CHIEF COMPLAINT: EtOH withdrawal with a possible episode of emesis and a possible
seizure.

PRESENT ILLNESS: Mr. [**Known lastname 68181**] is a 25 year-old man with a history of alcoholism and
seizure disorder who presents with alcohol withdrawal.  His last
drink was 3pm on day prior to admission, [**10-12**].  Patient has a
history of seizures and believes he may have had one yesterday
but cannot recall.  He awoke outside his apartment covered in
dirt which usually happens after he has a seizure.
.
He was last admitted for alcohol withdrawal in early [**2190-9-15**]
and had a positive urine tox for benzos at that time. He was
discharged with a plan to follow-up with the [**Hospital 778**] clinic and
declined substance abuse treatment.  Patient briefly restarted
his antiepileptic medications but stopped them about 10 days
ago.  He has been drinking between [**1-16**] to 1.5 gallons of liquor
(vodka or whiskey) daily.  Last night, he presented to the ED
for evaluation, as he felt chest pain, general malaise, was
tremulous, and had some abdominal pain.
.
In the ED, initial vs were: 99.2 128 139/79 20 100%. He was
given valium 10 mg IV x 3, 2 liters NS, a banana bag,
multivitamin, and zofran x 2. His serum EtOH was 330 with
osmolality of 380 (gap 86 which correlates with his EtOH level)
with otherwise negative serum and urine tox screen.  Patient had
a negative CXR, CT head and C-spine.  While in the ER, he had an
episode of coffee ground emesis that cleared with NG lavage. He
was given IV PPI and admitted to the [**Hospital Unit Name 153**] for further
monitoring.  Vitals on transfer were 98.7, 112, 147/90, 20, 96%
RA.
.
On the floor, he is anxious and tremulous but feels better after
NG lavage.  He did not have any emesis prior to coffee grounds
in the ED but has had frequent painful burping over the past few
days.  No current nausea but he does complain of headache behind
his eyes and across his temples, left sided chest pain with deep
inspiration and light sensitivitity.  He has had loose, greenish
stools over the past few days that he associates with his
alcohol intake.  Patient endorses visual hallucinations of
cockroaches on the floor.

MEDICAL HISTORY: - Alcoholism
- Hx. seizures (GTC) related to hx. of head injury (hit by bat
per pt.); was on tegretol until 1 year ago and neurontin since
then for ppx
- Previous 1 year admission in [**2184-5-15**] to psychiatry at [**Hospital1 **]
state hospital w/ dx of Schizoaffective disorder, GAD, social
anxiety and PTSD. Tried on numerous antipsychotic meds and SSRIs
according to patient. Pt now on clonazepam for anxiety, but
admits poor compliance. Previous suicide attempt by jumping,
broke his ankles according to pt.
- ?Hepatitis C

MEDICATION ON ADMISSION: Acetaminophen 650 mg PO/NG Q6H:PRN pain
Clonazepam 2 mg PO/NG QAM
Clonazepam 1 mg PO/NG QPM
Gabapentin 600 mg PO/NG Q8H
Multivitamins 1 TAB PO/NG DAILY
Nicotine Polacrilex 2 mg PO Q1H:PRN smoking cessation
Thiamine 100 mg PO/NG DAILY

ALLERGIES: Prozac / Haldol

PHYSICAL EXAM: Vitals: T: 100.5 BP: 158/81 P: 112 R: 16 O2: 96%
General: Alert, oriented, tremulous, somewhat flattened affect.
Neuro: PERLA, normal EOM, normal sensation in V, good strength
in facial muscles, hearing well bilaterally, normal movements of
the tongue with rising palate, good strength of [**Doctor First Name 81**]. Strength 4/5
and equal bilaterally in UE and LE. Poor finger to nose test,
trembling when holding hands out, photophobia.
HEENT: EOMI, sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: CTAB
CV: tachy, normal S1/S2, no murmurs
Abdomen: soft, mildly tender over RUQ and mid lower quadrant,
non-distended
GU: No foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: Multiple scars - appear to be from cutting on the arms,
one is recent and still healing. Also multiple scars over the
pt's torso.

