CHIEF COMPLAINT: Unresponsive

PRESENT ILLNESS: Ms. [**Known lastname 2093**] is a 62 year old female with history of bipolar d/o
and multiple suicide attempts, DM, HCV, who was found outside of
her home drooling, diaphoretic, and non-verbal. She was taken by
EMS to [**Hospital3 1280**]. Upon arrival to the [**Hospital1 **] ED, her vitals
were BP 132/67, HR 78, T 98.6, RR 16, 96% on RA. She independent
at baseline and last spoke with her son the day before and
denied any mood disturbances. At [**Hospital1 **], she had a negative
head CT, c-spine CT, CXR, LP, and tox screen at OSH. She was
found to be hyperglycemic to 450 and so was given 10 units of
insulin. She was seen by neurology who felt she needed a higher
level of neurology care. They raised concern for non-convulsive
status. At [**Hospital1 **], she was given a banana bag, 10 units SQ of
regular insulin for hyperglycemia to 450, and dilantin 1 g IV
given the concern for non-convulsive status.
.
In the ED, initial vitals were T 97.9, HR 72, BP 122/60, RR 30,
99% on 4L NC. In triage, she was observed to be having episodes
of apnea. She was briefly hypotensive to 72/40 and responded to
2L IVF. A right femoral line was placed. She subsequently
developed hypotension to 81/42 and so levophed was started at
0.1 mg/kg/hr. She had a head CT, CT c-spine, and CXR repeated
here which were negative. She was given vancomycin, zosyn, and
ceftriaxone. Neuro consult was called, but they were unable to
evaluate the patient in the ED. She was given calcium and
glucagon in the case of potential calcium channel blocker
overdose.
.
Upon arrival to the [**Hospital Unit Name 153**], patient is diaphoretic and
unresponsive. She is non-verbal and does not follow commands.
.

MEDICAL HISTORY: Diabetes, type 2
Hypertension
Hepatitis ?C (diagnosed in the last 2-3 months)
Bipolar disorder (on disability for bipolar, with history of
several overdoses in these past most recently 6 months ago)
Hyperlipidemia

MEDICATION ON ADMISSION: Actos 30 mg daily
Asacol 800 mg [**Hospital1 **]
Glyburide 2.5 mg [**Hospital1 **]
Lamictal 100 mg [**Hospital1 **]
Lisiinopril 30 mg daily
Metformin 1000 mg daily
Simvastatin 20 mg daily
Aspirin 81
Lexapro 10 mg [**Hospital1 **]
?actonel

ALLERGIES: Clindamycin

PHYSICAL EXAM: Vitals: T 100.1, HR 75, BP 122/58 on 0.07 of levophed, RR
General: nonverbal, not following commands, eyes closed, jaw
clenched
HEENT: Sclera anicteric, pupils a 4 cm and very sluggish
reaction to light
Lungs: limited by patient cooperation
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly,
GU: foley present,
Ext: right femoral line, warm, well perfused, 2+ pulses, no
clubbing, cyanosis or edema
Neuro: non-verbal, Pupils equal and sluggishly reactive to light
from 4cm --> 3 cm, corneal reflex intact, face symmetric.
Withdraws to painful stimuli in all for extremities, but RUE has
triple flexion. Upper extremities are rigid with increased tone.

FAMILY HISTORY: Family history of alcoholism.

SOCIAL HISTORY: [**Last Name (LF) **], [**First Name3 (LF) **] her son. She has occasional beer per her son.
Poisoning by other and unspecified anticonvulsants,Coma,Acute respiratory failure,Drug-induced delirium,Hyperosmolality and/or hypernatremia,Bipolar disorder, unspecified,Unspecified viral hepatitis C without hepatic coma,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified alcohol dependence, continuous,Substance abuse in family,History of physical abuse,Other symptoms involving nervous and musculoskeletal systems,Tobacco use disorder,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Dysthymic disorder
Pois-anticonvul NEC/NOS,Coma,Acute respiratry failure,Drug-induced delirium,Hyperosmolality,Bipolar disorder NOS,Hpt C w/o hepat coma NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Alcoh dep NEC/NOS-contin,Substance abuse-family,Hx of physical abuse,Nerve/musculskel sym NEC,Tobacco use disorder,Hypotension NOS,DMII wo cmp uncntrld,Poison-drug/medicin NEC,Dysthymic disorder
Name:  [**Known lastname 4045**],[**Known firstname 4193**]                  Unit No:   [**Numeric Identifier 13745**]

