CHIEF COMPLAINT: Hallucinations, agitation.

PRESENT ILLNESS: This is a 46-year-old male
with a history of alcohol abuse transferred from [**Hospital3 103813**] Detox with agitation, change in mental status.  The
patient was admitted to the outside hospital for alcohol
detox on [**2154-4-24**].  He was placed on an Ativan taper, last
dose 1 mg this morning.  He presented to the MICU agitated,
disoriented with visual hallucinations requiring restraints.
He was given Valium and Haldol for suspected DTs.  He was
admitted to the MICU for frequent benzo dosing.  Further
review of systems is unable to be obtained secondary to
confusion.

MEDICAL HISTORY: 1.  Tobacco abuse.
2.  Hypercholesterolemia.
3.  Report by patient of increased blood sugars and increased
iron levels.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to Darvocet.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is separated.  He works in
construction, has a girlfriend.  Alcohol:  One pint to one
quart of vodka per day.  Tobacco:  Unknown.  Drugs:  Unknown.
Alcohol withdrawal delirium,Pure hypercholesterolemia,Tobacco use disorder,Adjustment disorder with depressed mood,Acute alcoholic hepatitis,Acute alcoholic intoxication in alcoholism, continuous
Delirium tremens,Pure hypercholesterolem,Tobacco use disorder,Adjustmnt dis w depressn,Ac alcoholic hepatitis,Ac alcohol intox-contin
Admission Date:  [**2154-4-27**]       Discharge Date:  [**2154-5-4**]

Date of Birth:   [**2108-4-18**]       Sex:  M

Service:

CHIEF COMPLAINT:  Hallucinations, agitation.

HISTORY OF THE PRESENT ILLNESS:  This is a 46-year-old male
with a history of alcohol abuse transferred from [**Hospital3 103813**] Detox with agitation, change in mental status.  The
patient was admitted to the outside hospital for alcohol
detox on [**2154-4-24**].  He was placed on an Ativan taper, last
dose 1 mg this morning.  He presented to the MICU agitated,
disoriented with visual hallucinations requiring restraints.
He was given Valium and Haldol for suspected DTs.  He was
admitted to the MICU for frequent benzo dosing.  Further
review of systems is unable to be obtained secondary to
confusion.

PAST MEDICAL HISTORY:
1.  Tobacco abuse.
2.  Hypercholesterolemia.
3.  Report by patient of increased blood sugars and increased
iron levels.

ADMISSION MEDICATIONS:
1.  Ativan taper.
2.  Zyprexa.

ALLERGIES:  The patient is allergic to Darvocet.

SOCIAL HISTORY:  The patient is separated.  He works in
construction, has a girlfriend.  Alcohol:  One pint to one
quart of vodka per day.  Tobacco:  Unknown.  Drugs:  Unknown.

FAMILY HISTORY:  Noncontributory.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Afebrile.
Blood pressure 140/90, pulse 80-110.  General:  Agitated and
restrained.  HEENT:  The pupils were equal and reactive.  The
extraocular muscles were intact.  Sclerae were anicteric. OP
clear, dry mucous membranes.  Chest:  Clear bilaterally.
Cardiac:  Tachy, normal S1, S2.  No murmurs.  Abdomen:  Soft,
nontender, normoactive bowel sounds.  Extremities:
Restrained but no pedal edema.  Neurologic:  He was alert and
oriented times one, cranial nerves II through XII were
intact.  Examination was nonfocal.

LABORATORY/RADIOLOGIC DATA:  White blood cell count 7.9, 74
neutrophils, 18 lymphocytes, 6 monos, hematocrit 41.1,
platelets 205,000.  Sodium 136, potassium 3.7, chloride 97,
bicarbonate 25, BUN 7, creatinine 0.8, glucose 84.  The urine
tox was negative.  Serum tox was negative.

EKG revealed a normal sinus rhythm at 90, normal axis, normal
intervals.  QTC was 416, no acute ST or T wave changes.

The chest x-ray showed no infiltrate or effusion.

HOSPITAL COURSE:  The patient was admitted to the MICU for
further management of his DTs.  The patient was evaluated by
Psychiatry who felt that his presentation was classic for
delirium tremens.  The patient was given Haldol and Valium
per CIWA scale.  His Valium maximum was 210 mg per day.  He
was also given multivitamins, thiamine, folate, and IV fluid
hydration.  His Haldol was discontinued secondary to his
prolonged QTC.  His Valium was tapered down.

