CHIEF COMPLAINT: Suspected overdose

PRESENT ILLNESS: 47M with history of hep C, DJD, osteoarthritis presenting in
police custody after reportedly ingesting prepared packets of
heroin or cocaine. Pt regularly injects heroin (2.5g/day) and
cocaine or heroin.  He reportedly swallowing 2gm bag of one of
these substances in plasticeal bag.  It is unknown exact amount
and if he consumed any cocaine.

MEDICAL HISTORY: hep C
DJD
osteoarthritis
Substance abuse disorder
depression/bipolar

MEDICATION ON ADMISSION: Celexa 40
Abilify 10
Wellbutrin 75
Lamictal 75

ALLERGIES: NSAIDS (Non-Steroidal Anti-Inflammatory Drug) / gabapentin

PHYSICAL EXAM: Vitals:  145/82, 88, 99% RA, 16
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-distended, bowel sounds present, no
organomegaly, no tenderness to palpation, no rebound or guarding

FAMILY HISTORY: NC

SOCIAL HISTORY: IVDU, smokes, no etoh.  lives in group home
Cocaine abuse, continuous,Chronic hepatitis C without mention of hepatic coma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified
Cocaine abuse-continuous,Chrnc hpt C wo hpat coma,Osteoarthros NOS-unspec,Depressive disorder NEC
Admission Date:  [**2154-7-9**]              Discharge Date:   [**2154-7-10**]

Date of Birth:  [**2106-8-21**]             Sex:   M

Service: MEDICINE

Allergies:
NSAIDS (Non-Steroidal Anti-Inflammatory Drug) / gabapentin

Attending:[**First Name3 (LF) 3984**]
Chief Complaint:
Suspected overdose

Major Surgical or Invasive Procedure:
None

History of Present Illness:
47M with history of hep C, DJD, osteoarthritis presenting in
police custody after reportedly ingesting prepared packets of
heroin or cocaine. Pt regularly injects heroin (2.5g/day) and
cocaine or heroin.  He reportedly swallowing 2gm bag of one of
these substances in plasticeal bag.  It is unknown exact amount
and if he consumed any cocaine.

Complains of back pain (chronic). No CP/SOB. No abdominal pain,
no n/v/d.

ED Course: pt awake and alert.
- Initial Vitals/Trigger: 99.5 100 138/95 12 100
- EKG: SR 81, normal axis no ST elevat qtc 408
- tox c/s - activated charcoal and whole bowel irrigation
Labs significant for serum tox:negative CBC: unremarkable
chemistry: bicarb 27, no gap.
- transfer vitals: 99.5 100 138/95 12 100% RA

On arrival to the MICU, patient's VS.  145/82, 88, 99% RA, 16,
afebrile.  He reports that he believes that he actually consumed
methamphetamine.  He complains of chest discomfort and is
concerned that he might rip out his NGT.  also felt like his
ears are very warm


Past Medical History:
hep C
DJD
osteoarthritis
Substance abuse disorder
depression/bipolar


Social History:
IVDU, smokes, no etoh.  lives in group home


Family History:
NC

Physical Exam:
Vitals:  145/82, 88, 99% RA, 16
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-distended, bowel sounds present, no
organomegaly, no tenderness to palpation, no rebound or guarding

GU: no foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, 2+ reflexes bilaterally, gait
deferred.

