CHIEF COMPLAINT: Respiratory failure

PRESENT ILLNESS: 32 yr old male with a history of schizophrenia, suicide attempt,
and cutting behavior, who presented from [**Hospital1 1680**] JP with altered
mental status, slurred
speech, and unsteady gait. Mr. [**Known lastname 9449**] had been admitted to
[**Hospital1 1680**] JP on [**2127-8-21**], following discharge from another hospital
after a suicide attempt. He was subsequently transferred to
[**Hospital1 18**] ICU where he was determined to be obtunded and hypercapnic
and was intubated.

MEDICAL HISTORY: Schizophrenia
Cutting behavior
Previous suicide attempts
Benzodiazepine abuse
Cocaine abuse

MEDICATION ON ADMISSION: Geodon 80 mg [**Hospital1 **]
Celexa 40 mg daily
Remeron 30 mg qhs
Klonopin 1 mg tid

ALLERGIES: Tylenol / Benadryl / Advil Cold & Sinus / Penicillins

PHYSICAL EXAM: GEN: Intubated and sedated.
Eye: anicteric
ENT: ETT C/D/I
CV: RRR No MRG
Pulm: CTA
Abd: SNT NABS no HSM
GU: WNL
Skin: dry
[**Last Name (un) **]: No lymphadenopathy
Neuro: unable to assess due to sedation

FAMILY HISTORY: Adopted. Mother has history of polysubstance abuse.

SOCIAL HISTORY: Lives with his mother. Denies alcohol or IVDU. Smoke 3.5 packs
per day.
Poisoning by benzodiazepine-based tranquilizers,Acute respiratory failure,Unspecified schizophrenia, unspecified,Cocaine dependence, continuous,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Accidents occurring in other specified places,Tobacco use disorder,Lumbago
Pois-benzodiazepine tran,Acute respiratry failure,Schizophrenia NOS-unspec,Cocaine depend-contin,Poison-psychotropic agt,Accident in place NEC,Tobacco use disorder,Lumbago
Admission Date:  [**2127-8-24**]              Discharge Date:   [**2127-8-27**]

Date of Birth:  [**2094-10-4**]             Sex:   M

Service: MEDICINE

Allergies:
Tylenol / Benadryl / Advil Cold & Sinus / Penicillins

Attending:[**First Name3 (LF) 1042**]
Chief Complaint:
Respiratory failure

Major Surgical or Invasive Procedure:
Intubation and mechanical ventilation

History of Present Illness:
32 yr old male with a history of schizophrenia, suicide attempt,
and cutting behavior, who presented from [**Hospital1 1680**] JP with altered
mental status, slurred
speech, and unsteady gait. Mr. [**Known lastname 9449**] had been admitted to
[**Hospital1 1680**] JP on [**2127-8-21**], following discharge from another hospital
after a suicide attempt. He was subsequently transferred to
[**Hospital1 18**] ICU where he was determined to be obtunded and hypercapnic
and was intubated.

Past Medical History:
Schizophrenia
Cutting behavior
Previous suicide attempts
Benzodiazepine abuse
Cocaine abuse

Social History:
Lives with his mother. Denies alcohol or IVDU. Smoke 3.5 packs
per day.

Family History:
Adopted. Mother has history of polysubstance abuse.

Physical Exam:
GEN: Intubated and sedated.
Eye: anicteric
ENT: ETT C/D/I
CV: RRR No MRG
Pulm: CTA
Abd: SNT NABS no HSM
GU: WNL
Skin: dry
[**Last Name (un) **]: No lymphadenopathy
Neuro: unable to assess due to sedation


Pertinent Results:
[**2127-8-24**] 01:55PM   WBC-6.2 RBC-4.82 HGB-15.5 HCT-43.7 MCV-91
MCH-32.1* MCHC-35.4* RDW-14.1
[**2127-8-24**] 01:55PM   AMYLASE-44
[**2127-8-24**] 01:59PM   GLUCOSE-109* LACTATE-1.9 NA+-144 K+-3.8
TCO2-25
[**2127-8-24**] 01:55PM   UREA N-14 CREAT-0.7
[**2127-8-24**] 04:42PM   CALCIUM-9.1 PHOSPHATE-4.0 MAGNESIUM-2.1
[**2127-8-24**] 04:42PM   CK(CPK)-392*
[**2127-8-24**] 04:42PM   CK-MB-3 cTropnT-<0.01
[**2127-8-24**] 02:09PM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-POS
amphetmn-NEG mthdone-NEG
[**2127-8-24**] 01:55PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

Head CT ([**8-24**]): No evidence of acute intracranial hemorrhage.
AP CXR ([**8-24**]): 1. Near complete right upper lobe collapse with
interposed consolidation and retrocardiac opacity. These
findings are most likely secondary to aspiration/mucous
plugging. 2. Satisfactory positioning of lines and tubes.
AP CXR ([**8-25**]): The patient has been extubated and right upper
lobe has almost entirely reexpanded. Very small regions of
peribronchial opacification are present in the left lower lung,
and adjacent to the left hilus. These should be followed to
exclude developing pneumonia. Lungs are otherwise clear. Heart
is of normal size and there is no pleural abnormality.

