CHIEF COMPLAINT: Vomiting

PRESENT ILLNESS: [**Known lastname 35961**] is a 37 year old right handed woman with a history of
intractable epilepsy.  In [**Month (only) 205**] of this year she started Felbatol
and this was increased to 1200mg TID in [**Month (only) **].  Her seizures
had improved from daily to weekly frequency. Her LFTS and CBC
were normal [**2119-8-4**]. Her other medications were Lyrica 200mg
[**Hospital1 **] and Topamax 300mg [**Hospital1 **] in addition to Depo-Provera and
Calcium.

MEDICAL HISTORY: Seizure disorder

MEDICATION ON ADMISSION: Medications:
Lyrica 200 mg PO BID
Felbamate 1000 mg TID
Topamax 300 mg TID
Depo-Provera

ALLERGIES: Neosporin Scar Solution / adhesive tape

PHYSICAL EXAM: Physical exam:  General physical exam is unremarkable.
Vital signs are stable and she is afebrile.
Neurological exam:
Mental Status:  She was alert and oriented, a bit irritable at
times.
Cranial nerves:  Extra-ocular movements are intact with end gaze
nystagmus bilaterally.  Face is symmetric.
Motor:  Normal tone and bulk. Strength is full throughout. There
is no drift or tremor.
Sensation to light touch is intact.
Coordination: Finger to nose is intact.

FAMILY HISTORY: Family History: no migraines, no stroke and no other family
members with epilepsy.

SOCIAL HISTORY: Social: FROM PREVIOUS NOTE confirmed by patient: She quit [**Hospital1 **]
[**Hospital1 189**] in the criminal justic department and went back in home
back in [**Month (only) 958**] or [**Month (only) 547**]/[**2116**].  She said it was because of
problems she was having with the school, not with the academics.
She is currently working in the family business flower shop.
Poisoning by aromatic analgesics, not elsewhere classified,Acute and subacute necrosis of liver,Epilepsy, unspecified, with intractable epilepsy,Acidosis,Other and unspecified coagulation defects,Accidental poisoning by aromatic analgesics, not elsewhere classified,Personal history of tobacco use,Proteinuria,Open wound of face, unspecified site, without mention of complication,Fall resulting in striking against other object
Pois-arom analgesics NEC,Acute necrosis of liver,Epilepsy NOS w intr epil,Acidosis,Coagulat defect NEC/NOS,Acc poison-arom analgesc,History of tobacco use,Proteinuria,Open wound of face NOS,Fall striking object NEC
Admission Date:  [**2119-10-15**]              Discharge Date:   [**2119-10-18**]

Date of Birth:  [**2082-3-9**]             Sex:   F

Service: NEUROLOGY

Allergies:
Neosporin Scar Solution / adhesive tape

Attending:[**First Name3 (LF) 11344**]
Chief Complaint:
Vomiting

Major Surgical or Invasive Procedure:
None


History of Present Illness:
 [**Known lastname 35961**] is a 37 year old right handed woman with a history of
intractable epilepsy.  In [**Month (only) 205**] of this year she started Felbatol
and this was increased to 1200mg TID in [**Month (only) **].  Her seizures
had improved from daily to weekly frequency. Her LFTS and CBC
were normal [**2119-8-4**]. Her other medications were Lyrica 200mg
[**Hospital1 **] and Topamax 300mg [**Hospital1 **] in addition to Depo-Provera and
Calcium.

On [**10-11**], the patient had accidental non-seizure related facial
and head trauma (see other notes for more details) in the
setting
of a few alcoholic beverages. The days after she had
considerable
pain and took 8g of acetaminophen in a 24h period of time. Then,
on [**10-14**] she presented to [**Hospital1 18**] ER with nausea and vomiting and
was found to have acute hepatitis with elevated transaminases
and
coagulations tests.   Her felbatol was stopped and Topamax was
decreased and she was started on Keppra.  In addition she
received a single loading dose of Dilantin and has received
intermittent Ativan as needed for seizures. She was evaluated by
the liver consult service and hepatic diagnostic testing was
sent.  Since then her liver function testing has improved.

She has now had multiple seizures over the past 2 days and is
being transferred to epilepsy service for futher management of
her refractory epilepsy.


Past Medical History:
Seizure disorder

Social History:
Social: FROM PREVIOUS NOTE confirmed by patient: She quit [**Hospital1 **]
[**Hospital1 189**] in the criminal justic department and went back in home
back in [**Month (only) 958**] or [**Month (only) 547**]/[**2116**].  She said it was because of
problems she was having with the school, not with the academics.
She is currently working in the family business flower shop.


