CHIEF COMPLAINT: Fall

PRESENT ILLNESS: 78 y/o man with PMH significant for COPD, hepattis C, and past
CVA admitted to the MICU on [**8-27**] following an ASA overdose. Pt
initially was brought to BICM from [**Location (un) 15383**] [**Hospital **] Facility following a fall. Per report, pt was found on
the floor after staff heard a "thump". Per second hand reports,
the pt has left the ALF in the past to do "drugs" and reports
that he drank ETOH on the night prior to admission.
.
On arrival to the [**Hospital1 18**] ED, the pt's VS were 97.3  79  126/93
20  96% RA. He denied SOB, tinnitus, and nausea/vomiting. He was
alert but agitated per notes when his baseline is reported to be
alert and oriented x3. In the ED, his ASA level was significant
at 50 mg/dL. He denied recent ASA use but reported that he had
taken it in the past. Rest of her urine and serum tox screen was
negative. Other labs were significant for a serum bicarb of 12
and an anion gap of 19. Urine pH was 6.0 and urine ketones were
positive. ABG was 7.48/19/06 thus consistent with a primary
respiratory alkalosis and primary metabolic alkalosis. Central
access was obtained and the pt was given 1 amp of bicarb then
place on a bicab drip. Pt was then admitted to the MICU for
further care.

MEDICAL HISTORY: 1. COPD
2. Hepatitis C
3. H/O CVA with left sided hemiparesis
4. GERD
5. Chronic low blood pressure
6. Cervical stenosis
7. BPH with history of bladder outlet obstruction- Pt is s/p
TURP in [**2140**].
8. Cervical and lumbar spinal stenosis
9. GERD
10. Neurogenic bladder
11. AAA
12. H/O nephrolithiasis
13. H/O diverticulitis
14. H/O LE edema
15. Cataracts
16. Peripheral neuropathy
17. S/P multiple rib fractures
18. Multifactorial gait abnormality
19. Chronic peripheral edema
20. DJD of the right knee

MEDICATION ON ADMISSION: ALF Medications:
1. ASA 81 mg daily
2. Docusate 100 mg [**Hospital1 **]
3. Tramadol 50 mg QID
4. MOM 30 ml PRN
5. Tylenol 600 mg Q4H PRN
6. Capsacian cream

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.0  144/73  61  14  99% RA
Gen- Alert. Oriented only to self. Does not know month, year,
place, or where he normally lives. Does recognize his health
care proxy who is with him.
HEENT- NC AT. PERRL. EOMI. Anicteric sclera. MMM. No lesions in
the oropharynx. Poor dentition.
Cardiac- RRR. S1 S2. III/VI SEM.
Pulm- CTAB. No wheezes, rales, or rhonchi.
Abdomen- Soft. Mild diffuse tenderness. No rebound or gaurding.
ND. Positive bowel sounds
Extremities- No c/c/e.
Neuro- CN II-XII intact. 5/5 strength in upper and lower
extremities on the right. 4/5 strength in upper and lower
extremities on the left.

FAMILY HISTORY: n/c

SOCIAL HISTORY: Pt lives at the [**Location (un) 15383**] [**Hospital3 400**] Facility. He used
to sing with the BB [**Doctor Last Name **] Orchestra and he still sings the blues.
Prior history of ETOH, tobacco, and IV drug use. I met the [**Hospital **]
health care proxy [**Name (NI) 401**] [**Name (NI) **]. His phone numbers are [**Telephone/Fax (1) 62678**]
and [**Telephone/Fax (1) 62679**].
Poisoning by salicylates,Alkalosis,Drug-induced delirium,Unspecified viral hepatitis C without hepatic coma,Other and unspecified coagulation defects,Chronic airway obstruction, not elsewhere classified,Accidental poisoning by salicylates,Other fall,Personal history of alcoholism,Other persistent mental disorders due to conditions classified elsewhere,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Neurogenic bladder NOS,Spinal stenosis in cervical region
Poisoning-salicylates,Alkalosis,Drug-induced delirium,Hpt C w/o hepat coma NOS,Coagulat defect NEC/NOS,Chr airway obstruct NEC,Acc poison-salicylates,Fall NEC,Hx of alcoholism,Mental disor NEC oth dis,Late ef-hemplga side NOS,Neurogenic bladder NOS,Cervical spinal stenosis
Admission Date:  [**2143-8-27**]              Discharge Date:   [**2143-9-2**]

Date of Birth:  [**2064-6-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 6029**]
Chief Complaint:
Fall

