CHIEF COMPLAINT: Tachypena and tachycardia

PRESENT ILLNESS: This is a 21 year-old male with a history of psychiatric
illness, with question of schizophrenia, who presents after
ingesting a "hand-full" of Zolpidem in front of his parents. En
route to ED, patient told EMS he had been hearing voices, which
instructed him to take the pills.

MEDICAL HISTORY: History of anxiety, prior episode of psychosis last summer with
paranoid delusions.
Herpes Zoster last [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] tremmor in right hand, unclear etiology (? sequela from
meningitis)

MEDICATION ON ADMISSION: Hydrochlorothiazide 25mg
Zolpidem 10mg
Loratadine ?
Citalopram 20mg (self d/c'd [**2145-11-6**])
Fluoxetine 20mg  (self d/c'd [**2145-11-6**])
Seroquel 100mg (self d/c'd [**2145-11-6**])

ALLERGIES: Bactrim / Penicillins

PHYSICAL EXAM: Vitals: T: BP: HR: RR: O2Sat:
GEN: Well-nourished, intubated, sedated
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: Moves all 4 extremities. Patellar DTR +1. Plantar reflex
downgoing.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: sister with autism

SOCIAL HISTORY: Patient works for computer company. Occassional alcohol and
marijuana use.
Poisoning by other sedatives and hypnotics,Poisoning by antiallergic and antiemetic drugs,Suicide and self-inflicted poisoning by other sedatives and hypnotics,Unspecified psychosis,Anxiety state, unspecified,Unspecified essential hypertension,Dehydration
Pois-sedative/hypnot NEC,Pois-antiallrg/antiemet,Poison-sedat/hypnotic,Psychosis NOS,Anxiety state NOS,Hypertension NOS,Dehydration
Admission Date:  [**2146-7-26**]              Discharge Date:   [**2146-7-28**]

Date of Birth:  [**2124-10-2**]             Sex:   M

Service: MEDICINE

Allergies:
Bactrim / Penicillins

Attending:[**First Name3 (LF) 2167**]
Chief Complaint:
Tachypena and tachycardia

Major Surgical or Invasive Procedure:
Endotracheal intubation [**7-25**], extubated [**7-26**]


History of Present Illness:
This is a 21 year-old male with a history of psychiatric
illness, with question of schizophrenia, who presents after
ingesting a "hand-full" of Zolpidem in front of his parents. En
route to ED, patient told EMS he had been hearing voices, which
instructed him to take the pills.

According to the patient's mother, he complained of anxiety
attack at work. Patient then told his mother that he was hearing
voices which were telling him to hurt himself. Patient then went
to his room and perseverated regarding the voices. Patients
mother took medications away but he kept a bottle of [**Month/Year (2) **], and
took a full fist of medications.  She also mentioned that he had
loratadine in his room, but does not believe he took this
medication.  He has been off his citalopram, sertraline and
seroquel since [**Month (only) 1096**].

In the ED, VS: 98.4 HR 146 BP 154/97 RR: 40 SaO2: 94% RA. The
patient was closely monitored and was found to be progressively
more tachypneic, tachycardic and somnolent and felt to not be
able to protect his airway, was intubated and transferred to the
ICU for further management. OG tube was placed, initially
misplaced but adjusted before transfer.


Past Medical History:
History of anxiety, prior episode of psychosis last summer with
paranoid delusions.
Herpes Zoster last [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] tremmor in right hand, unclear etiology (? sequela from
meningitis)


Social History:
Patient works for computer company. Occassional alcohol and
marijuana use.

Family History:
sister with autism

Physical Exam:
Vitals: T: BP: HR: RR: O2Sat:
GEN: Well-nourished, intubated, sedated
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: Moves all 4 extremities. Patellar DTR +1. Plantar reflex
downgoing.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

.