Family History:
Family History: no migraines, no stroke and no other family
members with epilepsy.


Physical Exam:
Physical exam:  General physical exam is unremarkable.
Vital signs are stable and she is afebrile.
Neurological exam:
Mental Status:  She was alert and oriented, a bit irritable at
times.
Cranial nerves:  Extra-ocular movements are intact with end gaze
nystagmus bilaterally.  Face is symmetric.
Motor:  Normal tone and bulk. Strength is full throughout. There
is no drift or tremor.
Sensation to light touch is intact.
Coordination: Finger to nose is intact.


Pertinent Results:
[**2119-10-18**] 06:15AM BLOOD WBC-4.0 RBC-3.80* Hgb-12.8 Hct-36.3
MCV-96 MCH-33.6* MCHC-35.1* RDW-13.5 Plt Ct-218
[**2119-10-18**] 06:15AM BLOOD PT-14.4* PTT-32.3 INR(PT)-1.2*
[**2119-10-18**] 06:15AM BLOOD Plt Ct-218
[**2119-10-15**] 06:44PM BLOOD Fibrino-269
[**2119-10-18**] 06:15AM BLOOD Glucose-80 UreaN-8 Creat-0.7 Na-139 K-3.6
Cl-108 HCO3-21* AnGap-14
[**2119-10-18**] 06:15AM BLOOD ALT-1148* AST-165* LD(LDH)-208
AlkPhos-103 TotBili-0.6
[**2119-10-14**] 10:40PM BLOOD ALT-3930* AST-4596* CK(CPK)-164
AlkPhos-118* TotBili-0.7
[**2119-10-18**] 06:15AM BLOOD Calcium-9.4 Phos-4.2# Mg-2.2
[**2119-10-15**] 06:44PM BLOOD calTIBC-164 Ferritn-2705* TRF-126*
[**2119-10-15**] 05:40AM BLOOD Ammonia-71*
[**2119-10-15**] 05:40AM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE
HBcAb-NEGATIVE HAV Ab-NEGATIVE IgM HAV-NEGATIVE
[**2119-10-15**] 05:40AM BLOOD AMA-NEGATIVE Smooth-NEGATIVE
[**2119-10-15**] 05:40AM BLOOD [**Doctor First Name **]-NEGATIVE
[**2119-10-15**] 06:44PM BLOOD IgG-549* IgM-111
[**2119-10-16**] 12:00PM BLOOD Phenyto-16.5

Brief Hospital Course:
Pt [**Name (NI) 35961**] was initially seen in the ED after intractable
vomiting and fear that she would have seizures. She had vomiting
secondary to acute liver failure in the setting of ETOH use, [**4-25**]
grams of Tylenol consumption over 24 hours and felbamate  use.
She was taken off all her AED's and she had a number of seizures
that were initially controlled with PRN Ativan and Keppra IV. As
her liver enzymes trended down she was restarted on lyrica and
topomax. Felbamate was not restarted and she continued on
keppra. She continued to have seizures but to a lesser extent
then on admission. She was evaluated by hepatology and the liver
transplant team. She was transferred to the neurology team for
further care and discharged the follow day. She was told to
follow up closely with the GI, PCP, [**Name10 (NameIs) **] Neurology services. She
had a script for outpatient lab draws.

Medications on Admission:
Medications:
Lyrica 200 mg PO BID
Felbamate 1000 mg TID
Topamax 300 mg TID
Depo-Provera


Discharge Medications:
1. pregabalin 100 mg Capsule Sig: Two (2) Capsule PO BID (2
times a day).
Disp:*120 Capsule(s)* Refills:*2*
2. topiramate 100 mg Tablet Sig: Three (3) Tablet PO BID (2
times a day).
Disp:*180 Tablet(s)* Refills:*2*
3. levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2
times a day).
Disp:*120 Tablet(s)* Refills:*2*
4. Outpatient Lab Work
Liver Function Test: AST,ALT,Total Bilirubin, INR, PT, PTT, LDH.
  Please have lab's drawn [**2119-10-20**]
5. Outpatient Lab Work
Liver Function Test: AST,ALT,Total Bilirubin, INR, PT, PTT, LDH.
  Please have lab's drawn [**2119-10-24**]
6. Outpatient Lab Work
Liver Function Test: AST,ALT,Total Bilirubin, INR, PT, PTT, LDH.
  Please have lab's drawn [**2119-10-31**]