ECG ([**8-24**]): NSR with early repolarization


Brief Hospital Course:
1. Respiratory failure: the patient was briefly intubated for
less than 24 hours and extubated without incident. His
respiratory failure was attributed to benzodiazepine overdose.

2. Altered mental status: also thought to be related to
benzodiazepine overdose, he quickly returned to his baseline
mental status without incident.

3. Schizophrenia: the patient was managed by the psychiatry
liaison with adjustment of his psychotropic medications

4. Suicide attempt: the patient had no further self-harm
attempts or ideation during this hospitalization

5. Cocaine abuse: the patient was not hypertensive during this
hospitalization.

6. Nicotine dependence: the patient was maintained on two 21mg
nicotine transdermal patches daily with good control of his
withdrawal symptoms

7. Mechanical fall with residual nonspecific low back pain: the
patient fell on hospital day 2 and landed on his buttocks. He
had some nonspecific low back pain which was initially
controlled with ibuprofen and cyclobenzaprine. On discharge, he
was receiving only ibuprofen.

Medications on Admission:
Geodon 80 mg [**Hospital1 **]
Celexa 40 mg daily
Remeron 30 mg qhs
Klonopin 1 mg tid

Discharge Medications:
1. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
2. Senna 8.8 mg/5 mL Syrup Sig: One (1) Tablet PO BID (2 times a
day) as needed.
3. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
4. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Nicotine 21 mg/24 hr Patch 24 hr Sig: Two (2) Patch 24 hr
Transdermal DAILY (Daily) as needed for nicotine withdrawal: 21
mcg x2.
6. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

7. Trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed.
8. Ziprasidone HCl 20 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
9. Risperidone 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
10. Ibuprofen 600 mg Tablet Sig: One (1) Tablet PO Q6H (every 6
hours) as needed for pain.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
klonopin overdose/suicide attempt
schizophrenia
nicotine dependence
chronic low back pain


Discharge Condition:
medically stable


Discharge Instructions:
You were hospitalized for a klonopin overdose.  You are being
transferred to an inpatient psychiatry facility.

Followup Instructions:
You will be an inpatient in a psychiatric facility [**Hospital1 **] in
[**Location (un) 18293**].
{'Poisoning by benzodiazepine-based tranquilizers,Acute respiratory failure,Unspecified schizophrenia, unspecified,Cocaine dependence, continuous,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Accidents occurring in other specified places,Tobacco use disorder,Lumbago'}


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: Respiratory failure

PRESENT ILLNESS: 32 yr old male with a history of schizophrenia, suicide attempt,
and cutting behavior, who presented from [**Hospital1 1680**] JP with altered
mental status, slurred
speech, and unsteady gait. Mr. [**Known lastname 9449**] had been admitted to
[**Hospital1 1680**] JP on [**2127-8-21**], following discharge from another hospital
after a suicide attempt. He was subsequently transferred to
[**Hospital1 18**] ICU where he was determined to be obtunded and hypercapnic
and was intubated.

MEDICAL HISTORY: Schizophrenia
Cutting behavior
Previous suicide attempts
Benzodiazepine abuse
Cocaine abuse

MEDICATION ON ADMISSION: Geodon 80 mg [**Hospital1 **]
Celexa 40 mg daily
Remeron 30 mg qhs
Klonopin 1 mg tid

ALLERGIES: Tylenol / Benadryl / Advil Cold & Sinus / Penicillins

PHYSICAL EXAM: GEN: Intubated and sedated.
Eye: anicteric
ENT: ETT C/D/I
CV: RRR No MRG
Pulm: CTA
Abd: SNT NABS no HSM
GU: WNL
Skin: dry
[**Last Name (un) **]: No lymphadenopathy
Neuro: unable to assess due to sedation

FAMILY HISTORY: Adopted. Mother has history of polysubstance abuse.

SOCIAL HISTORY: Lives with his mother. Denies alcohol or IVDU. Smoke 3.5 packs
per day. 

### Response:
{'Poisoning by benzodiazepine-based tranquilizers,Acute respiratory failure,Unspecified schizophrenia, unspecified,Cocaine dependence, continuous,Suicide and self-inflicted poisoning by tranquilizers and other psychotropic agents,Accidents occurring in other specified places,Tobacco use disorder,Lumbago'}
