Country 5142**], moved in early childhood 

### Response:
{'Poisoning by aromatic analgesics, not elsewhere classified,Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta,Hepatitis, unspecified,Accidental poisoning by aromatic analgesics, not elsewhere classified,Accidents occurring in unspecified place'}
