CHIEF COMPLAINT: Seizures

PRESENT ILLNESS: Patient is a 36 yo male with PMHx significant for seizures
diagnosed in [**4-7**] transferred from OSH due to seizures.
.
Patient was initially diagnosed with seizures 2 months earlier
after being in perfect health.  He seizures remained controlled
on dilantin and he was eventually transitioned to trileptal.
The
patient did not tolerate the trileptal and was hospitalized for
lethargy and attention defecits in [**5-8**].  He has been maintained
since that time on dilantin.
Per wife the patient has not been well for the last three days.
He has been tripping and twitching.  He also has had diarrhea
with muscle aches.  He has been unable to complete tasks such as
cooking that were easier for him before.  The patient missed a
dose of dilantin three days earlier.  He was at home last PM and
his wife noticed him to be more twitchy.  Upon going to bed at ~
10:30 PM the patient immediately was noticed to be moving all 4
extremities and foaming at the mouth.  He did not have
bladder/bowel incontinence or tongue biting.  The episode lasted
for 1 minute and the patient remained lethargic and confused.
EMS was called and the patient was taken to [**Hospital 1562**] hospital
where he was noticed to have a dilantin level of 1.5.  The
patient also began to vomit and due to his persistent lethargy,
he was intubated for airway protection.  He was given 1 mg of
dilantin and transferred to [**Hospital1 18**].
In the ED the patient had another episode of limb shaking in the
ED that stopped after administration of 2 mg of ativan.  The
patient was started
on a propafol gtt.  He was also noted to have a rectal temp of
102.

MEDICAL HISTORY: Seizure disorder

MEDICATION ON ADMISSION: Meds
dilantin 300 mg po qhs
.
Allergies
penicillin/ciprofloxacin

ALLERGIES: Penicillins / Cipro

PHYSICAL EXAM: Vitals - 102.9  134/83  88  18  100% CMV
Gen - intubated
CV - RRR S1/S2 no m/r/g
RESP - CTA b/l
ABD - soft NT ND +BS
Ext - no c/c/e
.
Neurologic Exam
MS - intubated
CN - PERRL + corneal reflex
Motor - normal tone
Sensory - [**Last Name (un) **]
Reflexes = [**1-8**] throughout, L plantar flexor, R plantar extensor

FAMILY HISTORY: There are no seizure disorders in his immediate family.

SOCIAL HISTORY: [**Name (NI) 32085**]
Pt has a PhD from [**Hospital1 1012**] and is currently in rabbi[**Name (NI) **] school.
His wife is a psychiatrist at the [**Hospital1 **].
They have two children.
He does not smoke, and he drank socially prior to his seizure
disorder's being diagnosed.
Other convulsions,Intestinal infection due to Clostridium difficile
Convulsions NEC,Int inf clstrdium dfcile
Admission Date:  [**2112-6-6**]              Discharge Date:   [**2112-6-14**]

Date of Birth:  [**2075-5-22**]             Sex:   M

Service: NEUROLOGY

Allergies:
Penicillins / Cipro

Attending:[**First Name3 (LF) 618**]
Chief Complaint:
Seizures

Major Surgical or Invasive Procedure:
intubation


History of Present Illness:
Patient is a 36 yo male with PMHx significant for seizures
diagnosed in [**4-7**] transferred from OSH due to seizures.
.
Patient was initially diagnosed with seizures 2 months earlier
after being in perfect health.  He seizures remained controlled
on dilantin and he was eventually transitioned to trileptal.
The
patient did not tolerate the trileptal and was hospitalized for
lethargy and attention defecits in [**5-8**].  He has been maintained
since that time on dilantin.
Per wife the patient has not been well for the last three days.
He has been tripping and twitching.  He also has had diarrhea
with muscle aches.  He has been unable to complete tasks such as
cooking that were easier for him before.  The patient missed a
dose of dilantin three days earlier.  He was at home last PM and
his wife noticed him to be more twitchy.  Upon going to bed at ~
10:30 PM the patient immediately was noticed to be moving all 4
extremities and foaming at the mouth.  He did not have
bladder/bowel incontinence or tongue biting.  The episode lasted
for 1 minute and the patient remained lethargic and confused.
EMS was called and the patient was taken to [**Hospital 1562**] hospital
where he was noticed to have a dilantin level of 1.5.  The
patient also began to vomit and due to his persistent lethargy,
he was intubated for airway protection.  He was given 1 mg of
dilantin and transferred to [**Hospital1 18**].
In the ED the patient had another episode of limb shaking in the
ED that stopped after administration of 2 mg of ativan.  The
patient was started
on a propafol gtt.  He was also noted to have a rectal temp of
102.


