CHIEF COMPLAINT: Swallowed broken glass

PRESENT ILLNESS: Mr. [**Known lastname **] is a 39 year old male with a PMH significant for
personality disorder with multiple foreign body ingestions,
admitted for ingestion of multiple pieces of broken glass. He
states that he is feeling increasingly depressed and swallowed
glass in an attempt to kill himself.  The patient was found with
a self inflicted neck laceration next to a noose hanging from a
tree.

MEDICAL HISTORY: 1. Multiple "suicide attempts" characterized by swallowing
glass, razor blades and other foreign bodies
2. Bipolar disorder
3. Depression
4. s/p MVA, s/p splenectomy

MEDICATION ON ADMISSION: 1. Clonazepam 0.5 mg PO TID
2. Lithium 300 QAM, 600 mg QHS

ALLERGIES: Haldol

PHYSICAL EXAM: VS 97.5 128/92 78 16 97%RA
Gen: NAD
HEENT: Perrl, eomi, sclerae anicteric, MMM, OP clear without
lesions, exudate or erythema.  Neck supple without
lymphadenopathy.
CV: Nl S1+S2, no m/r/g
Pulm: CTAB
Abd: S/ND. Tender to palpation throughout. +bs
Ext: No c/c/e
Neuro: AOx3. CN II-XII intact.

FAMILY HISTORY: Father alcoholic
Sister with depression and multiple psychiatric hospitalizations

SOCIAL HISTORY: Smokes [**1-30**] PPD, recreational cocaine and marijuana use;
occasional EtOH use.  The patient is homeless.  The patient was
convicted as a
level 3 sex offender in [**2185**].
Foreign body in esophagus,Suicidal ideation,Blood in stool,Suicide and self-inflicted injury by cutting and piercing instrument,Lack of housing,Unspecified viral hepatitis C without hepatic coma,Suicide and self-inflicted injury by other specified means,Tobacco use disorder,Antisocial personality disorder,Unspecified psychosexual disorder,Open wound of other and unspecified parts of neck, without mention of complication,Hypotension, unspecified
Foreign body esophagus,Suicidal ideation,Blood in stool,Injury-cut instrument,Lack of housing,Hpt C w/o hepat coma NOS,Injury-NEC,Tobacco use disorder,Antisocial personality,Psychosexual dis NOS,Open wound of neck NEC,Hypotension NOS
Admission Date:  [**2199-9-20**]              Discharge Date:   [**2199-9-26**]

Date of Birth:  [**2159-12-27**]             Sex:   M

Service: MEDICINE

Allergies:
Haldol

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
Swallowed broken glass

Major Surgical or Invasive Procedure:
Esophagoduodenoscopy


History of Present Illness:
Mr. [**Known lastname **] is a 39 year old male with a PMH significant for
personality disorder with multiple foreign body ingestions,
admitted for ingestion of multiple pieces of broken glass. He
states that he is feeling increasingly depressed and swallowed
glass in an attempt to kill himself.  The patient was found with
a self inflicted neck laceration next to a noose hanging from a
tree.

In the ED, the patient had a CXR and KUB that demonstrated
severeal pieces of glass below the diaphragm.  Surgery and GI
were consulted, and the patient underwent EGD with removal of
one [**Last Name (un) 63383**] of glass. The patient was transferred to the MICO for
further monitoring, where he remained stable and was called out
to the floor.

Currently, he is complaining of [**9-8**] sharp, diffuse abdominal
pain.  Denies f/c/s, CP/SOB, n/v/d, HA, palpitations, dysuria,
polyuria.  He denies any recent bowel movement and has not had
any hematochezia or melena.

Past Medical History:
1. Multiple "suicide attempts" characterized by swallowing
glass, razor blades and other foreign bodies
2. Bipolar disorder
3. Depression
4. s/p MVA, s/p splenectomy


Social History:
Smokes [**1-30**] PPD, recreational cocaine and marijuana use;
occasional EtOH use.  The patient is homeless.  The patient was
convicted as a
level 3 sex offender in [**2185**].