On [**2154-5-1**], the patient only required 45 mg for the past 24
hours, his restraints were removed and he was transferred to
the Medicine Floor with a one-to-one sitter.  He was still,
however, noted to have some periods of confabulation.  He had
increasing orientation, denied any headaches, diaphoresis,
pain, palpitations, nausea, vomiting, or hallucinations.  He
required no further doses of Valium, although complained of
insomnia and was given Trazodone in order to help him sleep.

The patient was noted to have some gait instability and was
evaluated by Physical Therapy who saw the patient twice and
felt on the second visit that the patient was stable and at
his baseline.  He was reevaluated by Psychiatry who felt that
he still had some delirium, question of paranoia.  They
recommended a head CT which is pending at the time of this
dictation.

His LFTs which were elevated earlier in his hospital course
with AST maximum of 156 and ALT maximum of 177 have all
trended back to normal range.  The remainder of his
electrolytes are normal.  He has had no episodes of
hyperglycemia.  His cholesterol was 165 and his iron was 62.

At this point, the patient has refused to return to inpatient
detox facility, requesting referral for outpatient substance
abuse center only.  He is being reevaluated by Psychiatry for
further recommendations, the head CT is currently pending.

DISCHARGE DIAGNOSIS:  Alcohol withdrawal.

DISCHARGE MEDICATIONS:
1.  Multivitamin one q.d.
2.  Folate 1 mg p.o. q.d.
3.  Thiamine 100 mg p.o. q.d.

The remainder of the [**Hospital 228**] hospital course will be
dictated as an addendum to this discharge summary.




                   DR.[**First Name (STitle) **],[**First Name3 (LF) 734**] 12-944

Dictated By:[**Last Name (NamePattern1) 9296**]
MEDQUIST36

D:  [**2154-5-3**]  02:59
T:  [**2154-5-3**]  16:20
JOB#:  [**Job Number **]


Name:  [**Known lastname 16998**], [**Known firstname **] H.                     Unit No:  [**Numeric Identifier 18290**]

Admission Date:  [**2154-4-27**]     Discharge Date:  [**2154-5-4**]

Date of Birth:   [**2108-4-18**]     Sex:  M

Service:

ADDENDUM:  The patient's head CT came back negative.  He was
reevaluated by psychiatry who felt that he was safe to be
discharged home.  He was given day number for [**Hospital 5763**]
Hospital outpatient rehab.  There were no changes made in his
discharge medications.






                   DR.[**First Name (STitle) **],[**First Name3 (LF) 27**] 12-944

Dictated By:[**Last Name (NamePattern1) 8583**]

MEDQUIST36

D:  [**2154-5-5**]  05:02
T:  [**2154-5-6**]  07:13
JOB#:  [**Job Number 18291**]
{'Alcohol withdrawal delirium,Pure hypercholesterolemia,Tobacco use disorder,Adjustment disorder with depressed mood,Acute alcoholic hepatitis,Acute alcoholic intoxication in alcoholism, continuous'}


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: Hallucinations, agitation.

PRESENT ILLNESS: This is a 46-year-old male
with a history of alcohol abuse transferred from [**Hospital3 103813**] Detox with agitation, change in mental status.  The
patient was admitted to the outside hospital for alcohol
detox on [**2154-4-24**].  He was placed on an Ativan taper, last
dose 1 mg this morning.  He presented to the MICU agitated,
disoriented with visual hallucinations requiring restraints.
He was given Valium and Haldol for suspected DTs.  He was
admitted to the MICU for frequent benzo dosing.  Further
review of systems is unable to be obtained secondary to
confusion.

MEDICAL HISTORY: 1.  Tobacco abuse.
2.  Hypercholesterolemia.
3.  Report by patient of increased blood sugars and increased
iron levels.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to Darvocet.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is separated.  He works in
construction, has a girlfriend.  Alcohol:  One pint to one
quart of vodka per day.  Tobacco:  Unknown.  Drugs:  Unknown. 

### Response:
{'Alcohol withdrawal delirium,Pure hypercholesterolemia,Tobacco use disorder,Adjustment disorder with depressed mood,Acute alcoholic hepatitis,Acute alcoholic intoxication in alcoholism, continuous'}