FAMILY HISTORY: The patient reports that his mother was depressed and had an
anxiety disorder. He also reports that his mother's side of the
family has struggled with EtOH abuse.

SOCIAL HISTORY: He drinks approximately a quart of vodka daily and two 40 oz
beers daily and smokes a quarter pack a day.  He reports using
cocaine on a single ocassion (last use [**7-24**]) though some OMR
notes report regular cocaine use.  No IVDU.  The pt related that
he was living in [**Hospital1 778**] with a much older boyfriend who has
dementia and has recently developed fecal incontinence. The pt
maintains he was the main caregiver and the two of them were
living off the boyfriend's pension. Recently, the boyfriend has
been sent to a nursing home by his brother and the pt no longer
has access to the apt where they were staying. Many of his
belongings remain in the apt.
Alcohol withdrawal,Hematemesis,Acute alcoholic intoxication in alcoholism, continuous,Schizoaffective disorder, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Chest pain, unspecified,Lack of housing
Alcohol withdrawal,Hematemesis,Ac alcohol intox-contin,Schizoaffective dis NOS,Epilep NOS w/o intr epil,Chest pain NOS,Lack of housing
Admission Date:  [**2190-10-13**]              Discharge Date:   [**2190-10-15**]

Date of Birth:  [**2165-3-8**]             Sex:   M

Service: MEDICINE

Allergies:
Prozac / Haldol

Attending:[**First Name3 (LF) 338**]
Chief Complaint:
EtOH withdrawal with a possible episode of emesis and a possible
seizure.

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 68181**] is a 25 year-old man with a history of alcoholism and
seizure disorder who presents with alcohol withdrawal.  His last
drink was 3pm on day prior to admission, [**10-12**].  Patient has a
history of seizures and believes he may have had one yesterday
but cannot recall.  He awoke outside his apartment covered in
dirt which usually happens after he has a seizure.
.
He was last admitted for alcohol withdrawal in early [**2190-9-15**]
and had a positive urine tox for benzos at that time. He was
discharged with a plan to follow-up with the [**Hospital 778**] clinic and
declined substance abuse treatment.  Patient briefly restarted
his antiepileptic medications but stopped them about 10 days
ago.  He has been drinking between [**1-16**] to 1.5 gallons of liquor
(vodka or whiskey) daily.  Last night, he presented to the ED
for evaluation, as he felt chest pain, general malaise, was
tremulous, and had some abdominal pain.
.
In the ED, initial vs were: 99.2 128 139/79 20 100%. He was
given valium 10 mg IV x 3, 2 liters NS, a banana bag,
multivitamin, and zofran x 2. His serum EtOH was 330 with
osmolality of 380 (gap 86 which correlates with his EtOH level)
with otherwise negative serum and urine tox screen.  Patient had
a negative CXR, CT head and C-spine.  While in the ER, he had an
episode of coffee ground emesis that cleared with NG lavage. He
was given IV PPI and admitted to the [**Hospital Unit Name 153**] for further
monitoring.  Vitals on transfer were 98.7, 112, 147/90, 20, 96%
RA.
.
On the floor, he is anxious and tremulous but feels better after
NG lavage.  He did not have any emesis prior to coffee grounds
in the ED but has had frequent painful burping over the past few
days.  No current nausea but he does complain of headache behind
his eyes and across his temples, left sided chest pain with deep
inspiration and light sensitivitity.  He has had loose, greenish
stools over the past few days that he associates with his
alcohol intake.  Patient endorses visual hallucinations of
cockroaches on the floor.


