CHIEF COMPLAINT: found unresponsive at home

PRESENT ILLNESS: 51 y/o female with PMH significant for seizures who per notes
was found down at home by her daughter. [**Name (NI) **] report, pt had been
lying on the couch all day. She then went to the restroom. When
her daughter went to check on her, she was laying on the
bathroom and had been incontinent of urine. Her daughter was
concerned that she could be postictal so she called EMS who
brought her to the [**Hospital1 18**] ED for further evaluation.
.
In the field, the EMS FS was 147. The pt received 1 of narcan
with little response. On arrival to the ED, her VS were 98  111
142/73  20  100% NRB. There was a concern that the pt was in
nonconvolsive status and a STAT neuro consult was obtained.
Speaking to the neuro resident, they did not feel she was in
nonconvolsive status. Her eyes were not deviated on exam. The pt
became very agitated with noxious stimuli. Pt was then intubated
for airway protection as she was nonresponsive. In the ED, the
pt received 10 mg of narcan with some response but she did not
wake up entirely or for any prolonged period of time. Her
toxicology screen was positive for tricyclics and ETOH.
Amphetimines were also seen in her urine. A toxicology consult
was obtained. The pt's QRS on her ECG was >100 but other ECG
findings and her clinical picture were not felt to be consistent
with a tricyclinc overdose. The pt was given bicarb with no
change in her ECG or clnical status. Pt was then sent to the
[**Hospital Unit Name 153**] for further care.
.

MEDICAL HISTORY: 1. CAD (MIBI [**2147**] with small reversible defect)
2. HTN
3. Hypercholesterolemia
4. ? h/o Sz (? related to EtOH)
5. depression (possible suicide attempt [**4-30**])
6. substance abuse (EtOH)

MEDICATION ON ADMISSION: 1. Toprol XL 200 daily
2. Lipitor 80 daily
3. Niferex 150 [**Hospital1 **]
4. Ultram 50 tid prn
5. procardia XL 120 daily
6. NTG prn
7. neurontin 300 daily
8. lactulose prn constipation
9. hctz 50 daily
10. ambien 10 qhs prn
11. Amytriptyline 125 qhs
12. avapro 300 daily
13. colace
14. compazine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98.0 140/83 90 14 100%
AC 600/14/.50
Gen- Sedated and intubated. Unresponsive.
HEENT- NC AT. PERRL. Anicteric sclera. MMM. Intubated.
Cardiac- RRR. S1 S2. No m,r,g.
Pulm- CTA anteriorly and laterally.
Abdomen- Obese. Soft. NT. ND. Positive bowel sounds.
Extremities- Warm. No c/c/e.
Neuro- Sedated. Intubated. Downgoing toes bilaterally.

FAMILY HISTORY: DM

SOCIAL HISTORY: Lives with husband and 3 kids. Occ ETOH. 3 cig/d x 4 months. No
IVDU/no illicit drug use. Does not work.
Toxic effect of ethyl alcohol,Poisoning by benzodiazepine-based tranquilizers,Alcohol abuse, unspecified,Acute respiratory failure,Other convulsions,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Accidental poisoning by alcoholic beverages,Accidental poisoning by benzodiazepine-based tranquilizers,Iron deficiency anemia, unspecified,Dysthymic disorder,Obesity, unspecified,Lumbago,Other urinary incontinence
Toxic eff ethyl alcohol,Pois-benzodiazepine tran,Alcohol abuse-unspec,Acute respiratry failure,Convulsions NEC,Hypertension NOS,Hyperlipidemia NEC/NOS,Acc poisn-alcohol bevrag,Acc poisn-benzdiaz tranq,Iron defic anemia NOS,Dysthymic disorder,Obesity NOS,Lumbago,Oth urinry incontinence
Admission Date:  [**2150-11-11**]              Discharge Date:   [**2150-11-13**]

Date of Birth:  [**2099-3-17**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
found unresponsive at home

