CHIEF COMPLAINT: etoh withdrawl

PRESENT ILLNESS: 52 yo M with a history of EtOH abuse presented to ED after a
fall onto face day prior to admission. He notes that he had been
clean and sober for 17 months, though "fell off the wagon" and
went into a 3 week drinking "bender". He sat at home on couch
for two days straight with only minimal movement, noting that he
soiled himself to avoid having to get up. He finally did arise
from the couch the evening prior to admission and fell forward
into his TV stand, hitting his left brow and ear. He notes that
his last drink of EtOH was on the evening prior to presentation.

MEDICAL HISTORY: # Alcohol abuse: Binges, no hx of DTs or seizures
# Depression
# R wrist fracture ([**7-/2196**])
# Acute pancreatitis s/p drinking binge
# Hemorrhoids

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam On Admission:
VS: T afebrile, BP 123/88, P 65, R 18, 98% on RA
GEN: NAD
HEENT: PERRL, oral mucosa slightly dry, oropharynx benign,
multiple facial abrasions and large left brow laceration with
sutures, ecchymotic and tender left ear
NECK: Supple
PULM: CTAB
CARD: RR, nl S1, nl S2, no M/R/G
ABD: BS+, soft, NT, ND
EXT: no C/C/E
Skin: shallow sacral ulcerations covered with a dry dressing
NEURO: Oriented x 3, slight resting tremor that attenuates with
distraction, tounge wag present

FAMILY HISTORY: # M a: Dementia
# F: Prostate CA
# Siblings (1 brother, 1 sister): No known illnesses

SOCIAL HISTORY: # Personal: Lives alone, recently divorced
# Professional: Real estate developer for [**Hospital3 **]
communities
# Alcohol: Began drinking in college on weekends. Moderate
social drinking after college. Binge-drinking began in
mid-[**2179**], during a period of high work stress. Longest period
of sobriety lasted 18 months; longest binge lasted three weeks.
Pt had Alcoholics Anonymous sponsor, and had undergone
"self-detox" previously by himself, as well as inpatient alcohol
rehabilitation.
# Tobacco: Social smoking, quit in ~[**2186**].
# Recreational drugs: Experimental marijuana in youth.
Alcohol withdrawal delirium,Hyposmolality and/or hyponatremia,Pressure ulcer, buttock,Thrombocytopenia, unspecified,Open wound of forehead, without mention of complication,Fall from other slipping, tripping, or stumbling,Other and unspecified alcohol dependence, continuous,Depressive disorder, not elsewhere classified
Delirium tremens,Hyposmolality,Pressure ulcer, buttock,Thrombocytopenia NOS,Open wound of forehead,Fall from slipping NEC,Alcoh dep NEC/NOS-contin,Depressive disorder NEC
Admission Date:  [**2199-6-27**]              Discharge Date:   [**2199-7-2**]

Date of Birth:  [**2147-3-9**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1990**]
Chief Complaint:
etoh withdrawl

Major Surgical or Invasive Procedure:
sutures in ED


History of Present Illness:
52 yo M with a history of EtOH abuse presented to ED after a
fall onto face day prior to admission. He notes that he had been
clean and sober for 17 months, though "fell off the wagon" and
went into a 3 week drinking "bender". He sat at home on couch
for two days straight with only minimal movement, noting that he
soiled himself to avoid having to get up. He finally did arise
from the couch the evening prior to admission and fell forward
into his TV stand, hitting his left brow and ear. He notes that
his last drink of EtOH was on the evening prior to presentation.

.


Past Medical History:
# Alcohol abuse: Binges, no hx of DTs or seizures
# Depression
# R wrist fracture ([**7-/2196**])
# Acute pancreatitis s/p drinking binge
# Hemorrhoids

Social History:
# Personal: Lives alone, recently divorced
# Professional: Real estate developer for [**Hospital3 **]
communities
# Alcohol: Began drinking in college on weekends. Moderate
social drinking after college. Binge-drinking began in
mid-[**2179**], during a period of high work stress. Longest period
of sobriety lasted 18 months; longest binge lasted three weeks.
Pt had Alcoholics Anonymous sponsor, and had undergone
"self-detox" previously by himself, as well as inpatient alcohol
rehabilitation.
# Tobacco: Social smoking, quit in ~[**2186**].
# Recreational drugs: Experimental marijuana in youth.


Family History:
# M a: Dementia
# F: Prostate CA
# Siblings (1 brother, 1 sister): No known illnesses

Physical Exam:
Physical Exam On Admission:
VS: T afebrile, BP 123/88, P 65, R 18, 98% on RA
GEN: NAD
HEENT: PERRL, oral mucosa slightly dry, oropharynx benign,
multiple facial abrasions and large left brow laceration with
sutures, ecchymotic and tender left ear
NECK: Supple
PULM: CTAB
CARD: RR, nl S1, nl S2, no M/R/G
ABD: BS+, soft, NT, ND
EXT: no C/C/E
Skin: shallow sacral ulcerations covered with a dry dressing
NEURO: Oriented x 3, slight resting tremor that attenuates with
distraction, tounge wag present

Pertinent Results:
Labs on Discharge:
CBC WBC-4.4 RBC-3.13* Hgb-10.2* Hct-31.4* MCV-101* MCH-32.7*
MCHC-32.6 RDW-14.3 Plt Ct-281
Coags: BLOOD PT-11.6 PTT-28.8 INR(PT)-1.0
Panel 10 Glucose-103* UreaN-12 Creat-0.7 Na-139 K-4.2 Cl-104
HCO3-25 AnGap-14  Calcium-9.0 Phos-4.6* Mg-2.0