Pertinent Results:
[**2146-7-26**] 12:20AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2146-7-26**] 05:50PM   HCT-45.0
[**2146-7-26**] 09:31AM   TYPE-ART O2-70 PO2-68* PCO2-37 PH-7.41 TOTAL
CO2-24 BASE XS-0 INTUBATED-NOT INTUBA
[**2146-7-26**] 05:30AM   GLUCOSE-96 UREA N-7 CREAT-1.0 SODIUM-143
POTASSIUM-4.1 CHLORIDE-109* TOTAL CO2-22 ANION GAP-16
[**2146-7-26**] 05:30AM   CALCIUM-8.4 PHOSPHATE-4.6* MAGNESIUM-2.0
[**2146-7-26**] 12:11AM   ALT(SGPT)-36 AST(SGOT)-16 LD(LDH)-160 ALK
PHOS-72 TOT BILI-0.4
[**2146-7-26**] 12:11AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2146-7-26**] 12:11AM   PLT COUNT-332
[**2146-7-26**] 12:11AM   PT-14.2* PTT-27.0 INR(PT)-1.2*

Brief Hospital Course:
21 year-old male with a history of psychiatric illness, with
question of schizophrenia, who presents after ingesting a
"hand-full" of Zolpidem in front of his parents with episode of
acute psychosis.
<br>

# Toxic ingestion: Per report patient ingested a handful of
Zolpidem because he heard voices commanding him to kill himself,
with a question of loratidine ingestion as well, though after
rediscussion with pt and mother - only [**Name2 (NI) 13426**].  His urine and
serum tox screen were negative on arrive and he did not have any
acid-base disturbance.  He was intubated in the ED for airway
protection as it appeared he could not clear his secretions,
though he remained tachypneic and tachycardic in the ED.  He did
not receive flumazenil or charcoal. The patient remained stable
overnight in the ICU and was extubated successfully the next
morning.  He remained alert and oriented and his EKGs also
remained unchanged.  Toxicology was consulted and said that
zolpidem has a short half life and the effects had already worn
off.  Given that there was some question as to what he actually
ingested, we followed their recommendations to get serial EKGs
to look for QT prolongation, which he did not have in the ICU
and after 1 days observation on the floor.  Pt's labs followed
and wnl, also given pt with diffuse myalgia complaints CK also
wnl.  His sx along with sore throat (without sig exam findings),
low grade temps (no fever) night prior to transfer - sx/s all
more consistant with URI, unlikely withdrawal sx at this time.
(also noted sx improvement with tylonol with recs to continue po
prn).  Suicide precautions continued, as pt stable currently d/w
psychiatry service, will be transferred today to inpatient psych
facility for further care.  Per recs, started seroquel 25mg [**Hospital1 **]
for anxiety/psychosis sx - pt with positive responce, haldol was
ordered prn but was not needed on floor.
<br>

#Tachcardia:  Sinus Tachycardia 100-110 while awake, NSR 80-90
while sleeping.  The tachycardia did not improve with fluid
bolus or ativan.  He denies significant drug or alcohol abuse,
and is not likely withdrawing. Given the patient's history and
the change in HR overnight, anxiety is the most likely cause.
Pt's HR in 80s in am, stable for transfer.
<br>

#. Psychotic episode: Psychiatric history unclear, but report of
hearing voices which instructed paitent to harm self.  He
continued to hear voices throughout his stay int he ICU but by
morning 2, they were no longer commanding him to kill himself.
Given his age and symptoms, suspect schizophrenia but the time
course is too short to be diagnosed.  Also has traits of
Personality disorder.  Psychiatry was consulted and the patient
agreed to inpatient psychiatric stay.  He was given haldol prn
agitation once in the ICU and started on seroquel as above.  Per
inpatient psych team for further titration of medications.
<br>

#. Hypertension: Currently not active off of prior home dose of
HCTZ.  Will d/c home HCTZ at this time with d/c BP at 115/90.
PCP will need to f/u.  Inpatient psych center to schedule pt an
appointment at time of d/c from their fascility.
<br>

#Access: PIV, d/c at time of d/c (not needed on floor).