Family History:
Father alcoholic
Sister with depression and multiple psychiatric hospitalizations



Physical Exam:
VS 97.5 128/92 78 16 97%RA
Gen: NAD
HEENT: Perrl, eomi, sclerae anicteric, MMM, OP clear without
lesions, exudate or erythema.  Neck supple without
lymphadenopathy.
CV: Nl S1+S2, no m/r/g
Pulm: CTAB
Abd: S/ND. Tender to palpation throughout. +bs
Ext: No c/c/e
Neuro: AOx3. CN II-XII intact.

Pertinent Results:
[**2199-9-23**] 06:45AM BLOOD WBC-6.4 RBC-4.53* Hgb-14.2 Hct-41.7
MCV-92 MCH-31.4 MCHC-34.1 RDW-13.1 Plt Ct-245
[**2199-9-20**] 01:10AM BLOOD Neuts-71.8* Lymphs-23.0 Monos-3.8 Eos-1.1
Baso-0.2
[**2199-9-20**] 04:54PM BLOOD PT-13.3 PTT-28.6 INR(PT)-1.1
[**2199-9-23**] 06:45AM BLOOD Glucose-86 UreaN-9 Creat-1.0 Na-138 K-4.2
Cl-103 HCO3-29 AnGap-10
[**2199-9-20**] 01:10AM BLOOD ALT-197* AST-133* AlkPhos-83 TotBili-0.3
[**2199-9-23**] 06:45AM BLOOD Calcium-9.7 Phos-3.9 Mg-2.1
[**2199-9-21**] 05:55AM BLOOD Lithium-0.7
[**2199-9-20**] 01:10AM BLOOD ASA-NEG Ethanol-38* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG

CXR ([**9-20**]): Lateral view confirms suspicion for foreign body in
the upper
esophagus. These findings were discussed with the
gastroenterology fellow,
Dr. [**First Name (STitle) **] [**Name (STitle) 6220**], at the time of the exam

CXR ([**9-21**]): There is no evidence of pneumothorax,
pneumomediastinum or pneumoperitoneum.  Cardiomediastinal
contours are normal. The lungs are clear. Foreign body
previously described in the esophagus is not clearly visualized
in this examination.

KUB ([**9-20**]): Five pieces of radiopaque foreign body identified
within the
stomach and first portion of the duodenum, likely the reportedly
swallowed
glass.

KUB ([**9-21**]): Multiple glass fragments (four pieces) are located
through the ascending and transverse colon. There is no
pneumoperitoneum or bowel obstruction or ileus.

KUB ([**9-22**]): Multiple dense foreign bodies (glass) project in the
pelvis. They are in the distal descending colon, sigmoid, and
rectum. Fecal material is in the colon. Osseous structures are
unremarkable.

KUB ([**9-23**]): PFI-Foreign bodies no longer seen.

Brief Hospital Course:
Mr. [**Known lastname **] is a 39 year old male with a PMH significant for
psychiatric illness and multiple hospitalizations for foreign
body ingestion admitted after a neck laceration and ingestion of
several pieces of broken glass.

1. Foreign body ingestion: Appears to be broken glass, as one
piece was removed by GI via EGD.  Daily KUB radiographs were
taken, which demostrated that the patient had cleared the broken
glass. During his hospitalization, while under the supervision
of a 1:1 sitter, the patient then swallowed a clip from his
hospital room and a tube of toothpaste. A repeat EGD was
performed, but GI was unable to remove any objects. The
following day, while under the supervision of a Security sitter,
he ingested two shower curtain hooks.

2 Psych: Patient has significant psychiatric illness with
multiple foreign body ingestions/suicide attempts thought to be
attention seeking behavior.  Consult-liason psychiatry was
consulted and the patient was cleared for discharge when
medically stable.  On initial attempt to discharge, the patient
stated that, "you guys will have to scrape my body off the
[**Location (un) 2452**] line train."  Psychiatry was re-consulted and this was
felt to be a pattern of the patient's underlying psychiatric
illness.  The patient on [**9-25**] became increasingly agitated and
actively suicidal in his hospital room. He requested to be
placed in leather 4 point restraints to prevent him from trying
to throw himself through the window. He later freed himself from
the restraints. A code purple was called, and the patient was
placed in handcuffs and required chemical sedation to maximize
his own safety.

3. Disposition: As the patient became increasingly agitated and
difficult to control, he was unsafe to remain on CC7. Psychiatry
felt that the patient was not a candidate for psychiatric
hospitalization, so he was discharged from CC7 to the [**Hospital1 18**]
Emergency Department seclusion room.

