CHIEF COMPLAINT: abdominal pain and vomiting x2 days
Reason for MICU admission: hepatic failure from presumed Tylenol
OD

PRESENT ILLNESS: patient is a 25-year-old woman with history of psychiatric
illness and ?prior suicide attempts (per mother) who was
transferred to [**Hospital1 18**] after being found to have transaminases
upwards of [**Numeric Identifier 961**] after reported Tylenol ingestion. Per patient
(and corroborated by mother), patient reported taking a
"fistful" of tylenol two days prior to admission for headache.
She denies any suicide attempt or recent life-altering events,
but per her mother she has many psychiatric problems and mother
suspects a suicide attempt. The patient reports persistent
nausea and emesis for the past two days and inability to take
anything by mouth. She denies any bowel movements for the past
two days and reports that she has been urinating but that it's
been very dark. She reports some moderate abdominal pain and
chest pain as well, but denies any shortness of breath. On
evaluation patient answers with mostly one word answers and she
trails off mid-sentence several times.
Over the phone the mother also told us that [**Name (NI) 87933**] tried to
run away 3 months ago. She also endorsed history of prior
suicide attempts.
.
At [**Hospital6 204**], patient was found to have an AST
>[**Numeric Identifier 961**], ALT >1000, lipase of 538, K 2.9, Cl 93. Patient was
given an acetylcysteine bolus, and started on a drip. She was
then transferred to [**Hospital1 18**] for work-up for possible liver
transplant.
.
In the ED, initial vital signs were: 97.7, 60, 109/54, 16,
100%RA. Patient was continued on NAC 6.25 mg/kg/hr. Tox, liver
and transplant surgery were consulted. An EKG was done and
demonstrated sinus rythm, QRS normal, QTc 480. Labs notable for
ALT [**Numeric Identifier 3301**] and AST [**Numeric Identifier 961**], TBili 5.5 and INR 2.7. Renal function
was normal, with potassium of 2.7. CBC was within normal limits.
Tylenol level was undetectable (three days post-ingestion), and
other urine toxicology was negative. In addition to the NAC, she
was given several liters of normal saline and her potassium was
repleted.
.
On the floor, her vitals were stable and she was satting well.
She reported abdominal pain and mild nausea.

MEDICAL HISTORY: ? depression

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:100.1 BP:108/62 P:50s R:12 O2:100% RA
GEN: dishevelled, alert and interactive, no asterixis. Oriented
to hospital, city, year.
HEENT: positive for scleral icterus, mucus membranes moist, but
lips are cracked and dry.
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, TTP in epigastrium with no rebound or
guarding and hypoactive bowel soundsExt: No LE edema, LE warm
and well perfused

FAMILY HISTORY: cardiac History in the family.

SOCIAL HISTORY: she reports living at home with mother. Denies any significant
other. States that she does nothing for work or school. Both
patient and mother endorses that [**Name (NI) 87933**] drinks alcohol
(variable amounts, [**Known firstname 87933**] stated last drink was 4 days ago - 1
drink) and smokes cigarettes. No other clear illicit drug use.
Poisoning by aromatic analgesics, not elsewhere classified,Acute and subacute necrosis of liver,Acidosis,Other and unspecified coagulation defects,Suicidal ideation,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Unspecified episodic mood disorder,Nausea alone,Abnormal involuntary movements,Other nonspecific abnormal serum enzyme levels,Anemia, unspecified
Pois-arom analgesics NEC,Acute necrosis of liver,Acidosis,Coagulat defect NEC/NOS,Suicidal ideation,Poison-analgesics,Episodic mood disord NOS,Nausea alone,Abn involun movement NEC,Abn serum enzy level NEC,Anemia NOS
Admission Date:  [**2176-11-7**]              Discharge Date:   [**2176-11-12**]

Date of Birth:  [**2150-11-28**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 13256**]
Chief Complaint:
abdominal pain and vomiting x2 days
Reason for MICU admission: hepatic failure from presumed Tylenol
OD