Major Surgical or Invasive Procedure:
None


History of Present Illness:
78 y/o man with PMH significant for COPD, hepattis C, and past
CVA admitted to the MICU on [**8-27**] following an ASA overdose. Pt
initially was brought to BICM from [**Location (un) 15383**] [**Hospital **] Facility following a fall. Per report, pt was found on
the floor after staff heard a "thump". Per second hand reports,
the pt has left the ALF in the past to do "drugs" and reports
that he drank ETOH on the night prior to admission.
.
On arrival to the [**Hospital1 18**] ED, the pt's VS were 97.3  79  126/93
20  96% RA. He denied SOB, tinnitus, and nausea/vomiting. He was
alert but agitated per notes when his baseline is reported to be
alert and oriented x3. In the ED, his ASA level was significant
at 50 mg/dL. He denied recent ASA use but reported that he had
taken it in the past. Rest of her urine and serum tox screen was
negative. Other labs were significant for a serum bicarb of 12
and an anion gap of 19. Urine pH was 6.0 and urine ketones were
positive. ABG was 7.48/19/06 thus consistent with a primary
respiratory alkalosis and primary metabolic alkalosis. Central
access was obtained and the pt was given 1 amp of bicarb then
place on a bicab drip. Pt was then admitted to the MICU for
further care.

Past Medical History:
1. COPD
2. Hepatitis C
3. H/O CVA with left sided hemiparesis
4. GERD
5. Chronic low blood pressure
6. Cervical stenosis
7. BPH with history of bladder outlet obstruction- Pt is s/p
TURP in [**2140**].
8. Cervical and lumbar spinal stenosis
9. GERD
10. Neurogenic bladder
11. AAA
12. H/O nephrolithiasis
13. H/O diverticulitis
14. H/O LE edema
15. Cataracts
16. Peripheral neuropathy
17. S/P multiple rib fractures
18. Multifactorial gait abnormality
19. Chronic peripheral edema
20. DJD of the right knee

Social History:
Pt lives at the [**Location (un) 15383**] [**Hospital3 400**] Facility. He used
to sing with the BB [**Doctor Last Name **] Orchestra and he still sings the blues.
Prior history of ETOH, tobacco, and IV drug use. I met the [**Hospital **]
health care proxy [**Name (NI) 401**] [**Name (NI) **]. His phone numbers are [**Telephone/Fax (1) 62678**]
and [**Telephone/Fax (1) 62679**].

Family History:
n/c

Physical Exam:
99.0  144/73  61  14  99% RA
Gen- Alert. Oriented only to self. Does not know month, year,
place, or where he normally lives. Does recognize his health
care proxy who is with him.
HEENT- NC AT. PERRL. EOMI. Anicteric sclera. MMM. No lesions in
the oropharynx. Poor dentition.
Cardiac- RRR. S1 S2. III/VI SEM.
Pulm- CTAB. No wheezes, rales, or rhonchi.
Abdomen- Soft. Mild diffuse tenderness. No rebound or gaurding.
ND. Positive bowel sounds
Extremities- No c/c/e.
Neuro- CN II-XII intact. 5/5 strength in upper and lower
extremities on the right. 4/5 strength in upper and lower
extremities on the left.

Pertinent Results:
[**2143-8-27**] 01:49AM BLOOD WBC-5.2 RBC-4.23* Hgb-13.1* Hct-39.4*
MCV-93 MCH-30.9 MCHC-33.2 RDW-15.4 Plt Ct-135*
[**2143-8-30**] 04:49AM BLOOD WBC-3.4* RBC-3.92* Hgb-11.9* Hct-36.9*
MCV-94 MCH-30.4 MCHC-32.3 RDW-15.1 Plt Ct-120*
[**2143-8-27**] 01:49AM BLOOD Neuts-59.8 Lymphs-33.3 Monos-5.5 Eos-1.3
Baso-0.2
[**2143-8-30**] 04:49AM BLOOD Neuts-50.7 Lymphs-36.0 Monos-5.5 Eos-7.6*
Baso-0.3
[**2143-8-27**] 01:49AM BLOOD PT-16.2* PTT-31.4 INR(PT)-1.8
[**2143-8-30**] 04:49AM BLOOD PT-16.0* PTT-87.1* INR(PT)-1.8
[**2143-8-27**] 01:49AM BLOOD Glucose-85 UreaN-19 Creat-1.0 Na-137
K-3.9 Cl-106 HCO3-12* AnGap-23*
[**2143-8-30**] 04:49AM BLOOD Glucose-107* UreaN-6 Creat-0.6 Na-139
K-3.8 Cl-109* HCO3-23 AnGap-11
[**2143-8-27**] 01:49AM BLOOD ALT-84* AST-161* AlkPhos-81 Amylase-54
TotBili-0.6
[**2143-8-27**] 01:49AM BLOOD Lipase-14
[**2143-8-27**] 01:49AM BLOOD Albumin-3.8 Calcium-8.5 Phos-3.2 Mg-2.4
[**2143-8-30**] 04:49AM BLOOD Calcium-8.3* Phos-3.2 Mg-1.7
[**2143-8-28**] 03:20AM BLOOD calTIBC-268 VitB12-805 Hapto-23* TRF-206
[**2143-8-27**] 08:00AM BLOOD Osmolal-288
[**2143-8-28**] 03:20AM BLOOD TSH-0.76
[**2143-8-27**] 01:49AM BLOOD ASA-50* Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2143-8-27**] 05:40AM BLOOD Type-ART pO2-96 pCO2-19* pH-7.48*
calHCO3-15* Base XS--5 Intubat-NOT INTUBA

