CHIEF COMPLAINT: Status epilepticus.

PRESENT ILLNESS: The patient is a 43 year old
right handed woman with a history of seizure disorder who was
found by her boyfriend on the day of admission unresponsive
and shaking all over, which is typical of her normal
seizures.  It is unknown how long she had been seizing at the
point that he found her.  Emergency medical services were
called and they brought her to an outside hospital where she
continued to seize.  She was intubated and was loaded with
phenytoin with resolution of seizures.  She was then
transferred to [**Hospital1 69**] and had a
head CT which showed diffuse edema.  She was seen by
neurosurgery for evaluation and they felt there was nothing
that needed to be intervened on at that time.  Patient was
later able to give the history that her last seizure was
approximately six months ago.  She said her boyfriend had the
flu the week before admission and she had developed a cough
and some fever in the days prior to her seizure.  Her
seizures are generalized tonic clonic, often start with a
yell.  They go on to include her whole body and can last up
to 10 to 15 minutes.  Patient also says she has some history
of drinking five or six beers a night and that she had
recently tried to cut that out completely because of her
boyfriend not wanting her to drink anymore.  She also says
that she has had no difficulty obtaining Dilantin and she has
continued to take it as per her normal routine.

MEDICAL HISTORY: The patient has had generalized tonic
clonic seizures since age 5.  She has been on Dilantin for
that.  She has a past history of bipolar disorder as well as
multiple psychiatric hospitalizations.  She has
hypothyroidism.  She has a history of asthma.

MEDICATION ON ADMISSION: Include Dilantin 400 mg p.o.
q.o.d. and 500 mg p.o. q.o.d., Depakote 500 mg p.o. b.i.d.
which she takes for her psychiatric issues.  She also was on
Wellbutrin at the time of admission.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: The patient lives with her boyfriend.
Apparently has a history of medication noncompliance,
according to her father.  [**Name (NI) 1403**] at Papa [**Male First Name (un) 45193**].  She drinks
five or six beers a day.  Denies other alcohol or drug use.
She is not a smoker.
Grand mal status,Cellulitis and abscess of upper arm and forearm,Bacteremia,Phlebitis and thrombophlebitis of deep veins of upper extremities,Depressive disorder, not elsewhere classified,Unspecified acquired hypothyroidism,Bipolar I disorder, most recent episode (or current) unspecified,Asthma, unspecified type, unspecified
Grand mal status,Cellulitis of arm,Bacteremia,Phlbts deep vn up extrm,Depressive disorder NEC,Hypothyroidism NOS,Bipolor I current NOS,Asthma NOS
Admission Date:  [**2131-12-2**]       Discharge Date:  [**2131-12-10**]

Date of Birth:   [**2087-12-11**]       Sex:  F

Service:  NEURO MED

HISTORY OF PRESENT ILLNESS:  The patient is a 43 year old
right handed woman with a history of seizure disorder who was
found by her boyfriend on the day of admission unresponsive
and shaking all over, which is typical of her normal
seizures.  It is unknown how long she had been seizing at the
point that he found her.  Emergency medical services were
called and they brought her to an outside hospital where she
continued to seize.  She was intubated and was loaded with
phenytoin with resolution of seizures.  She was then
transferred to [**Hospital1 69**] and had a
head CT which showed diffuse edema.  She was seen by
neurosurgery for evaluation and they felt there was nothing
that needed to be intervened on at that time.  Patient was
later able to give the history that her last seizure was
approximately six months ago.  She said her boyfriend had the
flu the week before admission and she had developed a cough
and some fever in the days prior to her seizure.  Her
seizures are generalized tonic clonic, often start with a
yell.  They go on to include her whole body and can last up
to 10 to 15 minutes.  Patient also says she has some history
of drinking five or six beers a night and that she had
recently tried to cut that out completely because of her
boyfriend not wanting her to drink anymore.  She also says
that she has had no difficulty obtaining Dilantin and she has
continued to take it as per her normal routine.