Major Surgical or Invasive Procedure:
None

History of Present Illness:
patient is a 25-year-old woman with history of psychiatric
illness and ?prior suicide attempts (per mother) who was
transferred to [**Hospital1 18**] after being found to have transaminases
upwards of [**Numeric Identifier 961**] after reported Tylenol ingestion. Per patient
(and corroborated by mother), patient reported taking a
"fistful" of tylenol two days prior to admission for headache.
She denies any suicide attempt or recent life-altering events,
but per her mother she has many psychiatric problems and mother
suspects a suicide attempt. The patient reports persistent
nausea and emesis for the past two days and inability to take
anything by mouth. She denies any bowel movements for the past
two days and reports that she has been urinating but that it's
been very dark. She reports some moderate abdominal pain and
chest pain as well, but denies any shortness of breath. On
evaluation patient answers with mostly one word answers and she
trails off mid-sentence several times.
Over the phone the mother also told us that [**Name (NI) 87933**] tried to
run away 3 months ago. She also endorsed history of prior
suicide attempts.
.
At [**Hospital6 204**], patient was found to have an AST
>[**Numeric Identifier 961**], ALT >1000, lipase of 538, K 2.9, Cl 93. Patient was
given an acetylcysteine bolus, and started on a drip. She was
then transferred to [**Hospital1 18**] for work-up for possible liver
transplant.
.
In the ED, initial vital signs were: 97.7, 60, 109/54, 16,
100%RA. Patient was continued on NAC 6.25 mg/kg/hr. Tox, liver
and transplant surgery were consulted. An EKG was done and
demonstrated sinus rythm, QRS normal, QTc 480. Labs notable for
ALT [**Numeric Identifier 3301**] and AST [**Numeric Identifier 961**], TBili 5.5 and INR 2.7. Renal function
was normal, with potassium of 2.7. CBC was within normal limits.
Tylenol level was undetectable (three days post-ingestion), and
other urine toxicology was negative. In addition to the NAC, she
was given several liters of normal saline and her potassium was
repleted.
.
On the floor, her vitals were stable and she was satting well.
She reported abdominal pain and mild nausea.

Past Medical History:
? depression

Social History:
she reports living at home with mother. Denies any significant
other. States that she does nothing for work or school. Both
patient and mother endorses that [**Name (NI) 87933**] drinks alcohol
(variable amounts, [**Known firstname 87933**] stated last drink was 4 days ago - 1
drink) and smokes cigarettes. No other clear illicit drug use.

Family History:
cardiac History in the family.

Physical Exam:
Vitals: T:100.1 BP:108/62 P:50s R:12 O2:100% RA
GEN: dishevelled, alert and interactive, no asterixis. Oriented
to hospital, city, year.
HEENT: positive for scleral icterus, mucus membranes moist, but
lips are cracked and dry.
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, TTP in epigastrium with no rebound or
guarding and hypoactive bowel soundsExt: No LE edema, LE warm
and well perfused

Pertinent Results:
1. Labs on admission:
[**2176-11-7**] 01:10AM BLOOD WBC-10.7 RBC-4.60 Hgb-13.9 Hct-39.2
MCV-85 MCH-30.3 MCHC-35.6* RDW-13.4 Plt Ct-184
[**2176-11-7**] 01:10AM BLOOD Neuts-91.8* Lymphs-4.8* Monos-2.1 Eos-0.7
Baso-0.6
[**2176-11-7**] 01:10AM BLOOD PT-27.7* PTT-32.3 INR(PT)-2.7*
[**2176-11-7**] 01:10AM BLOOD Glucose-157* UreaN-19 Creat-0.5 Na-135
K-2.7* Cl-93* HCO3-30 AnGap-15
[**2176-11-7**] 01:10AM BLOOD ALT-[**Numeric Identifier 87934**]* AST-[**Numeric Identifier **]* AlkPhos-58
TotBili-5.5*
[**2176-11-7**] 01:10AM BLOOD Lipase-124*
[**2176-11-7**] 04:40AM BLOOD Albumin-3.6 Calcium-7.4* Phos-1.5* Mg-2.2
[**2176-11-8**] 04:00AM BLOOD Hapto-<5*
[**2176-11-7**] 01:10AM BLOOD Ammonia-55
[**2176-11-7**] 04:40AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE
HBcAb-NEGATIVE HAV Ab-POSITIVE
[**2176-11-7**] 01:10AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2176-11-7**] 04:40AM BLOOD HCV Ab-NEGATIVE
[**2176-11-7**] 08:03AM BLOOD Lactate-2.5* K-3.1*
.
2. Labs on discharge:
[**2176-11-12**] 05:27AM BLOOD WBC-8.5 RBC-3.15* Hgb-9.6* Hct-28.2*
MCV-90 MCH-30.5 MCHC-34.1 RDW-16.1* Plt Ct-208
[**2176-11-12**] 05:27AM BLOOD Neuts-59.2 Lymphs-31.9 Monos-5.7 Eos-2.5
Baso-0.8
[**2176-11-12**] 05:27AM BLOOD PT-12.5 PTT-27.8 INR(PT)-1.1
[**2176-11-12**] 05:27AM BLOOD Glucose-88 UreaN-10 Creat-0.6 Na-135
K-4.7 Cl-102 HCO3-26 AnGap-12
[**2176-11-12**] 05:27AM BLOOD ALT-1525* AST-82* AlkPhos-72 Amylase-174*
TotBili-0.9
[**2176-11-12**] 05:27AM BLOOD Lipase-205*
[**2176-11-12**] 05:27AM BLOOD Calcium-8.9 Phos-4.4# Mg-2.1
.
3. Diagnostics:
CXR [**2176-11-7**]: IMPRESSION: No acute cardiopulmonary process.
KUB [**2176-11-8**]: IMPRESSION: No evidence for ileus or obstruction.
.
Pending Studies at the time of discharge:
[**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) 32883**] Ceruloplasmin
Urine 24 hour Copper level
[**Last Name (NamePattern1) 32883**] Hepatitis A IgM