Past Medical History:
Seizure disorder

Social History:
[**Name (NI) 32085**]
Pt has a PhD from [**Hospital1 1012**] and is currently in rabbi[**Name (NI) **] school.
His wife is a psychiatrist at the [**Hospital1 **].
They have two children.
He does not smoke, and he drank socially prior to his seizure
disorder's being diagnosed.


Family History:
There are no seizure disorders in his immediate family.

Physical Exam:
Vitals - 102.9  134/83  88  18  100% CMV
Gen - intubated
CV - RRR S1/S2 no m/r/g
RESP - CTA b/l
ABD - soft NT ND +BS
Ext - no c/c/e
.
Neurologic Exam
MS - intubated
CN - PERRL + corneal reflex
Motor - normal tone
Sensory - [**Last Name (un) **]
Reflexes = [**1-8**] throughout, L plantar flexor, R plantar extensor


Pertinent Results:
[**2112-6-6**] 08:38PM   GLUCOSE-103 UREA N-15 CREAT-1.2 SODIUM-144
POTASSIUM-3.6 CHLORIDE-107 TOTAL CO2-29 ANION GAP-12
[**2112-6-6**] 08:38PM   CALCIUM-9.0 PHOSPHATE-3.4 MAGNESIUM-2.0
[**2112-6-6**] 08:38PM   WBC-10.5 RBC-4.78 HGB-14.4 HCT-41.4 MCV-87
MCH-30.0 MCHC-34.7 RDW-12.6
[**2112-6-6**] 08:38PM   NEUTS-80.7* LYMPHS-12.6* MONOS-6.0 EOS-0.3
BASOS-0.4
[**2112-6-6**] 08:38PM   PLT COUNT-223
[**2112-6-6**] 06:10AM   TYPE-ART TEMP-39.3 PO2-305* PCO2-49* PH-7.39
TOTAL CO2-31* BASE XS-4 INTUBATED-INTUBATED
[**2112-6-6**] 06:09AM   LACTATE-3.2*
[**2112-6-6**] 05:10AM   GLUCOSE-220* UREA N-18 CREAT-1.3* SODIUM-141
POTASSIUM-3.6 CHLORIDE-103 TOTAL CO2-30 ANION GAP-12
[**2112-6-6**] 05:10AM   PHENYTOIN-15.4
[**2112-6-6**] 05:10AM URINE  HOURS-RANDOM
[**2112-6-6**] 05:10AM URINE  GR HOLD-HOLD
[**2112-6-6**] 05:10AM   WBC-15.6*# RBC-4.91 HGB-14.4 HCT-42.1 MCV-86
MCH-29.4 MCHC-34.3 RDW-12.6
[**2112-6-6**] 05:10AM   PLT COUNT-288
[**2112-6-6**] 05:10AM   PT-12.7 PTT-22.3 INR(PT)-1.1
[**2112-6-6**] 05:10AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.014
[**2112-6-6**] 05:10AM URINE  BLOOD-TR NITRITE-NEG PROTEIN-NEG
GLUCOSE-TR KETONE-50 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG
[**2112-6-6**] 05:10AM URINE  AMORPH-MANY URIC ACID-MOD
[**2112-6-6**] 05:10AM URINE  AMORPH-MANY URIC ACID-MOD
[**2112-6-6**] 05:10AM URINE  MUCOUS-MOD SPERM-FEW

CXR:
IMPRESSION: Interval resolution of bibasilar atelectasis.

EEG:

FINDINGS:
ABNORMALITY #1: Throughout the entire record, transitions from
wakefulness to stages I, II, and III of sleep occurred directly
and
abruptly. These tended to occur throughout the waking record
with
sudden transitions.
BACKGROUND: Moderately well-formed 8 Hz activity was seen of
moderate
voltage though this was not well-sustained at any point in the
waking
record. The anterior-posterior voltage gradient was preserved
bilaterally.
HYPERVENTILATION: Not performed.
INTERMITTENT PHOTIC STIMULATION: Not performed.
SLEEP: The patient made the rapid transitions to stage I, II,
and III
as described above repeatedly throughout wakefulness.
CARDIAC MONITOR: No arrhythmias noted.
IMPRESSION: Abnormal EEG due to the rapid transitions into
drowsiness
and sleep suggestive of an early encephalopathy.



Brief Hospital Course:
The patient had been intubated at an outside hospital, and he
remained intubated at [**Hospital1 18**]; he was admitted to the neuro ICU.
His propofol was weaned and he was extubated the following day.
His dilantin level was low, and he was given extra doses for the
next several days to bring his level up.  He had no recurrence
of seizure.  For diarrhea and abdominal discomfort, a C-Diff
toxin was checked and was positive; Metronidazole was started on
[**6-9**] for a fourteen day course.  He was stable and transferred to
the floor until his dilantin level was therapeutic.