#Prophylaxis: Patient refused subQ heparin, will wear
pneumoboots, PPI, bowel regimen

# Code Status: Full

#Dispo: inpatient psych today


Medications on Admission:
Hydrochlorothiazide 25mg
Zolpidem 10mg
Loratadine ?
Citalopram 20mg (self d/c'd [**2145-11-6**])
Fluoxetine 20mg  (self d/c'd [**2145-11-6**])
Seroquel 100mg (self d/c'd [**2145-11-6**])


Discharge Medications:
1. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed for pain.
3. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital 882**] Hospital (acute inpatient psychiatric unit)

Discharge Diagnosis:
Primary Diagnosis: Zolpidem Overdose
Secondary Diagnoses: Psychosis, anxiety, HTN


Discharge Condition:
stable


Discharge Instructions:
You were admitted for management of Zolpidem overdose.  We made
no changes to your home medications.  You are being transferred
to an inpatient psychiatric facility for ongoing care.  If you
develop chest pain, shortness of breath, vomiting, suicidal
ideation or auditory command hallucinations or any general
worsening of your condition please contact your PCP or come to
the emergency department.

Followup Instructions:
Please call PCP to set up a follow up appointment once you know
you'll be discharged from psych center - this will be to follow
up on your blood pressure.  Your blood pressure was stable here
off of your hydrochlorothiazide, we would recommend to hold off
of this medication till re-evaluated.

Follow up with Psych as per inpatient recs



Completed by:[**2146-7-28**]
{'Poisoning by other sedatives and hypnotics,Poisoning by antiallergic and antiemetic drugs,Suicide and self-inflicted poisoning by other sedatives and hypnotics,Unspecified psychosis,Anxiety state, unspecified,Unspecified essential hypertension,Dehydration'}


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: Tachypena and tachycardia

PRESENT ILLNESS: This is a 21 year-old male with a history of psychiatric
illness, with question of schizophrenia, who presents after
ingesting a "hand-full" of Zolpidem in front of his parents. En
route to ED, patient told EMS he had been hearing voices, which
instructed him to take the pills.

MEDICAL HISTORY: History of anxiety, prior episode of psychosis last summer with
paranoid delusions.
Herpes Zoster last [**First Name4 (NamePattern1) **]
[**Last Name (NamePattern1) **] tremmor in right hand, unclear etiology (? sequela from
meningitis)

MEDICATION ON ADMISSION: Hydrochlorothiazide 25mg
Zolpidem 10mg
Loratadine ?
Citalopram 20mg (self d/c'd [**2145-11-6**])
Fluoxetine 20mg  (self d/c'd [**2145-11-6**])
Seroquel 100mg (self d/c'd [**2145-11-6**])

ALLERGIES: Bactrim / Penicillins

PHYSICAL EXAM: Vitals: T: BP: HR: RR: O2Sat:
GEN: Well-nourished, intubated, sedated
HEENT: EOMI, PERRL, sclera anicteric, no epistaxis or
rhinorrhea, MMM, OP Clear
NECK: No JVD, carotid pulses brisk, no bruits, no cervical
lymphadenopathy, trachea midline
COR: RRR, no M/G/R, normal S1 S2, radial pulses +2
PULM: Lungs CTAB, no W/R/R
ABD: Soft, NT, ND, +BS, no HSM, no masses
EXT: No C/C/E, no palpable cords
NEURO: Moves all 4 extremities. Patellar DTR +1. Plantar reflex
downgoing.
SKIN: No jaundice, cyanosis, or gross dermatitis. No ecchymoses.

FAMILY HISTORY: sister with autism

SOCIAL HISTORY: Patient works for computer company. Occassional alcohol and
marijuana use. 

### Response:
{'Poisoning by other sedatives and hypnotics,Poisoning by antiallergic and antiemetic drugs,Suicide and self-inflicted poisoning by other sedatives and hypnotics,Unspecified psychosis,Anxiety state, unspecified,Unspecified essential hypertension,Dehydration'}