CT C Spine ([**8-27**])- Extensive degenerative change throughout the
cervical spine with loss of intervertebral disc space height at
multiple levels and vaccum disc degeneration. Loss of vertebral
body height and sclerosis seen at C3, C4, and C5. Pt is s/p
laminectomy of C3 through C7. Mild retrolisthesis of C3 on C4
and C4 on C5. Also mild anterolisthesis of C7 on T1. Disc
herniations are seen at C3/4, S4/5, and C5/6. Soft tissues are
unremarkable.
.
CT head ([**8-27**])- No evidence of intracranial hemorrhage,
hydrocephalus, shift of normally midline structures, or edema.
Small-to-moderate amount of periventricular white matter
hypoattenuation consistent with chronic small vessel ischemia.
[**Doctor Last Name **]-shite matter differentioation appears intact throughout.
Opacified right sphenoid sinus with sclerotic sinus wall
indicative of chronic sinusitis.

Brief Hospital Course:
78 y/o man with PMH significant for COPD, hepattis C, and past
CVA admitted to the MICU on [**8-27**] following an ASA overdose.
.
1. Overdose - The pt was followed by the toxicology and renal
services. Pt was continued on a bicarb drip in the MICU and 5 mg
SQ vitamin K for coagulopathy. Pt's potassium was also
agressively repleated. He did not require hemodialysis. On
[**8-28**], the bicarbonate drip was discontinued per toxicology
recommendations. He was called out to the floor and remained
stable while there.  Psychiatry was consulted and felt that the
overdose was not a suicide attempt and may have been the result
of underlying dementia.  His lytes were followed closely and
repleted prn.
.
2. Altered mental status- The pt is oriented only to himself and
has very poor short term memory at baseline likely secondary to
a strong pmh of alcoholism.  On admission he was acutely
agitated and oriented x0.  However, this cleared well throughout
his admission and he returned to baseline prior to his d/c.
Psychiatry felt that he had underlying dementia and recommended
outpatient monitoring for this condition.  He was originally
maintained on a CIWA scale but this was d/c prior to his d/c.
He also required a sitter early in his admission but this also
was d/c prior to his discharge.
.
3. COPD - His breathing, per pt report, was at baseline on the
floor and no interventions were attempted.
.
4. Gerd - the patient was maintained on protonix during his
admission.
.
5. Fall - The etiology of his fall was either mechanical or
related to his aspirin overdose.  He was evaluated by PT who
recommended that he be d/c to a rehab facility and this was
done.
.


Medications on Admission:
ALF Medications:
1. ASA 81 mg daily
2. Docusate 100 mg [**Hospital1 **]
3. Tramadol 50 mg QID
4. MOM 30 ml PRN
5. Tylenol 600 mg Q4H PRN
6. Capsacian cream

Discharge Medications:
1. Nicotine 2 mg Gum Sig: Two (2) mg Buccal Q1H (every hour) as
needed.
2. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).
3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
5. Haloperidol 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day) as needed for Agitation.


Discharge Disposition:
Home With Service

Facility:
[**Location (un) **]

Discharge Diagnosis:
Primary diagnosis:
ASA overdose

Secondary diagnosis:
Mental status changes
S/P fall


Discharge Condition:
Stable


Discharge Instructions:
1. Please take all medications as prescribed.

2. Please keep all follow up appointments.

3. Seek medical attention for fevers, chills, chest pain,
abdominal pain, shortness of breath, or any other concerning
symptoms.

Followup Instructions:
1. You will be followed by the physician at [**Location (un) 15383**]
[**Hospital3 400**] when you return there following your rehab stay.