Medications on Admission:
1. Clonazepam 0.5 mg PO TID
2. Lithium 300 QAM, 600 mg QHS

Discharge Medications:
1. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
2. Lithium Carbonate 300 mg Capsule Sig: 1 tab QAM, 2 tab QHS
Capsule PO  .


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary - Foreign body ingestion

Secondary
personality disorder/sociopathy with multiple foreign body
ingesitons (glass, metal objects) . Per psych no major mental
illness. Needs 1:1 sitter with patient in view at all times. No
small objects are to be left within hand reach. No utensils on
food trays.
Status post splenectomy
Hep C


Discharge Condition:
Patient was discharged to ED seclusion room in stable condition,
with leather restraints on his feet and shackles on his hands.


Discharge Instructions:
PATIENT DISCHARGED TO EMERGENCY ROOM FOR PATIENT SAFETY

1. You were admitted because you ingested broken glass. We
removed one piece of glass from your throat, and watched via
xrays the rest of the pieces pass out of your body.  You kept on
swallowing foreign objects while hospitalized.  You should stop
swallowing foreign bodies.

2. As you are becoming increasingly agitated, you are being
discharged to the [**Hospital1 18**] Emergency Department seclusion area.

Followup Instructions:
Please follow-up with your primary psychiatrist, Dr. [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] at [**Hospital1 2177**] on Friday  ([**9-27**]) at 8 AM.

You will need to establish primary care.  You can get a PCP at
[**Hospital1 2177**] by calling [**Telephone/Fax (1) 11463**].  You can get a PCP at [**Hospital1 18**] by
calling ([**Telephone/Fax (1) 1300**].


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]

Completed by:[**2199-9-27**]
{'Foreign body in esophagus,Suicidal ideation,Blood in stool,Suicide and self-inflicted injury by cutting and piercing instrument,Lack of housing,Unspecified viral hepatitis C without hepatic coma,Suicide and self-inflicted injury by other specified means,Tobacco use disorder,Antisocial personality disorder,Unspecified psychosexual disorder,Open wound of other and unspecified parts of neck, without mention of complication,Hypotension, unspecified'}


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: Swallowed broken glass

PRESENT ILLNESS: Mr. [**Known lastname **] is a 39 year old male with a PMH significant for
personality disorder with multiple foreign body ingestions,
admitted for ingestion of multiple pieces of broken glass. He
states that he is feeling increasingly depressed and swallowed
glass in an attempt to kill himself.  The patient was found with
a self inflicted neck laceration next to a noose hanging from a
tree.

MEDICAL HISTORY: 1. Multiple "suicide attempts" characterized by swallowing
glass, razor blades and other foreign bodies
2. Bipolar disorder
3. Depression
4. s/p MVA, s/p splenectomy

MEDICATION ON ADMISSION: 1. Clonazepam 0.5 mg PO TID
2. Lithium 300 QAM, 600 mg QHS

ALLERGIES: Haldol

PHYSICAL EXAM: VS 97.5 128/92 78 16 97%RA
Gen: NAD
HEENT: Perrl, eomi, sclerae anicteric, MMM, OP clear without
lesions, exudate or erythema.  Neck supple without
lymphadenopathy.
CV: Nl S1+S2, no m/r/g
Pulm: CTAB
Abd: S/ND. Tender to palpation throughout. +bs
Ext: No c/c/e
Neuro: AOx3. CN II-XII intact.

FAMILY HISTORY: Father alcoholic
Sister with depression and multiple psychiatric hospitalizations

SOCIAL HISTORY: Smokes [**1-30**] PPD, recreational cocaine and marijuana use;
occasional EtOH use.  The patient is homeless.  The patient was
convicted as a
level 3 sex offender in [**2185**]. 

### Response:
{'Foreign body in esophagus,Suicidal ideation,Blood in stool,Suicide and self-inflicted injury by cutting and piercing instrument,Lack of housing,Unspecified viral hepatitis C without hepatic coma,Suicide and self-inflicted injury by other specified means,Tobacco use disorder,Antisocial personality disorder,Unspecified psychosexual disorder,Open wound of other and unspecified parts of neck, without mention of complication,Hypotension, unspecified'}