Major Surgical or Invasive Procedure:
Endotrachial Intubation


History of Present Illness:
51 y/o female with PMH significant for seizures who per notes
was found down at home by her daughter. [**Name (NI) **] report, pt had been
lying on the couch all day. She then went to the restroom. When
her daughter went to check on her, she was laying on the
bathroom and had been incontinent of urine. Her daughter was
concerned that she could be postictal so she called EMS who
brought her to the [**Hospital1 18**] ED for further evaluation.
.
In the field, the EMS FS was 147. The pt received 1 of narcan
with little response. On arrival to the ED, her VS were 98  111
142/73  20  100% NRB. There was a concern that the pt was in
nonconvolsive status and a STAT neuro consult was obtained.
Speaking to the neuro resident, they did not feel she was in
nonconvolsive status. Her eyes were not deviated on exam. The pt
became very agitated with noxious stimuli. Pt was then intubated
for airway protection as she was nonresponsive. In the ED, the
pt received 10 mg of narcan with some response but she did not
wake up entirely or for any prolonged period of time. Her
toxicology screen was positive for tricyclics and ETOH.
Amphetimines were also seen in her urine. A toxicology consult
was obtained. The pt's QRS on her ECG was >100 but other ECG
findings and her clinical picture were not felt to be consistent
with a tricyclinc overdose. The pt was given bicarb with no
change in her ECG or clnical status. Pt was then sent to the
[**Hospital Unit Name 153**] for further care.
.


Past Medical History:
1. CAD (MIBI [**2147**] with small reversible defect)
2. HTN
3. Hypercholesterolemia
4. ? h/o Sz (? related to EtOH)
5. depression (possible suicide attempt [**4-30**])
6. substance abuse (EtOH)


Social History:
Lives with husband and 3 kids. Occ ETOH. 3 cig/d x 4 months. No
IVDU/no illicit drug use. Does not work.


Family History:
DM

Physical Exam:
98.0 140/83 90 14 100%
AC 600/14/.50
Gen- Sedated and intubated. Unresponsive.
HEENT- NC AT. PERRL. Anicteric sclera. MMM. Intubated.
Cardiac- RRR. S1 S2. No m,r,g.
Pulm- CTA anteriorly and laterally.
Abdomen- Obese. Soft. NT. ND. Positive bowel sounds.
Extremities- Warm. No c/c/e.
Neuro- Sedated. Intubated. Downgoing toes bilaterally.


Pertinent Results:
CXR [**11-11**]- Low lung volumes. No definite infiltrate. Per
radiology, ETT tube in place.
.
Head CT [**11-11**] - Very limited due to pt motion. No gross evidence
for hemorrhage, mass effect, shift of normally midline
structures, or hydrocephalus. Density values of the brain
parenchyma are grossly within normal limits. [**Doctor Last Name **]-white matter
differentiation is grossly intact. Visualized osseous structures
show no evidence for fracture.
.
ECG [**11-11**] - Pt with multiple ECGs in the ED. Sinus rhythm. QRS
about 125 in all.
..

[**2150-11-11**] 06:00PM   WBC-9.5 RBC-3.56* HGB-9.3* HCT-28.2* MCV-79*
MCH-26.2* MCHC-33.0 RDW-18.4*
[**2150-11-11**] 06:00PM   PLT COUNT-333
[**2150-11-11**] 06:00PM   PT-12.9 PTT-24.6 INR(PT)-1.1
[**2150-11-11**] 06:00PM   ASA-NEG ETHANOL-107* CARBAMZPN-<1.0*
ACETMNPHN-NEG bnzodzpn-NEG barbitrt-NEG tricyclic-POS
[**2150-11-11**] 06:00PM   ALT(SGPT)-28 AST(SGOT)-28 CK(CPK)-424* ALK
PHOS-72 AMYLASE-150* TOT BILI-0.2
[**2150-11-11**] 07:57PM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-POS mthdone-NEG
[**2150-11-11**] 11:05PM   GLUCOSE-123* UREA N-11 CREAT-0.8 SODIUM-140
POTASSIUM-3.3 CHLORIDE-106 TOTAL CO2-28 ANION GAP-9
[**2150-11-11**] 11:05PM   ALT(SGPT)-29 AST(SGOT)-27 LD(LDH)-273*
CK(CPK)-389* ALK PHOS-67 AMYLASE-146* TOT BILI-0.3
[**2150-11-11**] 11:05PM   LIPASE-20
[**2150-11-11**] 11:05PM   CK-MB-5 cTropnT-<0.01