Medications on Admission:
Meds
dilantin 300 mg po qhs
.
Allergies
penicillin/ciprofloxacin

Discharge Medications:
1. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3
times a day) for 8 days.
Disp:*24 Tablet(s)* Refills:*0*
2. Outpatient Lab Work
Please check dilantin level
3. Dilantin 100 mg Capsule Sig: Three (3) Capsule PO twice a
day: Brand name only.
Disp:*180 Capsule(s)* Refills:*5*
4. Dilantin 100 mg Capsule Sig: Four (4) Capsule PO at bedtime:
brand name only.
Disp:*120 Capsule(s)* Refills:*5*
5. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime) as needed: please take sparing 1-2x weekly at most.
Disp:*10 Tablet(s)* Refills:*1*
6. Lorazepam 1 mg Tablet Sig: One (1) Tablet PO prn as needed
for as directed by Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 437**].
Disp:*30 Tablet(s)* Refills:*1*


Discharge Disposition:
Home

Discharge Diagnosis:
epilepsy
clostridium difficile colitis


Discharge Condition:
stable

Discharge Instructions:
Please call Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 437**] if you experience any episodes of
confusion, limb shaking, loss of consciousness, generalized
twitching.  Please call your PCP or return to the ED if you
experience persistent diarrhea, nausea, vomiting, fever, chills,
night sweats.

You should have your dilantin level drawn on monday, [**2112-6-13**]


Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 1216**] [**Last Name (NamePattern4) 1217**], MD Where: [**Hospital6 29**]
NEUROLOGY Phone:[**Telephone/Fax (1) 2928**] Date/Time:[**2112-6-27**] 9:30


                             [**Name6 (MD) **] [**Name8 (MD) **] MD, [**MD Number(3) 632**]

Completed by:[**2112-6-15**]
{'Other convulsions,Intestinal infection due to Clostridium difficile'}


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: Seizures

PRESENT ILLNESS: Patient is a 36 yo male with PMHx significant for seizures
diagnosed in [**4-7**] transferred from OSH due to seizures.
.
Patient was initially diagnosed with seizures 2 months earlier
after being in perfect health.  He seizures remained controlled
on dilantin and he was eventually transitioned to trileptal.
The
patient did not tolerate the trileptal and was hospitalized for
lethargy and attention defecits in [**5-8**].  He has been maintained
since that time on dilantin.
Per wife the patient has not been well for the last three days.
He has been tripping and twitching.  He also has had diarrhea
with muscle aches.  He has been unable to complete tasks such as
cooking that were easier for him before.  The patient missed a
dose of dilantin three days earlier.  He was at home last PM and
his wife noticed him to be more twitchy.  Upon going to bed at ~
10:30 PM the patient immediately was noticed to be moving all 4
extremities and foaming at the mouth.  He did not have
bladder/bowel incontinence or tongue biting.  The episode lasted
for 1 minute and the patient remained lethargic and confused.
EMS was called and the patient was taken to [**Hospital 1562**] hospital
where he was noticed to have a dilantin level of 1.5.  The
patient also began to vomit and due to his persistent lethargy,
he was intubated for airway protection.  He was given 1 mg of
dilantin and transferred to [**Hospital1 18**].
In the ED the patient had another episode of limb shaking in the
ED that stopped after administration of 2 mg of ativan.  The
patient was started
on a propafol gtt.  He was also noted to have a rectal temp of
102.

MEDICAL HISTORY: Seizure disorder

MEDICATION ON ADMISSION: Meds
dilantin 300 mg po qhs
.
Allergies
penicillin/ciprofloxacin

ALLERGIES: Penicillins / Cipro

PHYSICAL EXAM: Vitals - 102.9  134/83  88  18  100% CMV
Gen - intubated
CV - RRR S1/S2 no m/r/g
RESP - CTA b/l
ABD - soft NT ND +BS
Ext - no c/c/e
.
Neurologic Exam
MS - intubated
CN - PERRL + corneal reflex
Motor - normal tone
Sensory - [**Last Name (un) **]
Reflexes = [**1-8**] throughout, L plantar flexor, R plantar extensor

FAMILY HISTORY: There are no seizure disorders in his immediate family.

SOCIAL HISTORY: [**Name (NI) 32085**]
Pt has a PhD from [**Hospital1 1012**] and is currently in rabbi[**Name (NI) **] school.
His wife is a psychiatrist at the [**Hospital1 **].
They have two children.
He does not smoke, and he drank socially prior to his seizure
disorder's being diagnosed. 

### Response:
{'Other convulsions,Intestinal infection due to Clostridium difficile'}