PAST MEDICAL HISTORY:  The patient has had generalized tonic
clonic seizures since age 5.  She has been on Dilantin for
that.  She has a past history of bipolar disorder as well as
multiple psychiatric hospitalizations.  She has
hypothyroidism.  She has a history of asthma.

MEDICATIONS ON ADMISSION:  Include Dilantin 400 mg p.o.
q.o.d. and 500 mg p.o. q.o.d., Depakote 500 mg p.o. b.i.d.
which she takes for her psychiatric issues.  She also was on
Wellbutrin at the time of admission.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient lives with her boyfriend.
Apparently has a history of medication noncompliance,
according to her father.  [**Name (NI) 1403**] at Papa [**Male First Name (un) 45193**].  She drinks
five or six beers a day.  Denies other alcohol or drug use.
She is not a smoker.

FAMILY HISTORY:  Unknown.

PHYSICAL EXAMINATION:  Vital signs on admission were
temperature of 100.8, pulse 112, respirations 16, blood
pressure 118/94.  HEENT exam was normocephalic, atraumatic.
Neck was supple.  Lungs were clear to auscultation
bilaterally.  Cardiac exam was regular rate and rhythm.
Abdomen was soft, nondistended, nontender.  Extremities were
without edema.  Neurologically she was sedated, intubated,
not following commands at time of admission.  On cranial
nerve exam pupils were equal, round and reactive to light.
Optic disks were normal, but not well visualized.  She did
have positive doll's eyes, positive corneals.  Face was
symmetric.  Gag was intact.  On motor exam at that time she
was moving all four extremities purposefully.  No abnormal
tone.  On sensory exam she was able to localize to pain in
upper extremities.  Reflexes were 2+ and symmetric throughout
except for absent ankle jerks and upgoing plantar responses
bilaterally.

LABORATORY DATA:  On admission white count was 12.9 with a
left shift.  LFTs were within normal limits.  Dilantin level
was 11.  Depakote level was 33.  Head CT showed diffuse loss
of sulci and diffuse cerebral edema.

HOSPITAL COURSE:  The patient is a 43 year old woman with a
history of seizure disorder who presented in status
epilepticus likely in the setting of an upper respiratory
infection.  She was intubated on arrival.  She had stopped
seizing clinically and she remained seizure free throughout
the remainder of her hospital course.  She was loaded with
Dilantin and her levels were checked and were around 15 with
a reduced albumin around 2.8.  Depakote is used for
depression and was continued at its prior dose.  She was
initially thought to have some concern for meningitis, so she
had a lumbar puncture on admission which showed no white
cells.  She had 1000 red cells which then decreased to 32 red
cells in tube four.  She had no organisms and no
polymorphonuclear lymphs.

She was extubated several days later on the unit, however,
continued to spike fevers which were low grade.  On [**12-6**] she spiked a temperature to 103.  Blood cultures were
drawn and she was noted to have methicillin resistant staph
epi and also was noted to have a large amount of erythema and
swelling over the former IUB site in the right elbow.  She
was started on vancomycin for cellulitis.  She had a right
arm ultrasound which showed some thrombus in the brachial
vein superficially only.  She was continued on vancomycin and
is to have a total of 14 days course.  A PICC line was placed
in her left upper extremity on [**2131-12-9**].

She continued to improve with her mental status as her fever
retreated and her post ictal state resolved.  However, she
continued to have mild gait instability.  Due to the fact
that she needed to continue on IV antibiotics as well as her
gait instability, she is planned to be discharged to rehab
for physical therapy and IV antibiotics.

CONDITION ON DISCHARGE:  Stable.

DISCHARGE MEDICATIONS:
1.  Synthroid 100 mcg p.o. q.day.
2.  Dilantin 400 mg p.o. q.o.d. alternating with Dilantin 500
mg p.o. q.o.d.
3.  Vancomycin 1 gm IV q.12 hours for 10 days, then
discontinue.
4.  Protonix 40 mg p.o. q.day.
5.  Albuterol two puffs p.o. q.four to six hours p.r.n.
6.  Guaifenesin 10 cc p.o. q.four to six hours p.r.n.