Admission Date:  [**2192-2-16**]              Discharge Date:   [**2192-2-20**]

Date of Birth:  [**2129-3-11**]             Sex:   F

Service: MEDICINE

Allergies:
Clindamycin

Attending:[**First Name3 (LF) 13746**]
Addendum:
Discharge meds on DC summary incorrect Asacol TID and metformin
is [**Hospital1 **]

 Glyburide  2.5 mg Tablet  Sig:  One (1) Tablet PO BID (2 times
a day).  Tablet(s)
  Aspirin  81 mg Tablet  Sig:  One (1) Tablet PO once a day.

  Lisinopril  30 mg Tablet  Sig:  One (1) Tablet PO once a day.

  Actos  30 mg Tablet  Sig:  One (1) Tablet PO once a day.
  Asacol  400 mg Tablet, Delayed Release (E.C.)  Sig:  Two (2)
Tablet, Delayed Release (E.C.) PO three times a day.
  Pantoprazole  40 mg Tablet, Delayed Release (E.C.)  Sig:  One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

  Metformin  1,000 mg Tablet  Sig:  One (1) Tablet PO twice a
day.

Also PCP is
[**Name9 (PRE) **] Name: [**Doctor Last Name 13747**]
First Name: [**Doctor First Name **]
Specialty: Internal Medicine
Sub-specialty:
Office Phone: ([**Telephone/Fax (1) 13748**]
Office Fax: ([**Telephone/Fax (1) 13749**]
Address Line 1: [**Last Name (NamePattern1) 13750**] [**Apartment Address(1) 13751**]
Address Line 2:
City: [**Location (un) 4887**]
State: MA
Zip: [**Numeric Identifier 13752**]


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 536**] - [**Location (un) 42**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 13753**] MD [**MD Number(2) 13754**]

Completed by:[**2192-2-20**]

Admission Date:  [**2192-2-16**]              Discharge Date:   [**2192-2-20**]

Date of Birth:  [**2129-3-11**]             Sex:   F

Service: MEDICINE

Allergies:
Clindamycin

Attending:[**First Name3 (LF) 1646**]
Chief Complaint:
Unresponsive

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Ms. [**Known lastname 2093**] is a 62 year old female with history of bipolar d/o
and multiple suicide attempts, DM, HCV, who was found outside of
her home drooling, diaphoretic, and non-verbal. She was taken by
EMS to [**Hospital3 1280**]. Upon arrival to the [**Hospital1 **] ED, her vitals
were BP 132/67, HR 78, T 98.6, RR 16, 96% on RA. She independent
at baseline and last spoke with her son the day before and
denied any mood disturbances. At [**Hospital1 **], she had a negative
head CT, c-spine CT, CXR, LP, and tox screen at OSH. She was
found to be hyperglycemic to 450 and so was given 10 units of
insulin. She was seen by neurology who felt she needed a higher
level of neurology care. They raised concern for non-convulsive
status. At [**Hospital1 **], she was given a banana bag, 10 units SQ of
regular insulin for hyperglycemia to 450, and dilantin 1 g IV
given the concern for non-convulsive status.
.
In the ED, initial vitals were T 97.9, HR 72, BP 122/60, RR 30,
99% on 4L NC. In triage, she was observed to be having episodes
of apnea. She was briefly hypotensive to 72/40 and responded to
2L IVF. A right femoral line was placed. She subsequently
developed hypotension to 81/42 and so levophed was started at
0.1 mg/kg/hr. She had a head CT, CT c-spine, and CXR repeated
here which were negative. She was given vancomycin, zosyn, and
ceftriaxone. Neuro consult was called, but they were unable to
evaluate the patient in the ED. She was given calcium and
glucagon in the case of potential calcium channel blocker
overdose.
.
Upon arrival to the [**Hospital Unit Name 153**], patient is diaphoretic and
unresponsive. She is non-verbal and does not follow commands.
.


