CHIEF COMPLAINT: drug overdose/suicide attempt

PRESENT ILLNESS: 39 yo female who was found unresponsive with pillboxes of
trileptal, fluoxetine, and baclofen lying in her car.  Her
mother states that she last saw the patient around 2 pm when the
patient stated she was going to run errands and would be back
shortly.  Ms. [**Known lastname 34821**] friend later [**Name (NI) 653**] her mother when
she had not been seen for the entire afternoon and the patient
was then found around 8pm laying in her car. In the ED, she had
intermittent agitation and was intubated for airway protection.
Her mother states that the patient had been depressed recently
with stressors being adjusting to a new country, financial
difficulties, her husband's infidelity, a recent ectopic
pregnancy, and obsession over the death of her cat.

MEDICAL HISTORY: depression/anxiety.  No history of mania or psychosis. No
history of prior suicide attempts. No history of self-injurious
behavior.

MEDICATION ON ADMISSION: fluoxetine (unknown dose)

ALLERGIES: Penicillins

PHYSICAL EXAM: PE: 96.0 121/78 85 98% on AC 550/16/50/
Gen: non-reponsive to verbal stimuli, withdrawing to pain.
HEENT: dilated pupils, minimally reactive, OP clear, MMM,
anicteric sclerae
Neck: no masses, no LAD, no JVD, no carotid bruit
CV: S1S2, RRR, no m/r/g
Chest: cta b/l, no crackles or wheezes.
Abd: soft, nd, +bs, no organomegaly, no rebound, no guarding, no
pelvic tenderness, no tampon in place
Extr: no cyanosis, no clubbing; no edema, 2+ pulses b/l.
neuro: funduscopic exam intact, no neck stiffness, withdrawing
to pain in all extremities, reflesxes 1+ bilaterally, no
rigidity
Skin: pressure ulcer on R dorsum of foot, mild erythema around
.
On discharge: similar exam, not intubated.  Patient carries on
appropriate conversation with Russian interpreter.

FAMILY HISTORY: n/c

SOCIAL HISTORY: Supportive parents. Both are college professors and have [**Name5 (PTitle) 19301**] in
the US a lot longer. Pt was a nurse assistant in [**Country 532**] and has
been working part time in the US. Is apparently in the process
of looking for a new job.
Poisoning by skeletal muscle relaxants,Acute respiratory failure,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Poisoning by other and unspecified anticonvulsants,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Depressive disorder, not elsewhere classified
Pois-skelet muscle relax,Acute respiratry failure,Urin tract infection NOS,Pneumonia, organism NOS,Pois-anticonvul NEC/NOS,Poison-drug/medicin NEC,Depressive disorder NEC
Admission Date:  [**2181-12-25**]              Discharge Date:   [**2181-12-30**]

Date of Birth:  [**2142-5-9**]             Sex:   F

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 3556**]
Chief Complaint:
drug overdose/suicide attempt

Major Surgical or Invasive Procedure:
intubation

History of Present Illness:
39 yo female who was found unresponsive with pillboxes of
trileptal, fluoxetine, and baclofen lying in her car.  Her
mother states that she last saw the patient around 2 pm when the
patient stated she was going to run errands and would be back
shortly.  Ms. [**Known lastname 34821**] friend later [**Name (NI) 653**] her mother when
she had not been seen for the entire afternoon and the patient
was then found around 8pm laying in her car. In the ED, she had
intermittent agitation and was intubated for airway protection.
Her mother states that the patient had been depressed recently
with stressors being adjusting to a new country, financial
difficulties, her husband's infidelity, a recent ectopic
pregnancy, and obsession over the death of her cat.


Past Medical History:
depression/anxiety.  No history of mania or psychosis. No
history of prior suicide attempts. No history of self-injurious
behavior.


Social History:
Supportive parents. Both are college professors and have [**Name5 (PTitle) 19301**] in
the US a lot longer. Pt was a nurse assistant in [**Country 532**] and has
been working part time in the US. Is apparently in the process
of looking for a new job.

Family History:
n/c

Physical Exam:
PE: 96.0 121/78 85 98% on AC 550/16/50/
Gen: non-reponsive to verbal stimuli, withdrawing to pain.
HEENT: dilated pupils, minimally reactive, OP clear, MMM,
anicteric sclerae
Neck: no masses, no LAD, no JVD, no carotid bruit
CV: S1S2, RRR, no m/r/g
Chest: cta b/l, no crackles or wheezes.
Abd: soft, nd, +bs, no organomegaly, no rebound, no guarding, no
pelvic tenderness, no tampon in place
Extr: no cyanosis, no clubbing; no edema, 2+ pulses b/l.
neuro: funduscopic exam intact, no neck stiffness, withdrawing
to pain in all extremities, reflesxes 1+ bilaterally, no
rigidity
Skin: pressure ulcer on R dorsum of foot, mild erythema around
.
On discharge: similar exam, not intubated.  Patient carries on
appropriate conversation with Russian interpreter.