Past Medical History:
- Alcoholism
- Hx. seizures (GTC) related to hx. of head injury (hit by bat
per pt.); was on tegretol until 1 year ago and neurontin since
then for ppx
- Previous 1 year admission in [**2184-5-15**] to psychiatry at [**Hospital1 **]
state hospital w/ dx of Schizoaffective disorder, GAD, social
anxiety and PTSD. Tried on numerous antipsychotic meds and SSRIs
according to patient. Pt now on clonazepam for anxiety, but
admits poor compliance. Previous suicide attempt by jumping,
broke his ankles according to pt.
- ?Hepatitis C


Social History:
He drinks approximately a quart of vodka daily and two 40 oz
beers daily and smokes a quarter pack a day.  He reports using
cocaine on a single ocassion (last use [**7-24**]) though some OMR
notes report regular cocaine use.  No IVDU.  The pt related that
he was living in [**Hospital1 778**] with a much older boyfriend who has
dementia and has recently developed fecal incontinence. The pt
maintains he was the main caregiver and the two of them were
living off the boyfriend's pension. Recently, the boyfriend has
been sent to a nursing home by his brother and the pt no longer
has access to the apt where they were staying. Many of his
belongings remain in the apt.

The pt is considering moving in with his parents who live in New
[**Location (un) **].

Family History:
The patient reports that his mother was depressed and had an
anxiety disorder. He also reports that his mother's side of the
family has struggled with EtOH abuse.

Physical Exam:
Vitals: T: 100.5 BP: 158/81 P: 112 R: 16 O2: 96%
General: Alert, oriented, tremulous, somewhat flattened affect.
Neuro: PERLA, normal EOM, normal sensation in V, good strength
in facial muscles, hearing well bilaterally, normal movements of
the tongue with rising palate, good strength of [**Doctor First Name 81**]. Strength 4/5
and equal bilaterally in UE and LE. Poor finger to nose test,
trembling when holding hands out, photophobia.
HEENT: EOMI, sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: CTAB
CV: tachy, normal S1/S2, no murmurs
Abdomen: soft, mildly tender over RUQ and mid lower quadrant,
non-distended
GU: No foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: Multiple scars - appear to be from cutting on the arms,
one is recent and still healing. Also multiple scars over the
pt's torso.

Pertinent Results:
[**2190-10-14**] 12:00PM BLOOD WBC-3.6* RBC-4.54* Hgb-13.8* Hct-42.3
MCV-93 MCH-30.4 MCHC-32.7 RDW-15.2 Plt Ct-84*

[**2190-10-15**] 04:26AM BLOOD WBC-2.8* RBC-4.35* Hgb-13.3* Hct-40.7
MCV-94 MCH-30.6 MCHC-32.7 RDW-15.3 Plt Ct-75*
[**2190-10-15**] 04:26AM BLOOD Plt Ct-75*
[**2190-10-15**] 04:26AM BLOOD Glucose-114* UreaN-15 Creat-0.7 Na-137
K-4.2 Cl-102 HCO3-24 AnGap-15
[**2190-10-15**] 04:26AM BLOOD Calcium-8.7 Phos-2.0* Mg-2.0
[**2190-10-13**] 01:10AM BLOOD ASA-NEG Ethanol-330* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

Brief Hospital Course:
Mr. [**Known lastname 68181**] is a 25 year-old man with a history of alcoholism and
seizure disorder who presents with alcohol withdrawal and coffee
ground emesis.
.
# Alcoholism/withdrawal: History of alcoholism with multiple
admissions for withdrawal. Has attempted detox in past but
unsuccessful. Also has history of seizures in setting of
withdrawal.  Treated with diazepam 10mg IV q1hr CIWA x12hrs and
then switched to PO diazepam. Currently requiring diazepam
~q4hrs as per CIWA.  started on thiamine, folate, MVI.  Social
work and Psych consulted.
.
# Coffee ground emesis: Reported in the ED and cleared with NG
lavage.  He has a positive Hep C antibody but no titer in our
system and no known history of varices.  Current coffee grounds
could be related to small [**Doctor First Name **]-[**Doctor Last Name **] tear in the setting of
retching or gastritis.  Treated with PPI IV BID and PRN Zofran.
Now switched to PO PPI.  Hct stable with No further melena or
emesis. Appears pt not actively bleeding.  [**Month (only) 116**] need EGD as
outpatient.  Would recommend HCV viral load and genotyping as
well as HIV test as an outpatient
.
# Psychiatric history: Psychiatry consulted for any suggestions
about treatment of possible psych conditions while in-patient
and requested that pt not be given clonazepam.  Will need
psychiatric f/u as outpatient