Past Medical History:
Diabetes, type 2
Hypertension
Hepatitis ?C (diagnosed in the last 2-3 months)
Bipolar disorder (on disability for bipolar, with history of
several overdoses in these past most recently 6 months ago)
Hyperlipidemia


Social History:
[**Last Name (LF) **], [**First Name3 (LF) **] her son. She has occasional beer per her son.

Family History:
Family history of alcoholism.

Physical Exam:
Vitals: T 100.1, HR 75, BP 122/58 on 0.07 of levophed, RR
General: nonverbal, not following commands, eyes closed, jaw
clenched
HEENT: Sclera anicteric, pupils a 4 cm and very sluggish
reaction to light
Lungs: limited by patient cooperation
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly,
GU: foley present,
Ext: right femoral line, warm, well perfused, 2+ pulses, no
clubbing, cyanosis or edema
Neuro: non-verbal, Pupils equal and sluggishly reactive to light
from 4cm --> 3 cm, corneal reflex intact, face symmetric.
Withdraws to painful stimuli in all for extremities, but RUE has
triple flexion. Upper extremities are rigid with increased tone.



Pertinent Results:
[**2192-2-15**] 10:00PM BLOOD WBC-8.3 RBC-4.02* Hgb-12.9 Hct-38.1
MCV-95 MCH-32.1* MCHC-33.9 RDW-15.6* Plt Ct-165
[**2192-2-15**] 10:00PM BLOOD Neuts-82.6* Lymphs-13.3* Monos-3.3
Eos-0.1 Baso-0.7
[**2192-2-15**] 10:00PM BLOOD ALT-142* AST-83* LD(LDH)-188 AlkPhos-76
TotBili-0.3
[**2192-2-15**] 10:00PM BLOOD Phenyto-11.3 Lithium-0.3*
[**2192-2-15**] 10:00PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

CT HEAD
HISTORY: 62-year-old woman with altered mental status.

FINDINGS: There is no acute intracranial hemorrhage, mass
effect, shift of
midline structures, or edema. [**Doctor Last Name **]-white matter differentiation
is normally
preserved. The ventricles and cerebral sulci are prominent,
likely reflecting
age-related involutional change. Note is made of cavum septum
pellucidum et
vergae. A small, 3 mm lipoma is located posterior to the
splenium of the
corpus callosum.

Mucosal thickening of the right maxillary sinus is minimal. The
visualized
paranasal sinuses are otherwise normally aerated. The mastoid
air cells are
clear. Vascular calcifications involve the internal carotid
arteries
bilaterally.

IMPRESSION: No acute intracranial hemorrhage or edema.

NOTE ON ATTENDING REVIEW:

There is a slightly dense focus in the left side of pons, (se 2
and 3, im 9)
which is liekly artifactual on the thin section reformations
obtained.
Attention can be paid on follow up studies.


Brief Hospital Course:
Ms. [**Known lastname 2093**] is a 62 year old female with diabetes, HTN, HL,
bipolar disorder with multiple prior suicide attempts from
medication overdoses who is admitted with altered mental status.