Pertinent Results:
PLT COUNT-290#
WBC-10.0# RBC-4.05* HGB-12.7 HCT-36.8 MCV-91 MCH-31.2 MCHC-34.4
RDW-13.8
ASA-NEG ETHANOL-29* ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG
tricyclic-NEG
CALCIUM-8.4 PHOSPHATE-2.2* MAGNESIUM-1.9
GLUCOSE-96 UREA N-9 CREAT-0.8 SODIUM-140 POTASSIUM-4.1
CHLORIDE-104 TOTAL CO2-23 ANION GAP-17
UA negative
URINE  bnzodzpn-NEG barbitrt-POS opiates-NEG cocaine-NEG
amphetmn-NEG mthdone-NEG
HCG-<5
.
[**12-26**] Urine Cx + for E coli (pansensitive)
.
1 sputum + for coag + staph and e coli(pan sensitive); repeat
sputum negative.
.
bld cx [**2-4**] + coag+ staph.
.
[**12-27**] CXR: faint RUL density suspicious for PNA

Brief Hospital Course:
A/P 39 yo with no records and no contactable family member, who
presents with Baclofen, trileptal, and fluoxetine overdose.
.
# Baclofen overdose is known to cause intermittent coma and
delirium, consistent with her admission presentation. Trileptal
causes sedative effects; fluoxetine can cause serotonin syndrome
but the patient had no evidence of this.  Neither did she have
EKG changes suggestive of SSRI overdose.  Ms. [**Known lastname **] was
intubated for airway protection and toxicology was called who
recommended supportive care for all sedatives.  Baclofen can
lower seizure threshhold, but Ms. [**Known lastname **] did not have seizure
activity and was not prophylaxed for this.  She had a fairly
prolonged course of delerium/agitation and was thus kept on the
ventilator for 3 days. She was sedated with propofol rather than
benzodiazepines.  when she was alert with improved agitation she
was extubated and has done well from a respiratory stand point.
She has since expressed anxiety/fear and depression but no
active suicidal ideation.  Psychiatry has been following and
recommended prn haldol for anxiety.
.
# Ms [**Known lastname **] had an isolated fever on HD 3 and had sputum,
urine, and blood cultures sent.  Her urine and sputum were + for
E coli (pan-sensitive) and her sputum was also + for staph
aureus (pan-sensitive).  She was therefore treated with Bactrim
but refused the medication and then was switched to levofloxacin
for three days.
.
# Code: full
.
.
After discussion with the patient and the medical staff, all
were in agreement that Ms. [**Known firstname 34822**] [**Known lastname **] was a suitable
candidate for transfer to inpatient psychiatry.
.

Medications on Admission:
fluoxetine (unknown dose)

Discharge Medications:
1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).


Discharge Disposition:
Extended Care

Discharge Diagnosis:
baclofen, trileptal, and fluoxetine overdose
depression/suicide attempt
pneumonia
urinary tract infection


Discharge Condition:
stable

Discharge Instructions:
In addition to your medication overdose, you were treated for a
urinary infection and possible pneumonia. If you have fevers,
chills, back pain, worsening cough, you should be reevaluated
for this.

Followup Instructions:
please call to make a followup appointment with your PCP and
with your psychiatrist within the next 1 week following
psychiatric discharge.
Please have a CXR repeated in [**5-3**] weeks. You had increased
interstitial markings on your CXR in the hospital.


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 3559**] MD, [**MD Number(3) 3560**]

Completed by:[**2182-1-24**]
{'Poisoning by skeletal muscle relaxants,Acute respiratory failure,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Poisoning by other and unspecified anticonvulsants,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,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: drug overdose/suicide attempt

PRESENT ILLNESS: 39 yo female who was found unresponsive with pillboxes of
trileptal, fluoxetine, and baclofen lying in her car.  Her
mother states that she last saw the patient around 2 pm when the
patient stated she was going to run errands and would be back
shortly.  Ms. [**Known lastname 34821**] friend later [**Name (NI) 653**] her mother when
she had not been seen for the entire afternoon and the patient
was then found around 8pm laying in her car. In the ED, she had
intermittent agitation and was intubated for airway protection.
Her mother states that the patient had been depressed recently
with stressors being adjusting to a new country, financial
difficulties, her husband's infidelity, a recent ectopic
pregnancy, and obsession over the death of her cat.

MEDICAL HISTORY: depression/anxiety.  No history of mania or psychosis. No
history of prior suicide attempts. No history of self-injurious
behavior.

MEDICATION ON ADMISSION: fluoxetine (unknown dose)

ALLERGIES: Penicillins

PHYSICAL EXAM: PE: 96.0 121/78 85 98% on AC 550/16/50/
Gen: non-reponsive to verbal stimuli, withdrawing to pain.
HEENT: dilated pupils, minimally reactive, OP clear, MMM,
anicteric sclerae
Neck: no masses, no LAD, no JVD, no carotid bruit
CV: S1S2, RRR, no m/r/g
Chest: cta b/l, no crackles or wheezes.
Abd: soft, nd, +bs, no organomegaly, no rebound, no guarding, no
pelvic tenderness, no tampon in place
Extr: no cyanosis, no clubbing; no edema, 2+ pulses b/l.
neuro: funduscopic exam intact, no neck stiffness, withdrawing
to pain in all extremities, reflesxes 1+ bilaterally, no
rigidity
Skin: pressure ulcer on R dorsum of foot, mild erythema around
.
On discharge: similar exam, not intubated.  Patient carries on
appropriate conversation with Russian interpreter.

FAMILY HISTORY: n/c

SOCIAL HISTORY: Supportive parents. Both are college professors and have [**Name5 (PTitle) 19301**] in
the US a lot longer. Pt was a nurse assistant in [**Country 532**] and has
been working part time in the US. Is apparently in the process
of looking for a new job. 

### Response:
{'Poisoning by skeletal muscle relaxants,Acute respiratory failure,Urinary tract infection, site not specified,Pneumonia, organism unspecified,Poisoning by other and unspecified anticonvulsants,Suicide and self-inflicted poisoning by other specified drugs and medicinal substances,Depressive disorder, not elsewhere classified'}