Discharge Disposition:
Home

Discharge Diagnosis:
Tylenol Overdose


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


Discharge Instructions:
You were admitted for acute liver failure in the setting of
taking [**4-25**] grams of tylenol. You were taken off the Felbamate
beacuse this could also cause liver failure. You were slowly put
back on your tomopax and lyrica and you were started on Keppra.
Your seizure are controlled but not fully. You will need to
follow up with Dr [**First Name (STitle) **] for medicaiton adjustments. You will
also have a follow up appointment to be seen by the liver
doctors.  Please do not take the felbamate. Please do not take
tylenol. Please do not drink alcohol. Please do not drive.

Followup Instructions:
Department: NEUROLOGY
When: FRIDAY [**2119-11-3**] at 4:00 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 7025**], MD [**Telephone/Fax (1) 3294**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 858**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: LIVER CENTER
When: MONDAY [**2119-10-23**] at 11:50 AM
With: [**Name6 (MD) 1382**] [**Name8 (MD) 1383**], MD [**Telephone/Fax (1) 2422**]
Building: LM [**Hospital Unit Name **] [**Location (un) 858**]
Campus: WEST     Best Parking: [**Hospital Ward Name **] Garage

Department: [**Hospital3 249**]
When: WEDNESDAY [**2119-10-25**] at 11:40 AM
With: [**First Name8 (NamePattern2) 2878**] [**First Name8 (NamePattern2) 26**] [**Last Name (NamePattern1) 2879**], MD [**Telephone/Fax (1) 250**]
Building: [**Hospital6 29**] [**Location (un) **]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Provider: [**First Name8 (NamePattern2) 2878**] [**First Name8 (NamePattern2) 26**] [**Last Name (NamePattern1) 2879**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2119-10-26**] 10:40



Completed by:[**2119-10-19**]
{'Poisoning by aromatic analgesics, not elsewhere classified,Acute and subacute necrosis of liver,Epilepsy, unspecified, with intractable epilepsy,Acidosis,Other and unspecified coagulation defects,Accidental poisoning by aromatic analgesics, not elsewhere classified,Personal history of tobacco use,Proteinuria,Open wound of face, unspecified site, without mention of complication,Fall resulting in striking against other object'}


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: Vomiting

PRESENT ILLNESS: [**Known lastname 35961**] is a 37 year old right handed woman with a history of
intractable epilepsy.  In [**Month (only) 205**] of this year she started Felbatol
and this was increased to 1200mg TID in [**Month (only) **].  Her seizures
had improved from daily to weekly frequency. Her LFTS and CBC
were normal [**2119-8-4**]. Her other medications were Lyrica 200mg
[**Hospital1 **] and Topamax 300mg [**Hospital1 **] in addition to Depo-Provera and
Calcium.

MEDICAL HISTORY: Seizure disorder

MEDICATION ON ADMISSION: Medications:
Lyrica 200 mg PO BID
Felbamate 1000 mg TID
Topamax 300 mg TID
Depo-Provera

ALLERGIES: Neosporin Scar Solution / adhesive tape

PHYSICAL EXAM: Physical exam:  General physical exam is unremarkable.
Vital signs are stable and she is afebrile.
Neurological exam:
Mental Status:  She was alert and oriented, a bit irritable at
times.
Cranial nerves:  Extra-ocular movements are intact with end gaze
nystagmus bilaterally.  Face is symmetric.
Motor:  Normal tone and bulk. Strength is full throughout. There
is no drift or tremor.
Sensation to light touch is intact.
Coordination: Finger to nose is intact.

FAMILY HISTORY: Family History: no migraines, no stroke and no other family
members with epilepsy.

SOCIAL HISTORY: Social: FROM PREVIOUS NOTE confirmed by patient: She quit [**Hospital1 **]
[**Hospital1 189**] in the criminal justic department and went back in home
back in [**Month (only) 958**] or [**Month (only) 547**]/[**2116**].  She said it was because of
problems she was having with the school, not with the academics.
She is currently working in the family business flower shop. 

### Response:
{'Poisoning by aromatic analgesics, not elsewhere classified,Acute and subacute necrosis of liver,Epilepsy, unspecified, with intractable epilepsy,Acidosis,Other and unspecified coagulation defects,Accidental poisoning by aromatic analgesics, not elsewhere classified,Personal history of tobacco use,Proteinuria,Open wound of face, unspecified site, without mention of complication,Fall resulting in striking against other object'}