# Seizure disorder: Was on gabapentin in past but has not been
taking medications for weeks.  We were unable to obtain
outpatient neurology records.  We restarted gabapentin.  No
documented seizures during ICU stay
.
# Transaminitis: His transaminitis may be related to alcohol
intoxication but he does have a history of positive Hep C
antibody without viral load.  LFTs stable during hospital
course.  Recommend f/u of Hep C and consider HIV testing
.
# Left chest pain: Unlikely to represent ACS, patient states it
is associated with withdrawal. No EKG changes.  CP resolved as
withdrawal improved.  [**Month (only) 116**] be related to anxiety


Medications on Admission:
Acetaminophen 650 mg PO/NG Q6H:PRN pain
Clonazepam 2 mg PO/NG QAM
Clonazepam 1 mg PO/NG QPM
Gabapentin 600 mg PO/NG Q8H
Multivitamins 1 TAB PO/NG DAILY
Nicotine Polacrilex 2 mg PO Q1H:PRN smoking cessation
Thiamine 100 mg PO/NG DAILY


Discharge Medications:
1. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO Q8H (every
8 hours).
2. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q8H (every
8 hours) as needed for pain.
3. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
7. Diazepam 10 mg Tablet Sig: One (1) Tablet PO every four (4)
hours as needed for CIWA > 10: Take 1 pill 6 times a day on
[**10-15**] times a day on [**10-16**] and 2 times a day on [**10-15**] and then
stop.
Disp:*12 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Alcohol Withdrawl


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


Discharge Instructions:
You came to the hospital with symptoms of withdrawing from
alcohol.  We admitted you to the ICU and monitored you for
seizures but did not see any.  We treated your alcohol withdrawl
with diazepam and consulted psych and social work.  We strongly
believe that you need to go to a program to help your problems
with alcoholism. You have been provided information about
alcohol withdrawl programs for you to attend on Monday.  You
also have information about shelters in the area.
.
We also strongly suggest that you need to have your hepatitis C
followed up, the combination of hepatitis and alcohol can have a
serious effect on your liver and you should be monitored
closely.
.
We also noted that your blood counts were low, and this is
probably from your alcohol use, but we suggest that you get an
HIV test with your primary care doctor or at a local department
of health or community health center.
.
We have made the following changes to your medications:
ADDED Diazepam taper over the next 3 days:
-6 times a day then 4 times a day then 2 times a day then stop.
ADDED Pantoprazole for stomach protection
ADDED Folic Acid
Decreased Tylenol to 350 up to four times a day
Stopped Clonazepam (replaced by diazepam)
.
You should continue to take all your medications as directed and
follow up with your primary care doctor.

Followup Instructions:
Call your primary care doctor [**First Name (Titles) **] [**Last Name (Titles) **] an appointment in the
next week
.
Attend the suggested outpatient alcohol treatment program
starting Monday [**10-18**].
{'Alcohol withdrawal,Hematemesis,Acute alcoholic intoxication in alcoholism, continuous,Schizoaffective disorder, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Chest pain, unspecified,Lack of housing'}


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 withdrawal with a possible episode of emesis and a possible
seizure.