.
1. Altered mental status. Patient presented with altered menal
status. CT head and c-spine were unremarakable. UA and CXR
negative. Patient's infectious workup was negative though she
did have a left shift on her differential and an elevated
lactate. The differential for her altered mental status included
seizure/post-ictal state, occult infection, unknown ingestion.
Her osmolar gap was 3 and Stox/Utox were negative, but patient
has history of multiple suicide attempts in the past with
ingestions of prescribed meds. Muscular rigidity, temperature
and history of medication overdoses raises the question of
serotonin syndrome.  A neuro consult was called and they
recommended EEG (negative for seizure), MRI (negative for
intracranial process/mass), LP (negative), TSH (wnl).  Dilantin
was continued. They then recommended 24hr EEG which showed no
evidence of seizure and dilantin was stopped. Outside hospital
lamictal levels were elevated at 35.  Her mental status grdually
improved.  On speaking with her son, she said that she had
"taken a lot of pills" before she came in.  Psychiatry was
consulted for suicide attempt, and recommended prn haldol for
agitation, 1:1 sitter, and inpatient psychiatric admission on
discharge.
.
2. Hypotension. Differential for hypotension was hypovolemic
versus septic. She had no positive culture data as yet and no
localizing symptoms though patients mental status make history
limited. Patient's presentation of being found down raises the
possibility of hypovolemia from poor PO intake. She was treated
with prn IVF boluses, empiric antibiotics with
vanco/ceftriaxone, kept on levophed prn. Her home lisinopril was
initially held then restarted on discharge.
.
3. Elevated lactate. Raised the possibility of an infection, but
infectious workup was negative. Also, could be secondary to
seizure activity but negative EEG. Trended and found to resolve
on ICU day 1.
.
4. Hyperglycemia. Patient presented with hyperglycemia to 450
which has responded to insulin. No evidence of DKA. She was kept
on an HISS, we followed fingersticks, and held her home actos,
glyburide, and metformin. All DM meds were restarted upon
discharge.
.
5. Bipolar disorder. Patient has a history of bipolar disorder,
on disability. Multiple prior overdoses with medications.
.
6. Hepatitis C. Patient with ALT of 142, AST 83, with normal
albumin. INR normal at OSH. Per OSH report, patient was recently
diagnosed in [**12-11**]. No evidcence of cirrhosis by labs or on exam.
 LFTs trended down. Likely from hep C. She needs follow up with
her PCP for this, then referral to GI from there.
.
7. Hyperlipidemia.  Held simvastatin given elevated LFTs and
inability to take POs. This should be held until f/u with PCP.
.
8. ? artifact on CT. CT head needs repeat as o/p to follow up
likely artifact. See read above.
.
Code: DNR/DNI, paperwork in the chart
.
Communication: son [**First Name4 (NamePattern1) **] [**Name (NI) 2093**] [**Telephone/Fax (1) 86846**])   Was updated on
status at the time of discharge.


Medications on Admission:
Actos 30 mg daily
Asacol 800 mg [**Hospital1 **]
Glyburide 2.5 mg [**Hospital1 **]
Lamictal 100 mg [**Hospital1 **]
Lisiinopril 30 mg daily
Metformin 1000 mg daily
Simvastatin 20 mg daily
Aspirin 81
Lexapro 10 mg [**Hospital1 **]
?actonel


Discharge Medications:
1. Metformin 1,000 mg Tablet Extended Rel 24 hr Sig: One (1)
Tablet Extended Rel 24 hr PO once a day.
2. Glyburide 2.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day). Tablet(s)
3. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
4. Lisinopril 30 mg Tablet Sig: One (1) Tablet PO once a day.
5. Actos 30 mg Tablet Sig: One (1) Tablet PO once a day.
6. Asacol 400 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO twice a day.
7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).


Discharge Disposition:
Extended Care

Facility:
[**Hospital1 69**] - [**Location (un) 86**]

Discharge Diagnosis:
Primary Diagnosis: 292.81 DELIRIUM, DRUG INDUCED
Secondary Diagnosis: 296.80 BIPOLAR DISORDER, UNSPECIFIED
Secondary Diagnosis: 969.3 OVERDOSE, ANTIPSYCHOTIC
Secondary Diagnosis: V62.84 SUICIDAL IDEATION
Secondary Diagnosis: 250.02 DIABETES TYPE II, UNCONTROLLED, W/O
COMPLICATIONS


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


Discharge Instructions:
patient being transferred to facility, [**Hospital1 18**] Psychiatric
Inpatient Service

Followup Instructions:
At the time of discharge from inpatient psychiatry, please have
the patient make an appointment with her primary care doctor.
{'Poisoning by other and unspecified anticonvulsants,Coma,Acute respiratory failure,Drug-induced delirium,Hyperosmolality and/or hypernatremia,Bipolar disorder, unspecified,Unspecified viral hepatitis C without hepatic coma,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified alcohol dependence, continuous,Substance abuse in family,History of physical abuse,Other symptoms involving nervous and musculoskeletal systems,Tobacco use disorder,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Dysthymic 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: Unresponsive