Brief Hospital Course:
Ms. [**Known lastname **] is a 25-year-old woman with PMH of possible depression
with psychotic features, and no other known PMHx, who was
admitted with transaminitis [**2-20**] to Tylenol overdose.

# Transaminitis/Liver failure - Likely [**2-20**] to Tylenol overdose
with no h/o co-ingestion. Pt admitted to suicide attempt. Pt was
treated with NAC infusion which was stopped after LFTs trended
down. Hepatitis A positive, vaccinated against Hep B, HCV
negative, CMV IgG positive but IgM negative. Studies for [**Doctor First Name **]
were sent and are pending at the time of discharge.  A 24 hour
urine was collected to test copper levels for wilson's disease
and this was pending at the time of overdose.  At the time of
discharge, ALT was 1525 and AST was 82.  INR was 1.1.  These
were trending down each day and do not need to be checked daily.
 They can be checked in 1 week.  She was discharged to a
psychiatric facility for ongoing psychiatric care.
.
# Psych: Pt was evaluated by Psychiatry. Because this was a
suicide attempt, the patient is not allowed to refuse
treatments. Medical issues were cleared and she was placed in a
psychiatric facility.
.
#Electrolyte disturbances: Ms. [**Known lastname **] had low PO4, K+ and Ca of
unclear etiology, which were repleted in the MICU.
.
# Anemia: Her hematocrit trended down from 40.8 to 28.2.  She
remained stable for 5 days prior to discharge and hematocrit at
discharge was 28.2.  Her low blood counts were likely due to
acute illness and bone marrow suppression as well as her liver
injury.  This is expected to recover and she can have a CBC
checked in 1 week to follow-up.
.
# Elevated lipase: Pt with lipase that trended up to [**2170**]. Can
be related to Tylenol overdose, but may also have component of
pancreatitis given epigastric abdominal pain and nausea. This
improved on discharge with a lipase of 206.  She tolerated a
regular diet without abdominal pain on discharge and this does
not need to be rechecked.
.
# Nausea - Was considered secondary to liver failure or NAC.
She was managed with zofran IV PRN.  This improved on discharge.
.
She should follow-up with her primary care physician and
psychiatry team on discharge.
.
Pending labs at the time of discharge:
[**Doctor First Name **]
Urine Copper level
Hepatitis A IgM

Please check a CBC, electrolytes and LFTs in 1 week.

Medications on Admission:
None

Discharge Medications:
None

Discharge Disposition:
Extended Care

Facility:
[**Hospital1 **] 4 [**Hospital1 18**]

Discharge Diagnosis:
Acute liver failure from acetaminophen overdose


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


Discharge Instructions:
Ms. [**Known lastname **], you were admitted to the [**Hospital1 1170**] because you took too many tylenol pills, which resulted
in severe liver damage. You were first admitted to the intensive
care unit where you were treated with IV fluids and medications
to protect your liver. Gradually, your liver began to recover.
Your blood count also dropped, but you never required any blood
transfusions. The psychiatrists evaluated you, and given the
seriousness of your suicide attempt, they have recommended an
inpatient psychiatric stay.
.
We did not make any changes to your medications.
.
Please follow up with your primary care physician after
discharge.