[**2199-6-27**] BLOOD ALT-88* AST-146* CK(CPK)-475* AlkPhos-77
TotBili-1.1
[**2199-6-29**]  BLOOD ALT-87* AST-136* CK(CPK)-148 AlkPhos-83
TotBili-0.7
[**2199-6-30**]  BLOOD ALT-84* AST-103* AlkPhos-82 TotBili-0.4

[**2199-6-27**]  BLOOD calTIBC-204* VitB12-1475* Folate-GREATER TH
Ferritn-611* TRF-157*

Brief Hospital Course:
Pt is 52yo male with hx of alcohol abuse, but sober for 17
months, who went on a 3-week binge.  He was brought into the
hospital for head trauma after fall (no acute intracranial or
cervical process), and was subsequently found to have Stage 1
pressure ulcer in buttocks region.  Pt was started on Valium
overnight, and received a total (inc standing orders and PRN
CIWA>10) of 120mg.  Pt was given thiamine, folate, multivitamin,
and SW consult.  Iron panel was also checked, and revealed
Ferritin 611, Fe 46, TIBC 204.  B12 and folate wnl.  Pt was
transferred to floor when valium needs decreased.  Dry dressings
and frequent positional changes for buttock ulcer. He received a
total of 160+mg of Valium during his hospital stay. At the time
of discharge he was not tremulous or anxious, was able to
ambulate well and his ulcer on his buttock region was healing
well.

Medications on Admission:
None

Discharge Medications:
1. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
4. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl Topical
[**Hospital1 **] (2 times a day).
5. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day) as needed for pain.
6. Miconazole Nitrate 2 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2
times a day) as needed for sacral decubitus wound.
Disp:*1 tube* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Laceration to head
Pressure wounds
ETOH withdrawl


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


Discharge Instructions:
You were admitted for withdrawing for alcohol.  It was from
drinking too much the last few weeks.  You also had sores on
your bottom from sitting in one place too long.  You should stop
drinking and seek help as social work has directed.  You have
been to treatment programs before and should start going back
again.

As for your wounds, we recommend an antifungal cream for a short
period of time while it heals.  If it gets worse, you have
fevers or chills, or other concerns about it, you should seek
medical treatment because you're at a higher risk of infection.

And as for your stitches, you should see a doctor in our
[**Hospital 1944**] clinic to have them removed as outlined below.

Please take a multivitamin, thiamine and folate supplements
after leaving.

Please DO NOT drive for at least 48 hours.

Followup Instructions:
To remove your stitches please go to the following appointment:

Department: [**Hospital3 249**]
When: WEDNESDAY [**2199-7-10**] at 8:30 AM
With: [**Company 191**] POST [**Hospital 894**] CLINIC [**Telephone/Fax (1) 250**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Please schedule an appointment to follow up with your PCP in the
next week.
{'Alcohol withdrawal delirium,Hyposmolality and/or hyponatremia,Pressure ulcer, buttock,Thrombocytopenia, unspecified,Open wound of forehead, without mention of complication,Fall from other slipping, tripping, or stumbling,Other and unspecified alcohol dependence, continuous,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: etoh withdrawl

PRESENT ILLNESS: 52 yo M with a history of EtOH abuse presented to ED after a
fall onto face day prior to admission. He notes that he had been
clean and sober for 17 months, though "fell off the wagon" and
went into a 3 week drinking "bender". He sat at home on couch
for two days straight with only minimal movement, noting that he
soiled himself to avoid having to get up. He finally did arise
from the couch the evening prior to admission and fell forward
into his TV stand, hitting his left brow and ear. He notes that
his last drink of EtOH was on the evening prior to presentation.

MEDICAL HISTORY: # Alcohol abuse: Binges, no hx of DTs or seizures
# Depression
# R wrist fracture ([**7-/2196**])
# Acute pancreatitis s/p drinking binge
# Hemorrhoids

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam On Admission:
VS: T afebrile, BP 123/88, P 65, R 18, 98% on RA
GEN: NAD
HEENT: PERRL, oral mucosa slightly dry, oropharynx benign,
multiple facial abrasions and large left brow laceration with
sutures, ecchymotic and tender left ear
NECK: Supple
PULM: CTAB
CARD: RR, nl S1, nl S2, no M/R/G
ABD: BS+, soft, NT, ND
EXT: no C/C/E
Skin: shallow sacral ulcerations covered with a dry dressing
NEURO: Oriented x 3, slight resting tremor that attenuates with
distraction, tounge wag present

FAMILY HISTORY: # M a: Dementia
# F: Prostate CA
# Siblings (1 brother, 1 sister): No known illnesses

SOCIAL HISTORY: # Personal: Lives alone, recently divorced
# Professional: Real estate developer for [**Hospital3 **]
communities
# Alcohol: Began drinking in college on weekends. Moderate
social drinking after college. Binge-drinking began in
mid-[**2179**], during a period of high work stress. Longest period
of sobriety lasted 18 months; longest binge lasted three weeks.
Pt had Alcoholics Anonymous sponsor, and had undergone
"self-detox" previously by himself, as well as inpatient alcohol
rehabilitation.
# Tobacco: Social smoking, quit in ~[**2186**].
# Recreational drugs: Experimental marijuana in youth. 

### Response:
{'Alcohol withdrawal delirium,Hyposmolality and/or hyponatremia,Pressure ulcer, buttock,Thrombocytopenia, unspecified,Open wound of forehead, without mention of complication,Fall from other slipping, tripping, or stumbling,Other and unspecified alcohol dependence, continuous,Depressive disorder, not elsewhere classified'}
