CHIEF COMPLAINT: alcohol overdose

PRESENT ILLNESS: 55 yo male, h/o alcohol abuse, HTN, TBI (hit as a pedestrian,
with pins in leg at this time), presenting s/p overdose with
alcohol.  Pt was apparently found wandering around the street in
[**Location (un) 686**], brought in to hospital by EMS.  In the ED, he states
that he took [**1-24**] bottle of atenolol with ?amt Benadryl and vodka
(drinks 1 pint/day alcohol at baseline).  He was initially
following commands in the ED, with stable vitals, but his O2
sats dropped to 75%, became cyanotic, and he was intubated for
airway protection/admitted to the MICU for observation. He was
also given 50 mg charcoal in the ED.  He was put on CIWA, with
valium as needed, propofol gtt while intubated.  Pt was
extubated the next morning, did well, and was transferred for
the floor for further observation.  Pt was seen by psych,
reportedly had no current SI's (and was not trying to commit
suicide with overdose), but he does report symptoms of
depression (finanacial, family problems, concerns about his
son).  On admission, he also had a sodium of 150 which resolved
after hydration with D5W (presumed hypovolemic hypernatremia [**2-24**]
dehydration).

MEDICAL HISTORY: 1.  TBI, [**2-24**] being hit as a pedestrian, currently with pins in
knee
2.  HTN, on medication
3.  Alcohol abuse; no history of psych disease or inpt/outp
treatment
4.  ?facial rash/rosacea, on doxy

MEDICATION ON ADMISSION: Meds on Admission:
Atenolol 50 mg
Benadryl
Doxycycline

ALLERGIES: Penicillins

PHYSICAL EXAM: VS:  98.6       150/82    70     16     96% RA     wt=91.7 kg
Gen: mild distress, no tremor, somewhat disheveled, with beard
HEENT: PERRL, EOMI, OP clear
Neck: no lad, no JVD
Lungs: CTA bilaterally, no w/r/r
CV: RRR, nl S1/S1, no m/r/g
Abd: soft, nt/nd, nabs, no hsm
Extr: trace LE edema, R>L
Neuro/psych: denies SI, stable, requesting to leave

FAMILY HISTORY: Grandparent with alcoholism

SOCIAL HISTORY: Drinks 1 pint/day; history of drinking for past 15 years
(longest sobriety 9 mo), history of 5 detoxes, including at
[**Hospital1 **] 1 yr ago
No tobacco/drug use
Cocaine x 1 in remote past
Grad from BC, MA in teaching in Brown, former teacher, currently
unemployed
Divorced [**2130**]
Living in shelters over past 5 yrs
Has 18 yo son living with ex-wife
Toxic effect of ethyl alcohol,Acute respiratory failure,Hyposmolality and/or hyponatremia,Poisoning by other and unspecified agents primarily affecting the cardiovascular system,Poisoning by antiallergic and antiemetic drugs,Accidental poisoning by alcoholic beverages,Accidental poisoning by agents primarily affecting cardiovascular system,Unspecified essential hypertension,Rash and other nonspecific skin eruption,Depressive disorder, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Lack of housing,Cerebral artery occlusion, unspecified without mention of cerebral infarction
Toxic eff ethyl alcohol,Acute respiratry failure,Hyposmolality,Pois-cardiovasc agt NEC,Pois-antiallrg/antiemet,Acc poisn-alcohol bevrag,Acc poisn-cardiovasc agt,Hypertension NOS,Nonspecif skin erupt NEC,Depressive disorder NEC,Crnry athrscl natve vssl,Lack of housing,Crbl art oc NOS wo infrc
Admission Date:  [**2144-12-25**]              Discharge Date:   [**2144-12-29**]

Date of Birth:  [**2089-1-20**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1055**]
Chief Complaint:
alcohol overdose

Major Surgical or Invasive Procedure:
endotracheal intubation

History of Present Illness:
55 yo male, h/o alcohol abuse, HTN, TBI (hit as a pedestrian,
with pins in leg at this time), presenting s/p overdose with
alcohol.  Pt was apparently found wandering around the street in
[**Location (un) 686**], brought in to hospital by EMS.  In the ED, he states
that he took [**1-24**] bottle of atenolol with ?amt Benadryl and vodka
(drinks 1 pint/day alcohol at baseline).  He was initially
following commands in the ED, with stable vitals, but his O2
sats dropped to 75%, became cyanotic, and he was intubated for
airway protection/admitted to the MICU for observation. He was
also given 50 mg charcoal in the ED.  He was put on CIWA, with
valium as needed, propofol gtt while intubated.  Pt was
extubated the next morning, did well, and was transferred for
the floor for further observation.  Pt was seen by psych,
reportedly had no current SI's (and was not trying to commit
suicide with overdose), but he does report symptoms of
depression (finanacial, family problems, concerns about his
son).  On admission, he also had a sodium of 150 which resolved
after hydration with D5W (presumed hypovolemic hypernatremia [**2-24**]
dehydration).