Brief Hospital Course:
51 y/o female with PMH significant for EtOH abuse, ? EtOH
withdrawal seizures, and ? suicide attempt who was found down at
home by her daughter.
.
1. Mental status changes: Pt was found down at home per her
daughter with a change in mental status. Per report, she was
basically unresponsive but would respond to noxious stimuli. We
considered a wide differential including seizure, ingestion,
metabolic, and infection. Neuro was consulted but did not
believe she was in non-convulsive status. An EEG on [**11-12**] showed
no seizure activity in the morning. After contacting her PCP, [**Name10 (NameIs) **]
was unclear if she had a true seizure disorder.   Per PCP's
history, her seizures have only been related to withdrawal from
ETOH. Pt was found to have multiple ingestions on her tox
screens. Her serum tox screen was positive for tricyclics in
addition to ETOH. Pt's urine tox was positive for amphetamines.
Toxicology was consulted and did not feel her clinical picture
was consistent with a tricyclic overdose. They were concerned
that she could have taken another depressive medication which is
not detected on tox screen. Patient was monitored closely.
Serial EKGs checked. Patient's clinical picture was less
concerning for infection; she had a very abrupt onset of
symptoms, was afebrile during her stay,  and her WBC was WNL. A
lumbar puncture was not done. Patient was extubated soon after
arriving in the ICU and she was maintaining her O2 sats without
difficulty.  As patient became more alert, she was able to
provide more history.  She had a history of depression and EtOH
use; per patient she was not trying to commit suicide. She would
like to enroll in a dual diagnosis program to work on her
depression and anxiety as well as her alcoholism.  We were
unable to discharge patient directly to such a program. She will
follow up with her PCP next week and enroll in  the Partial Dual
Diagnosis Program on Monday [**2150-11-14**] at 9AM.
[**Hospital3 8063**] in [**Location (un) **], MA.
.
2. Seizure disorder- Per report, pt has a history of seizures in
the setting of EtOH withdrawal. Neurology evaluated the patient
and an EEG showed no evidence of seizure activity. Patient was
monitored closely for signs and symptoms of EtOH withdrawal. On
discharge no evidence of withdrawal.
.
3. Depression - Psychiatry was consulted. Patient not suicidal.
She was discharged to enroll in a dual diagnosis to address her
ongoing depression and substance abuse.
.
4. CAD - Patient was continued on a beta blocker, [**Last Name (un) **], and ASA.

.
5. HTN - Continued on outpatient regimen of Toprol, Avapro and
Procardia.
.
6. Anemia. Unclear etiology, appears to be iron deficient.
Likely related to EtOH use. B12 and Folate WNL in [**4-30**]. Stools
were guaiac negative. Continued on iron supplements.  She have
anemia follow-up by her PCP next week.


Medications on Admission:
1. Toprol XL 200 daily
2. Lipitor 80 daily
3. Niferex 150 [**Hospital1 **]
4. Ultram 50 tid prn
5. procardia XL 120 daily
6. NTG prn
7. neurontin 300 daily
8. lactulose prn constipation
9. hctz 50 daily
10. ambien 10 qhs prn
11. Amytriptyline 125 qhs
12. avapro 300 daily
13. colace
14. compazine


Discharge Medications:
1. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: Two (2) Tablet Sustained Release 24HR PO DAILY (Daily).
2. Polysaccharide Iron Complex 150 mg Capsule Sig: One (1)
Capsule PO DAILY (Daily).
3. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Lactulose 10 g/15 mL Syrup Sig: Thirty (30) ML PO Q8H (every
8 hours) as needed.
6. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
7. Hydrochlorothiazide 25 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Prochlorperazine 10 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed.
9. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime)
as needed.
10. Procardia XL 60 mg Tab, Sust Release Osmotic Push Sig: Two
(2) Tab, Sust Release Osmotic Push PO once a day.
11. Neurontin 300 mg Capsule Sig: One (1) Capsule PO once a day.

12. Avapro 300 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Anxiety
Mental Status Changes requiring Intubation

Secondary Diagnosis:
Coronary Artery Disease
Hypertension
Depression
History of EtOH abuse


Discharge Condition:
Good


Discharge Instructions:
Please call your primary care physician or return to the
hospital if you experience confusion, shortness of breath, chest
pain, or have any other concerns.  Please come to the emergency
room if you have any thougths of harming yourself.