Pertinent Results:
[**2154-7-9**] 10:00PM   GLUCOSE-117* UREA N-17 CREAT-1.2 SODIUM-142
POTASSIUM-3.8 CHLORIDE-103 TOTAL CO2-27 ANION GAP-16
[**2154-7-9**] 10:00PM   CK(CPK)-242
[**2154-7-9**] 10:00PM   cTropnT-<0.01
[**2154-7-9**] 10:00PM   CK-MB-3
[**2154-7-9**] 10:00PM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2154-7-9**] 10:00PM   WBC-4.9 RBC-4.77 HGB-13.5* HCT-41.6 MCV-87
MCH-28.3 MCHC-32.5 RDW-14.5
[**2154-7-9**] 10:00PM   NEUTS-66.1 LYMPHS-27.2 MONOS-5.5 EOS-0.5
BASOS-0.7
[**2154-7-9**] 10:00PM   PLT COUNT-134*
[**2154-7-10**] 01:42AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG

Discharge labs
[**2154-7-10**] 02:52AM BLOOD WBC-4.8 RBC-4.59* Hgb-13.0* Hct-39.4*
MCV-86 MCH-28.4 MCHC-33.1 RDW-14.6 Plt Ct-120*
[**2154-7-10**] 02:52AM BLOOD Glucose-108* UreaN-17 Creat-1.2 Na-142
K-3.9 Cl-108 HCO3-23 AnGap-15
[**2154-7-10**] 02:52AM BLOOD ALT-47* AST-40 AlkPhos-62 TotBili-0.2
[**2154-7-10**] 02:52AM BLOOD CK-MB-3 cTropnT-<0.01

Brief Hospital Course:
47M with h/o substance abuse, presents to [**Hospital1 18**] ED in police
custody after reported ingestion of heroin and cocaine vs meth

# Overdose: Patient was given one dose of activated charcoal
(1g/kg) in ED and was given GoLytely until charcoal noted to
pass. Patient did not pass any plastiseal bags, however.  Pt did
not have any signs or symptoms of overdose.  Patient remained
hemodynamicaly stable.  His blood and urine tox screens were
negative. EKG was unremarkable.  He is medically cleared to
return to jail under police custody.

# depression: c/w home meds

# Hep C: not currently treated.  does not appear to have
stigmata of cirrhosis


Medications on Admission:
Celexa 40
Abilify 10
Wellbutrin 75
Lamictal 75


Discharge Medications:
1. citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day.
2. aripiprazole 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Wellbutrin XL 150 mg Tablet Extended Release 24 hr Sig: 0.5
Tablet Extended Release 24 hr PO once a day.
4. lamotrigine 25 mg Tablet Sig: Three (3) Tablet PO DAILY
(Daily).


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary: Claimed drug overdose

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

Discharge Instructions:
Dear Mr [**Known lastname **],

You were brought here after claiming drug ingestion.  Your
toxicologies were negative and you did not have any signs or
symptoms of drug overdose.  You are safe to be discharged to
jail.

Followup Instructions:
With PCP at regular follow up

                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 2437**] MD [**MD Number(1) 2438**]
{'Cocaine abuse, continuous,Chronic hepatitis C without mention of hepatic coma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified'}


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: Suspected overdose

PRESENT ILLNESS: 47M with history of hep C, DJD, osteoarthritis presenting in
police custody after reportedly ingesting prepared packets of
heroin or cocaine. Pt regularly injects heroin (2.5g/day) and
cocaine or heroin.  He reportedly swallowing 2gm bag of one of
these substances in plasticeal bag.  It is unknown exact amount
and if he consumed any cocaine.

MEDICAL HISTORY: hep C
DJD
osteoarthritis
Substance abuse disorder
depression/bipolar

MEDICATION ON ADMISSION: Celexa 40
Abilify 10
Wellbutrin 75
Lamictal 75

ALLERGIES: NSAIDS (Non-Steroidal Anti-Inflammatory Drug) / gabapentin

PHYSICAL EXAM: Vitals:  145/82, 88, 99% RA, 16
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP not elevated, no LAD
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-distended, bowel sounds present, no
organomegaly, no tenderness to palpation, no rebound or guarding

FAMILY HISTORY: NC

SOCIAL HISTORY: IVDU, smokes, no etoh.  lives in group home 

### Response:
{'Cocaine abuse, continuous,Chronic hepatitis C without mention of hepatic coma,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Depressive disorder, not elsewhere classified'}