FOLLOWUP:  The patient is to follow up with her primary care
doctor, [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 634**].  However, she has no neurologist
who is managing her antiepileptic medications.  She was also
encouraged to follow up in neurology clinic with Dr.
[**Last Name (STitle) **].

DISCHARGE DIAGNOSES:
1.  Seizure disorder.
2.  Status epilepticus.
3.  Cellulitis.
4.  Thrombophlebitis.
5.  Gram positive bacteremia.
6.  Hypothyroidism.






                            [**Name6 (MD) 725**] [**Name8 (MD) 726**], M.D.  [**MD Number(1) 727**]

Dictated By:[**Last Name (NamePattern1) 1203**]
MEDQUIST36

D:  [**2131-12-10**]  12:25
T:  [**2131-12-10**]  12:27
JOB#:  [**Job Number 45194**]


Admission Date:  [**2131-12-2**]       Discharge Date:  [**2131-12-12**]

Date of Birth:   [**2087-12-11**]       Sex:  F

Service:  NEUROMEDICINE
CHIEF COMPLAINT:  Status epilepticus.

HISTORY OF THE PRESENT ILLNESS:  The patient is a 43-year-old
woman with a history of seizure disorder starting at age five
who was admitted in status epilepticus on [**2131-12-2**]
patient reports the onset of seizures since the age five she
says that other people have described as involving shaking of
all four extremities with loss of consciousness.  She denied
any prior history of head trauma or infection prior to the
onset.  Her seizures had been well controlled in the past
with no seizures for several months.

cold and a low-grade fever.  She also reports that she had
been drinking at least five beers per day and then suddenly
stopped several days prior to admission because her boyfriend
wanted her to cut back on her drinking.

On admission, she was intubated. A head CT showed diffuse
edema.  A lumbar puncture showed 0 white cells, 32 red cells,
normal protein and glucose, and a question of gram-positive
cocci.  She was sent to the Intensive Care Unit and initially
treated with ceftriaxone.  She was found to have opiates on
her tox screen.

She remained in the unit for the first several days and was
transferred to the General Neurology Floor on [**2131-12-5**].

PAST MEDICAL HISTORY:
1.  Seizure disorder since age five.
2.  Asthma.
3.  Hypothyroidism.
4.  Bipolar disorder.

MEDICATIONS ON ADMISSION:
1.  Dilantin 400 mg q.a.m., 500 mg every other day.
2.  Depakote 500 mg p.o. b.i.d.
3.  Wellbutrin.

ALLERGIES:  The patient has no known drug allergies.

SOCIAL HISTORY:  She drinks about five beers per day.  She
denied tobacco use.  She lives with her boyfriend.  She has
two children.  History of opiates were positive on a tox
screen on admission.

FAMILY HISTORY:  Unknown.

PHYSICAL EXAMINATION ON ADMISSION:  Vital signs:  Temperature
103, pulse 115, respirations 18, blood pressure 103/60,
saturating 98% on room air.  By the time that she presented
to the Neurology Floor on [**2131-12-5**], her examination
was significant for being generally drowsy but easily
arousable.  She was oriented to [**Hospital3 **] Hospital and
[**2131**].  She was able to answer some medical history questions,
keeping her eyes closed throughout the interview but will
open them to command.  Her cardiac examination was regular
but tachycardiac, no murmurs, rubs, or gallops appreciated.
The lungs were clear to auscultation anteriorly.  The abdomen
was soft, obese, nontender.  The extremities showed no edema.
Mental status:  She opens her eyes to command, moves all four
extremities spontaneously.  She was oriented times three with
normal naming and no dysarthria.  Cranial nerves:  The pupils
were 3 mm to 1 mm, round, and reactive to light.  The
extraocular movements were full.  Her face was equal.  The
tongue was midline.  The neck was supple with no meningismus.
Motor examination:  The patient cooperated poorly but she was
able to raise all four limbs off the bed with good strength
and appeared to have full strength throughout all muscle
groups bilaterally.  Sensation was intact to light touch,
vibration and cold were also intact in all four extremities.
Coordination could not be tested as the patient was not
cooperative.