Followup Instructions:
Please make a follow-up appointment within 1 week of discharge
with your primary care physician.



Completed by:[**2176-11-12**]
{'Poisoning by aromatic analgesics, not elsewhere classified,Acute and subacute necrosis of liver,Acidosis,Other and unspecified coagulation defects,Suicidal ideation,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Unspecified episodic mood disorder,Nausea alone,Abnormal involuntary movements,Other nonspecific abnormal serum enzyme levels,Anemia, 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: abdominal pain and vomiting x2 days
Reason for MICU admission: hepatic failure from presumed Tylenol
OD

PRESENT ILLNESS: patient is a 25-year-old woman with history of psychiatric
illness and ?prior suicide attempts (per mother) who was
transferred to [**Hospital1 18**] after being found to have transaminases
upwards of [**Numeric Identifier 961**] after reported Tylenol ingestion. Per patient
(and corroborated by mother), patient reported taking a
"fistful" of tylenol two days prior to admission for headache.
She denies any suicide attempt or recent life-altering events,
but per her mother she has many psychiatric problems and mother
suspects a suicide attempt. The patient reports persistent
nausea and emesis for the past two days and inability to take
anything by mouth. She denies any bowel movements for the past
two days and reports that she has been urinating but that it's
been very dark. She reports some moderate abdominal pain and
chest pain as well, but denies any shortness of breath. On
evaluation patient answers with mostly one word answers and she
trails off mid-sentence several times.
Over the phone the mother also told us that [**Name (NI) 87933**] tried to
run away 3 months ago. She also endorsed history of prior
suicide attempts.
.
At [**Hospital6 204**], patient was found to have an AST
>[**Numeric Identifier 961**], ALT >1000, lipase of 538, K 2.9, Cl 93. Patient was
given an acetylcysteine bolus, and started on a drip. She was
then transferred to [**Hospital1 18**] for work-up for possible liver
transplant.
.
In the ED, initial vital signs were: 97.7, 60, 109/54, 16,
100%RA. Patient was continued on NAC 6.25 mg/kg/hr. Tox, liver
and transplant surgery were consulted. An EKG was done and
demonstrated sinus rythm, QRS normal, QTc 480. Labs notable for
ALT [**Numeric Identifier 3301**] and AST [**Numeric Identifier 961**], TBili 5.5 and INR 2.7. Renal function
was normal, with potassium of 2.7. CBC was within normal limits.
Tylenol level was undetectable (three days post-ingestion), and
other urine toxicology was negative. In addition to the NAC, she
was given several liters of normal saline and her potassium was
repleted.
.
On the floor, her vitals were stable and she was satting well.
She reported abdominal pain and mild nausea.

MEDICAL HISTORY: ? depression

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T:100.1 BP:108/62 P:50s R:12 O2:100% RA
GEN: dishevelled, alert and interactive, no asterixis. Oriented
to hospital, city, year.
HEENT: positive for scleral icterus, mucus membranes moist, but
lips are cracked and dry.
CV: RRR, No M/G/R
PULM: Clear to auscultation b/l, No W/R/R
ABD: Soft, nondistended, TTP in epigastrium with no rebound or
guarding and hypoactive bowel soundsExt: No LE edema, LE warm
and well perfused

FAMILY HISTORY: cardiac History in the family.

SOCIAL HISTORY: she reports living at home with mother. Denies any significant
other. States that she does nothing for work or school. Both
patient and mother endorses that [**Name (NI) 87933**] drinks alcohol
(variable amounts, [**Known firstname 87933**] stated last drink was 4 days ago - 1
drink) and smokes cigarettes. No other clear illicit drug use. 

### Response:
{'Poisoning by aromatic analgesics, not elsewhere classified,Acute and subacute necrosis of liver,Acidosis,Other and unspecified coagulation defects,Suicidal ideation,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics,Unspecified episodic mood disorder,Nausea alone,Abnormal involuntary movements,Other nonspecific abnormal serum enzyme levels,Anemia, unspecified'}