2. Please follow-up with your primary care physician [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] at the VA on [**9-12**] at 3:00 PM. Call [**Telephone/Fax (1) 41354**] if you
have any questions about this appointment.


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(2) 6035**]

Completed by:[**2143-9-2**]
{'Poisoning by salicylates,Alkalosis,Drug-induced delirium,Unspecified viral hepatitis C without hepatic coma,Other and unspecified coagulation defects,Chronic airway obstruction, not elsewhere classified,Accidental poisoning by salicylates,Other fall,Personal history of alcoholism,Other persistent mental disorders due to conditions classified elsewhere,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Neurogenic bladder NOS,Spinal stenosis in cervical region'}


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: Fall

PRESENT ILLNESS: 78 y/o man with PMH significant for COPD, hepattis C, and past
CVA admitted to the MICU on [**8-27**] following an ASA overdose. Pt
initially was brought to BICM from [**Location (un) 15383**] [**Hospital **] Facility following a fall. Per report, pt was found on
the floor after staff heard a "thump". Per second hand reports,
the pt has left the ALF in the past to do "drugs" and reports
that he drank ETOH on the night prior to admission.
.
On arrival to the [**Hospital1 18**] ED, the pt's VS were 97.3  79  126/93
20  96% RA. He denied SOB, tinnitus, and nausea/vomiting. He was
alert but agitated per notes when his baseline is reported to be
alert and oriented x3. In the ED, his ASA level was significant
at 50 mg/dL. He denied recent ASA use but reported that he had
taken it in the past. Rest of her urine and serum tox screen was
negative. Other labs were significant for a serum bicarb of 12
and an anion gap of 19. Urine pH was 6.0 and urine ketones were
positive. ABG was 7.48/19/06 thus consistent with a primary
respiratory alkalosis and primary metabolic alkalosis. Central
access was obtained and the pt was given 1 amp of bicarb then
place on a bicab drip. Pt was then admitted to the MICU for
further care.

MEDICAL HISTORY: 1. COPD
2. Hepatitis C
3. H/O CVA with left sided hemiparesis
4. GERD
5. Chronic low blood pressure
6. Cervical stenosis
7. BPH with history of bladder outlet obstruction- Pt is s/p
TURP in [**2140**].
8. Cervical and lumbar spinal stenosis
9. GERD
10. Neurogenic bladder
11. AAA
12. H/O nephrolithiasis
13. H/O diverticulitis
14. H/O LE edema
15. Cataracts
16. Peripheral neuropathy
17. S/P multiple rib fractures
18. Multifactorial gait abnormality
19. Chronic peripheral edema
20. DJD of the right knee

MEDICATION ON ADMISSION: ALF Medications:
1. ASA 81 mg daily
2. Docusate 100 mg [**Hospital1 **]
3. Tramadol 50 mg QID
4. MOM 30 ml PRN
5. Tylenol 600 mg Q4H PRN
6. Capsacian cream

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 99.0  144/73  61  14  99% RA
Gen- Alert. Oriented only to self. Does not know month, year,
place, or where he normally lives. Does recognize his health
care proxy who is with him.
HEENT- NC AT. PERRL. EOMI. Anicteric sclera. MMM. No lesions in
the oropharynx. Poor dentition.
Cardiac- RRR. S1 S2. III/VI SEM.
Pulm- CTAB. No wheezes, rales, or rhonchi.
Abdomen- Soft. Mild diffuse tenderness. No rebound or gaurding.
ND. Positive bowel sounds
Extremities- No c/c/e.
Neuro- CN II-XII intact. 5/5 strength in upper and lower
extremities on the right. 4/5 strength in upper and lower
extremities on the left.

FAMILY HISTORY: n/c

SOCIAL HISTORY: Pt lives at the [**Location (un) 15383**] [**Hospital3 400**] Facility. He used
to sing with the BB [**Doctor Last Name **] Orchestra and he still sings the blues.
Prior history of ETOH, tobacco, and IV drug use. I met the [**Hospital **]
health care proxy [**Name (NI) 401**] [**Name (NI) **]. His phone numbers are [**Telephone/Fax (1) 62678**]
and [**Telephone/Fax (1) 62679**]. 

### Response:
{'Poisoning by salicylates,Alkalosis,Drug-induced delirium,Unspecified viral hepatitis C without hepatic coma,Other and unspecified coagulation defects,Chronic airway obstruction, not elsewhere classified,Accidental poisoning by salicylates,Other fall,Personal history of alcoholism,Other persistent mental disorders due to conditions classified elsewhere,Late effects of cerebrovascular disease, hemiplegia affecting unspecified side,Neurogenic bladder NOS,Spinal stenosis in cervical region'}