HOSPITAL COURSE:  The patient is a 43-year-old woman with a
history of seizure disorder admitted in status epilepticus,
intubated, and sent to the unit.  She was transferred to the
floor.  She remained seizure-free throughout the remainder of
her hospital course.  She was continued on Dilantin and
Depakote.  Her CSF cultures were reevaluated and came back
negative.  Ceftriaxone was discontinued.  She was placed on
thiamine and closely monitored for signs of alcohol withdrawal.
However, there was no evidence of that during admission.

The patient had an MRI as she had initially had diffuse
cerebral edema on a head CT on admission.  The [**Hospital 228**]
hospital course was also complicated by a right arm
superficial thrombosis and she was discharged to
rehabilitation in stable condition.



                 DR.[**Last Name (STitle) 45195**],[**First Name3 (LF) 725**] 13-268


Dictated By:[**Last Name (NamePattern1) 1203**]
MEDQUIST36

D:  [**2132-2-28**]  05:09
T:  [**2132-2-28**]  18:50
JOB#:  [**Job Number 45196**]
{'Grand mal status,Cellulitis and abscess of upper arm and forearm,Bacteremia,Phlebitis and thrombophlebitis of deep veins of upper extremities,Depressive disorder, not elsewhere classified,Unspecified acquired hypothyroidism,Bipolar I disorder, most recent episode (or current) unspecified,Asthma, unspecified type, unspecified'}


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: Status epilepticus.

PRESENT ILLNESS: The patient is a 43 year old
right handed woman with a history of seizure disorder who was
found by her boyfriend on the day of admission unresponsive
and shaking all over, which is typical of her normal
seizures.  It is unknown how long she had been seizing at the
point that he found her.  Emergency medical services were
called and they brought her to an outside hospital where she
continued to seize.  She was intubated and was loaded with
phenytoin with resolution of seizures.  She was then
transferred to [**Hospital1 69**] and had a
head CT which showed diffuse edema.  She was seen by
neurosurgery for evaluation and they felt there was nothing
that needed to be intervened on at that time.  Patient was
later able to give the history that her last seizure was
approximately six months ago.  She said her boyfriend had the
flu the week before admission and she had developed a cough
and some fever in the days prior to her seizure.  Her
seizures are generalized tonic clonic, often start with a
yell.  They go on to include her whole body and can last up
to 10 to 15 minutes.  Patient also says she has some history
of drinking five or six beers a night and that she had
recently tried to cut that out completely because of her
boyfriend not wanting her to drink anymore.  She also says
that she has had no difficulty obtaining Dilantin and she has
continued to take it as per her normal routine.

MEDICAL HISTORY: The patient has had generalized tonic
clonic seizures since age 5.  She has been on Dilantin for
that.  She has a past history of bipolar disorder as well as
multiple psychiatric hospitalizations.  She has
hypothyroidism.  She has a history of asthma.

MEDICATION ON ADMISSION: Include Dilantin 400 mg p.o.
q.o.d. and 500 mg p.o. q.o.d., Depakote 500 mg p.o. b.i.d.
which she takes for her psychiatric issues.  She also was on
Wellbutrin at the time of admission.

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Unknown.

SOCIAL HISTORY: The patient lives with her boyfriend.
Apparently has a history of medication noncompliance,
according to her father.  [**Name (NI) 1403**] at Papa [**Male First Name (un) 45193**].  She drinks
five or six beers a day.  Denies other alcohol or drug use.
She is not a smoker. 

### Response:
{'Grand mal status,Cellulitis and abscess of upper arm and forearm,Bacteremia,Phlebitis and thrombophlebitis of deep veins of upper extremities,Depressive disorder, not elsewhere classified,Unspecified acquired hypothyroidism,Bipolar I disorder, most recent episode (or current) unspecified,Asthma, unspecified type, unspecified'}