Please resume all your previous medications, except
Amitriptyline and Klonopin.

Followup Instructions:
1. Please follow up with Dr. [**Last Name (STitle) 35975**] next week.
([**Telephone/Fax (1) 24731**])

2. Please follow up at the Partial Dual Diagnosis Program on
Monday [**2150-11-14**] at 9AM.  Contact [**Name (NI) 19447**] - [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) 54752**] ([**Telephone/Fax (1) 61855**])
Located at:  [**Hospital3 8063**]
             [**Street Address(2) **]
             [**Location (un) **], MA
{'Toxic effect of ethyl alcohol,Poisoning by benzodiazepine-based tranquilizers,Alcohol abuse, unspecified,Acute respiratory failure,Other convulsions,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Accidental poisoning by alcoholic beverages,Accidental poisoning by benzodiazepine-based tranquilizers,Iron deficiency anemia, unspecified,Dysthymic disorder,Obesity, unspecified,Lumbago,Other urinary incontinence'}


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: found unresponsive at home

PRESENT ILLNESS: 51 y/o female with PMH significant for seizures who per notes
was found down at home by her daughter. [**Name (NI) **] report, pt had been
lying on the couch all day. She then went to the restroom. When
her daughter went to check on her, she was laying on the
bathroom and had been incontinent of urine. Her daughter was
concerned that she could be postictal so she called EMS who
brought her to the [**Hospital1 18**] ED for further evaluation.
.
In the field, the EMS FS was 147. The pt received 1 of narcan
with little response. On arrival to the ED, her VS were 98  111
142/73  20  100% NRB. There was a concern that the pt was in
nonconvolsive status and a STAT neuro consult was obtained.
Speaking to the neuro resident, they did not feel she was in
nonconvolsive status. Her eyes were not deviated on exam. The pt
became very agitated with noxious stimuli. Pt was then intubated
for airway protection as she was nonresponsive. In the ED, the
pt received 10 mg of narcan with some response but she did not
wake up entirely or for any prolonged period of time. Her
toxicology screen was positive for tricyclics and ETOH.
Amphetimines were also seen in her urine. A toxicology consult
was obtained. The pt's QRS on her ECG was >100 but other ECG
findings and her clinical picture were not felt to be consistent
with a tricyclinc overdose. The pt was given bicarb with no
change in her ECG or clnical status. Pt was then sent to the
[**Hospital Unit Name 153**] for further care.
.

MEDICAL HISTORY: 1. CAD (MIBI [**2147**] with small reversible defect)
2. HTN
3. Hypercholesterolemia
4. ? h/o Sz (? related to EtOH)
5. depression (possible suicide attempt [**4-30**])
6. substance abuse (EtOH)

MEDICATION ON ADMISSION: 1. Toprol XL 200 daily
2. Lipitor 80 daily
3. Niferex 150 [**Hospital1 **]
4. Ultram 50 tid prn
5. procardia XL 120 daily
6. NTG prn
7. neurontin 300 daily
8. lactulose prn constipation
9. hctz 50 daily
10. ambien 10 qhs prn
11. Amytriptyline 125 qhs
12. avapro 300 daily
13. colace
14. compazine

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 98.0 140/83 90 14 100%
AC 600/14/.50
Gen- Sedated and intubated. Unresponsive.
HEENT- NC AT. PERRL. Anicteric sclera. MMM. Intubated.
Cardiac- RRR. S1 S2. No m,r,g.
Pulm- CTA anteriorly and laterally.
Abdomen- Obese. Soft. NT. ND. Positive bowel sounds.
Extremities- Warm. No c/c/e.
Neuro- Sedated. Intubated. Downgoing toes bilaterally.

FAMILY HISTORY: DM

SOCIAL HISTORY: Lives with husband and 3 kids. Occ ETOH. 3 cig/d x 4 months. No
IVDU/no illicit drug use. Does not work. 

### Response:
{'Toxic effect of ethyl alcohol,Poisoning by benzodiazepine-based tranquilizers,Alcohol abuse, unspecified,Acute respiratory failure,Other convulsions,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Accidental poisoning by alcoholic beverages,Accidental poisoning by benzodiazepine-based tranquilizers,Iron deficiency anemia, unspecified,Dysthymic disorder,Obesity, unspecified,Lumbago,Other urinary incontinence'}