Pt currently stable, extubated, doing well on transfer to the
floor.  He was requesting to leave AMA on transfer to the floor,
still on 1:1 sitter.

Past Medical History:
1.  TBI, [**2-24**] being hit as a pedestrian, currently with pins in
knee
2.  HTN, on medication
3.  Alcohol abuse; no history of psych disease or inpt/outp
treatment
4.  ?facial rash/rosacea, on doxy

Meds on Admission:
Atenolol
Benadryl
Doxycycline

ALL: NKDA

Social History:
Drinks 1 pint/day; history of drinking for past 15 years
(longest sobriety 9 mo), history of 5 detoxes, including at
[**Hospital1 **] 1 yr ago
No tobacco/drug use
Cocaine x 1 in remote past
Grad from BC, MA in teaching in Brown, former teacher, currently
unemployed
Divorced [**2130**]
Living in shelters over past 5 yrs
Has 18 yo son living with ex-wife

Family History:
Grandparent with alcoholism

Physical Exam:
VS:  98.6       150/82    70     16     96% RA     wt=91.7 kg
Gen: mild distress, no tremor, somewhat disheveled, with beard
HEENT: PERRL, EOMI, OP clear
Neck: no lad, no JVD
Lungs: CTA bilaterally, no w/r/r
CV: RRR, nl S1/S1, no m/r/g
Abd: soft, nt/nd, nabs, no hsm
Extr: trace LE edema, R>L
Neuro/psych: denies SI, stable, requesting to leave

Pertinent Results:
EKG: NSR, LAD, nl intervals, no ST-T-wave changes, no change
from baseline EKG

CXR: low lung volumes, bibasilar atelectasis, NAD

[**2144-12-25**] 06:37PM   SODIUM-144
[**2144-12-25**] 06:37PM   LD(LDH)-243 CK(CPK)-123
[**2144-12-25**] 06:37PM   CK-MB-2 cTropnT-<0.01
[**2144-12-25**] 06:59AM   TYPE-ART PO2-138* PCO2-38 PH-7.47* TOTAL
CO2-28 BASE XS-4
[**2144-12-25**] 06:59AM   LACTATE-3.6* NA+-147
[**2144-12-25**] 06:10AM   GLUCOSE-136* UREA N-20 CREAT-0.8 SODIUM-148*
POTASSIUM-3.4 CHLORIDE-109* TOTAL CO2-27 ANION GAP-15
[**2144-12-25**] 06:10AM   ALT(SGPT)-24 AST(SGOT)-38 CK(CPK)-92 ALK
PHOS-58 TOT BILI-0.4
[**2144-12-25**] 06:10AM   CK-MB-NotDone cTropnT-<0.01
[**2144-12-25**] 06:10AM   CALCIUM-8.0* PHOSPHATE-2.4* MAGNESIUM-1.9
[**2144-12-25**] 03:20AM URINE  bnzodzpn-POS barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2144-12-25**] 12:49AM   ASA-NEG ETHANOL-398* ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

Brief Hospital Course:
A/P: 55 yo male, h/o alcohol abuse, HTN, TBI (pedestrian
accident), who presented after an overdose with EtOH,
?atenolol/benadryl, intubated initially for airway protection,
now extubated, doing well, transferred from MICU (overnight
stay) to floor.

1.  Alcohol overdose: pt s/p large amount of alcohol with
benadryl/atenolol, s/p intubation for airway protection and
overnight MICU stay for observation, received charcoal in the
ED, now extubated and doing well. He was maintained on CIWA
scale as well as on standing valium.  He required 45 mg valium 1
day post-extubation.  He was then put on 10 mg TID and tapered
accordingly. He did not require additional valium as per CIWA,
was stable hemodynamically, with no signs of DT's/autonomic
instability.  He was started on MVI/thiamine/folate supplements.
 He continued to deny any suicidal ideations and denied that his
overdose was a suicide attempt.  As per psych, he has a history
of changing his story/lying, and it was felt that he required
further psychiatric hospitalization. He was screened by BEST and
placed accordingly.

2.  Psych: as above, denies any SI/denies current SI.  As above,
psych felt he was not being completely truthful about his story.
 They recommended placement as per BEST.  He was screened and
placed accordingly.

3.  Hypernatremia: pt with Na=150 on admission, repleted free
water deficit (D5W) and Na 140 on transfer to the floor.  He
likely had hyponatremic hyponatremia which responded to fluid
resuscitation. His hyponatremia remained stable throughout the
rest of his hospitalization.

4.  HTN: Initially held BP meds, and Atenolol was restarted on
discharge.  His PCP should address with him the possibility of
adding a second bp [**Doctor Last Name 360**] for better control.

5.  CAD: cycled enzymes on admission, 2 sets neg, no EKG
changes, atenolol was continued on discharge, and pt with no
more symptoms.

6.  Dispo: Pt was stable on discharge.  He was discharged to
complete a valium taper.  He was discharged/placed as per BEST
on [**Hospital1 **] 4.