PRESENT ILLNESS: Mr. [**Known lastname 68181**] is a 25 year-old man with a history of alcoholism and
seizure disorder who presents with alcohol withdrawal.  His last
drink was 3pm on day prior to admission, [**10-12**].  Patient has a
history of seizures and believes he may have had one yesterday
but cannot recall.  He awoke outside his apartment covered in
dirt which usually happens after he has a seizure.
.
He was last admitted for alcohol withdrawal in early [**2190-9-15**]
and had a positive urine tox for benzos at that time. He was
discharged with a plan to follow-up with the [**Hospital 778**] clinic and
declined substance abuse treatment.  Patient briefly restarted
his antiepileptic medications but stopped them about 10 days
ago.  He has been drinking between [**1-16**] to 1.5 gallons of liquor
(vodka or whiskey) daily.  Last night, he presented to the ED
for evaluation, as he felt chest pain, general malaise, was
tremulous, and had some abdominal pain.
.
In the ED, initial vs were: 99.2 128 139/79 20 100%. He was
given valium 10 mg IV x 3, 2 liters NS, a banana bag,
multivitamin, and zofran x 2. His serum EtOH was 330 with
osmolality of 380 (gap 86 which correlates with his EtOH level)
with otherwise negative serum and urine tox screen.  Patient had
a negative CXR, CT head and C-spine.  While in the ER, he had an
episode of coffee ground emesis that cleared with NG lavage. He
was given IV PPI and admitted to the [**Hospital Unit Name 153**] for further
monitoring.  Vitals on transfer were 98.7, 112, 147/90, 20, 96%
RA.
.
On the floor, he is anxious and tremulous but feels better after
NG lavage.  He did not have any emesis prior to coffee grounds
in the ED but has had frequent painful burping over the past few
days.  No current nausea but he does complain of headache behind
his eyes and across his temples, left sided chest pain with deep
inspiration and light sensitivitity.  He has had loose, greenish
stools over the past few days that he associates with his
alcohol intake.  Patient endorses visual hallucinations of
cockroaches on the floor.

MEDICAL HISTORY: - Alcoholism
- Hx. seizures (GTC) related to hx. of head injury (hit by bat
per pt.); was on tegretol until 1 year ago and neurontin since
then for ppx
- Previous 1 year admission in [**2184-5-15**] to psychiatry at [**Hospital1 **]
state hospital w/ dx of Schizoaffective disorder, GAD, social
anxiety and PTSD. Tried on numerous antipsychotic meds and SSRIs
according to patient. Pt now on clonazepam for anxiety, but
admits poor compliance. Previous suicide attempt by jumping,
broke his ankles according to pt.
- ?Hepatitis C

MEDICATION ON ADMISSION: Acetaminophen 650 mg PO/NG Q6H:PRN pain
Clonazepam 2 mg PO/NG QAM
Clonazepam 1 mg PO/NG QPM
Gabapentin 600 mg PO/NG Q8H
Multivitamins 1 TAB PO/NG DAILY
Nicotine Polacrilex 2 mg PO Q1H:PRN smoking cessation
Thiamine 100 mg PO/NG DAILY

ALLERGIES: Prozac / Haldol

PHYSICAL EXAM: Vitals: T: 100.5 BP: 158/81 P: 112 R: 16 O2: 96%
General: Alert, oriented, tremulous, somewhat flattened affect.
Neuro: PERLA, normal EOM, normal sensation in V, good strength
in facial muscles, hearing well bilaterally, normal movements of
the tongue with rising palate, good strength of [**Doctor First Name 81**]. Strength 4/5
and equal bilaterally in UE and LE. Poor finger to nose test,
trembling when holding hands out, photophobia.
HEENT: EOMI, sclera anicteric, MMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: CTAB
CV: tachy, normal S1/S2, no murmurs
Abdomen: soft, mildly tender over RUQ and mid lower quadrant,
non-distended
GU: No foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: Multiple scars - appear to be from cutting on the arms,
one is recent and still healing. Also multiple scars over the
pt's torso.

FAMILY HISTORY: The patient reports that his mother was depressed and had an
anxiety disorder. He also reports that his mother's side of the
family has struggled with EtOH abuse.

SOCIAL HISTORY: He drinks approximately a quart of vodka daily and two 40 oz
beers daily and smokes a quarter pack a day.  He reports using
cocaine on a single ocassion (last use [**7-24**]) though some OMR
notes report regular cocaine use.  No IVDU.  The pt related that
he was living in [**Hospital1 778**] with a much older boyfriend who has
dementia and has recently developed fecal incontinence. The pt
maintains he was the main caregiver and the two of them were
living off the boyfriend's pension. Recently, the boyfriend has
been sent to a nursing home by his brother and the pt no longer
has access to the apt where they were staying. Many of his
belongings remain in the apt. 

### Response:
{'Alcohol withdrawal,Hematemesis,Acute alcoholic intoxication in alcoholism, continuous,Schizoaffective disorder, unspecified,Epilepsy, unspecified, without mention of intractable epilepsy,Chest pain, unspecified,Lack of housing'}