PRESENT ILLNESS: Ms. [**Known lastname 2093**] is a 62 year old female with history of bipolar d/o
and multiple suicide attempts, DM, HCV, who was found outside of
her home drooling, diaphoretic, and non-verbal. She was taken by
EMS to [**Hospital3 1280**]. Upon arrival to the [**Hospital1 **] ED, her vitals
were BP 132/67, HR 78, T 98.6, RR 16, 96% on RA. She independent
at baseline and last spoke with her son the day before and
denied any mood disturbances. At [**Hospital1 **], she had a negative
head CT, c-spine CT, CXR, LP, and tox screen at OSH. She was
found to be hyperglycemic to 450 and so was given 10 units of
insulin. She was seen by neurology who felt she needed a higher
level of neurology care. They raised concern for non-convulsive
status. At [**Hospital1 **], she was given a banana bag, 10 units SQ of
regular insulin for hyperglycemia to 450, and dilantin 1 g IV
given the concern for non-convulsive status.
.
In the ED, initial vitals were T 97.9, HR 72, BP 122/60, RR 30,
99% on 4L NC. In triage, she was observed to be having episodes
of apnea. She was briefly hypotensive to 72/40 and responded to
2L IVF. A right femoral line was placed. She subsequently
developed hypotension to 81/42 and so levophed was started at
0.1 mg/kg/hr. She had a head CT, CT c-spine, and CXR repeated
here which were negative. She was given vancomycin, zosyn, and
ceftriaxone. Neuro consult was called, but they were unable to
evaluate the patient in the ED. She was given calcium and
glucagon in the case of potential calcium channel blocker
overdose.
.
Upon arrival to the [**Hospital Unit Name 153**], patient is diaphoretic and
unresponsive. She is non-verbal and does not follow commands.
.

MEDICAL HISTORY: Diabetes, type 2
Hypertension
Hepatitis ?C (diagnosed in the last 2-3 months)
Bipolar disorder (on disability for bipolar, with history of
several overdoses in these past most recently 6 months ago)
Hyperlipidemia

MEDICATION ON ADMISSION: Actos 30 mg daily
Asacol 800 mg [**Hospital1 **]
Glyburide 2.5 mg [**Hospital1 **]
Lamictal 100 mg [**Hospital1 **]
Lisiinopril 30 mg daily
Metformin 1000 mg daily
Simvastatin 20 mg daily
Aspirin 81
Lexapro 10 mg [**Hospital1 **]
?actonel

ALLERGIES: Clindamycin

PHYSICAL EXAM: Vitals: T 100.1, HR 75, BP 122/58 on 0.07 of levophed, RR
General: nonverbal, not following commands, eyes closed, jaw
clenched
HEENT: Sclera anicteric, pupils a 4 cm and very sluggish
reaction to light
Lungs: limited by patient cooperation
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly,
GU: foley present,
Ext: right femoral line, warm, well perfused, 2+ pulses, no
clubbing, cyanosis or edema
Neuro: non-verbal, Pupils equal and sluggishly reactive to light
from 4cm --> 3 cm, corneal reflex intact, face symmetric.
Withdraws to painful stimuli in all for extremities, but RUE has
triple flexion. Upper extremities are rigid with increased tone.

FAMILY HISTORY: Family history of alcoholism.

SOCIAL HISTORY: [**Last Name (LF) **], [**First Name3 (LF) **] her son. She has occasional beer per her son. 

### Response:
{'Poisoning by other and unspecified anticonvulsants,Coma,Acute respiratory failure,Drug-induced delirium,Hyperosmolality and/or hypernatremia,Bipolar disorder, unspecified,Unspecified viral hepatitis C without hepatic coma,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Other and unspecified alcohol dependence, continuous,Substance abuse in family,History of physical abuse,Other symptoms involving nervous and musculoskeletal systems,Tobacco use disorder,Hypotension, unspecified,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Dysthymic disorder'}