Medications on Admission:
Meds on Admission:
Atenolol 50 mg
Benadryl
Doxycycline

ALL: NKDA

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

4. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed.
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed.
7. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
8. Diazepam 5 mg Tablet Sig: One (1) Tablet PO three times a day
as needed for 3 days: Please take 5 mg TID on [**12-28**] mg TID on
[**12-29**], 1mg TID on [**12-30**], then stop.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary diagnosis:
Alcohol overdose requiring intubation

Secondary diagnosis:
Hypertension


Discharge Condition:
Good

Discharge Instructions:
1.  Please take all your medications as prescribed.  The only
thing we added was a valium taper.  You should take 5 mg TID on
[**12-28**] mg TID on [**12-29**], 1mg TID on [**12-30**], and then off.  We also
added some vitamin supplements (thiamine, MVI, folate) that you
should take daily
2.  Please follow up with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], within 1-2 weeks
of leaving your facility.  Bring this discharge paperwork with
you to the appointment.
3.  Please call your PCP if you are experiencing chest pain,
shortness of breath, fevers/chills, or with any other concerns.

Followup Instructions:
Please follow up with your PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **], within 1-2 weeks of
leaving your facility.  Bring this discharge paperwork with you
to the appointment.  At this time, he should continue adding
another [**Doctor Last Name 360**] for blood pressure control to your regimen.
{'Toxic effect of ethyl alcohol,Acute respiratory failure,Hyposmolality and/or hyponatremia,Poisoning by other and unspecified agents primarily affecting the cardiovascular system,Poisoning by antiallergic and antiemetic drugs,Accidental poisoning by alcoholic beverages,Accidental poisoning by agents primarily affecting cardiovascular system,Unspecified essential hypertension,Rash and other nonspecific skin eruption,Depressive disorder, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Lack of housing,Cerebral artery occlusion, unspecified without mention of cerebral infarction'}


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: alcohol overdose

PRESENT ILLNESS: 55 yo male, h/o alcohol abuse, HTN, TBI (hit as a pedestrian,
with pins in leg at this time), presenting s/p overdose with
alcohol.  Pt was apparently found wandering around the street in
[**Location (un) 686**], brought in to hospital by EMS.  In the ED, he states
that he took [**1-24**] bottle of atenolol with ?amt Benadryl and vodka
(drinks 1 pint/day alcohol at baseline).  He was initially
following commands in the ED, with stable vitals, but his O2
sats dropped to 75%, became cyanotic, and he was intubated for
airway protection/admitted to the MICU for observation. He was
also given 50 mg charcoal in the ED.  He was put on CIWA, with
valium as needed, propofol gtt while intubated.  Pt was
extubated the next morning, did well, and was transferred for
the floor for further observation.  Pt was seen by psych,
reportedly had no current SI's (and was not trying to commit
suicide with overdose), but he does report symptoms of
depression (finanacial, family problems, concerns about his
son).  On admission, he also had a sodium of 150 which resolved
after hydration with D5W (presumed hypovolemic hypernatremia [**2-24**]
dehydration).

MEDICAL HISTORY: 1.  TBI, [**2-24**] being hit as a pedestrian, currently with pins in
knee
2.  HTN, on medication
3.  Alcohol abuse; no history of psych disease or inpt/outp
treatment
4.  ?facial rash/rosacea, on doxy

MEDICATION ON ADMISSION: Meds on Admission:
Atenolol 50 mg
Benadryl
Doxycycline

ALLERGIES: Penicillins

PHYSICAL EXAM: VS:  98.6       150/82    70     16     96% RA     wt=91.7 kg
Gen: mild distress, no tremor, somewhat disheveled, with beard
HEENT: PERRL, EOMI, OP clear
Neck: no lad, no JVD
Lungs: CTA bilaterally, no w/r/r
CV: RRR, nl S1/S1, no m/r/g
Abd: soft, nt/nd, nabs, no hsm
Extr: trace LE edema, R>L
Neuro/psych: denies SI, stable, requesting to leave

FAMILY HISTORY: Grandparent with alcoholism

SOCIAL HISTORY: Drinks 1 pint/day; history of drinking for past 15 years
(longest sobriety 9 mo), history of 5 detoxes, including at
[**Hospital1 **] 1 yr ago
No tobacco/drug use
Cocaine x 1 in remote past
Grad from BC, MA in teaching in Brown, former teacher, currently
unemployed
Divorced [**2130**]
Living in shelters over past 5 yrs
Has 18 yo son living with ex-wife 

### Response:
{'Toxic effect of ethyl alcohol,Acute respiratory failure,Hyposmolality and/or hyponatremia,Poisoning by other and unspecified agents primarily affecting the cardiovascular system,Poisoning by antiallergic and antiemetic drugs,Accidental poisoning by alcoholic beverages,Accidental poisoning by agents primarily affecting cardiovascular system,Unspecified essential hypertension,Rash and other nonspecific skin eruption,Depressive disorder, not elsewhere classified,Coronary atherosclerosis of native coronary artery,Lack of housing,Cerebral artery occlusion, unspecified without mention of cerebral infarction'}
