CHIEF COMPLAINT: Etoh intoxication

PRESENT ILLNESS: 44 yo white male with h/o etoh abuse and CAD was found down at
the [**Location (un) **] Mall.  He was speaking but was slow to respond.  He
took an unknown amount of valium/clonipin and ETOH.  His
fingerstick at the time was 361.  Per family pt has had a
problem with alcohol on and off, pain meds since approx five
years.  He also abuses klonipin and valium.  Family denies any
history of withdrawl seizures or DTs.
.
On arrival to the ED, he was tachycardic (p100) and hypertensive
(150/90).  4.8mg of narcan was given with little effect and he
was intubated for airway protection.  He also received charcoal.
 His BP improved to 113/56 after intubation.

MEDICAL HISTORY: CAD s/p anterior MI with stent to LAD- [**4-3**] at BUMC c/b
pericarditis.
Hypertension
Hypercholesterolemia
Gastroesophageal reflux disease
Depression
ETOH and drug abuse
.
PSHX:
Status post right knee surgery
Status panniculectomy [**2173**]

MEDICATION ON ADMISSION: 1. ASA 325 mg daily
2. Atenolol 100 mg daily
3. Lisinopril 20 mg daily
4. Lipitor 80 mg daily
5. Zetia 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: t97.4, 118/63, 89, 15, 99%
AC: TV 650x14, 5, 100%
Unresponsive to name and rub.  Intubated, large while male.
PERRL 4-->3, +corneal reflex
Neck supple.
Nl s1/s2- but transmitted upper airway sounds make exam
difficult.
CTA- transmitted sounds, no rales
large, soft, +bs
no edema, well perfused, difficult to elicit dtrs, no [**Name2 (NI) 6954**]
.
Post-extubation, PE on transfer to floor:
Tm- 99.6 99.6 126/73 90 23 99% RA
Gen- Obese man resting on the bed. Alert and oriented. NAD. Does
have difficulty giving details of the history.
HEENT- NC AT. EOMI. Anicteric sclera. MMM. No lesions in the
oropharynx.
Cardiac- RRR. S1 S2. No m,r,g.
Pulm- Faint crackles in the left base.
Abdomen- Obese. Soft. NT. ND. POsitive bowel sounds.
Extremities- Warm. No c/c/e. 1+ DP pulses bilaterally.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: ETOH and drug abuse.
H/o tobacco- many years tobacco, denies current use.
Moved out of mother's house last week.  lives in [**Company **] now.
Poisoning by other opiates and related narcotics,Sedative, hypnotic or anxiolytic abuse, continuous,Alcohol withdrawal,Accidental poisoning by other opiates and related narcotics,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Unspecified essential hypertension,Esophageal reflux
Poisoning-opiates NEC,Sed,hyp,anxiolytc ab-con,Alcohol withdrawal,Acc poison-opiates NEC,Crnry athrscl natve vssl,Status-post ptca,Old myocardial infarct,Hypertension NOS,Esophageal reflux
Admission Date:  [**2180-1-12**]              Discharge Date:   [**2180-1-15**]

Date of Birth:  [**2135-1-14**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 30**]
Chief Complaint:
Etoh intoxication


Major Surgical or Invasive Procedure:
Intubation and mechanical ventilation


History of Present Illness:
44 yo white male with h/o etoh abuse and CAD was found down at
the [**Location (un) **] Mall.  He was speaking but was slow to respond.  He
took an unknown amount of valium/clonipin and ETOH.  His
fingerstick at the time was 361.  Per family pt has had a
problem with alcohol on and off, pain meds since approx five
years.  He also abuses klonipin and valium.  Family denies any
history of withdrawl seizures or DTs.
.
On arrival to the ED, he was tachycardic (p100) and hypertensive
(150/90).  4.8mg of narcan was given with little effect and he
was intubated for airway protection.  He also received charcoal.
 His BP improved to 113/56 after intubation.


Past Medical History:
CAD s/p anterior MI with stent to LAD- [**4-3**] at BUMC c/b
pericarditis.
Hypertension
Hypercholesterolemia
Gastroesophageal reflux disease
Depression
ETOH and drug abuse
.
PSHX:
Status post right knee surgery
Status panniculectomy [**2173**]

Social History:
ETOH and drug abuse.
H/o tobacco- many years tobacco, denies current use.
Moved out of mother's house last week.  lives in [**Company **] now.

Family History:
Unknown

Physical Exam:
PE: t97.4, 118/63, 89, 15, 99%
AC: TV 650x14, 5, 100%
Unresponsive to name and rub.  Intubated, large while male.
PERRL 4-->3, +corneal reflex
Neck supple.
Nl s1/s2- but transmitted upper airway sounds make exam
difficult.
CTA- transmitted sounds, no rales
large, soft, +bs
no edema, well perfused, difficult to elicit dtrs, no [**Name2 (NI) 6954**]
.
Post-extubation, PE on transfer to floor:
Tm- 99.6 99.6 126/73 90 23 99% RA
Gen- Obese man resting on the bed. Alert and oriented. NAD. Does
have difficulty giving details of the history.
HEENT- NC AT. EOMI. Anicteric sclera. MMM. No lesions in the
oropharynx.
Cardiac- RRR. S1 S2. No m,r,g.
Pulm- Faint crackles in the left base.
Abdomen- Obese. Soft. NT. ND. POsitive bowel sounds.
Extremities- Warm. No c/c/e. 1+ DP pulses bilaterally.


Pertinent Results:
Labs on admission:
Tox screen: +benzos, +barbituates, +etoh (175)
WBC 6, Hct 40.4, Plt 298
Na 143, K 4.7, Cl 103, HCO3 24, BUN 12, Cr 0.9, Glu 145, AG 16
Ca 9, Ph 4.3, Mg 2
ALT 64*, AST 41*, LD(LDH) 251*, AlkPhos 94, TBili 0.1
INR 2.6
CPK 368, MB 5
ABG: 7.38/43/101
..
UA: [**2180-1-12**] 07:21PM URINE Color-Yellow Appear-Clear Sp
[**Last Name (un) **]-1.016
[**2180-1-12**] 07:21PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG
.
URINE TOX benzo-POS barb-POS opiates-NEG cocaine-NEG amph-NEG
mthdone-NEG
.
Repeat UA [**2180-1-13**]: Cloudy, straw colored, USG 1.030, Blood-SM,
Nitr-NEG, Prot-NEG, Glu-NEG, Ket-NEG, Bili-NEG, Urobiln-NEG,
pH-5.0, LE-NEG, RBC 141*, WBC 2, Bact NONE, Yeast NONE, Epi 0,
AmorphX MOD
.
Cardiac enzymes:
[**2180-1-12**] 05:15PM BLOOD CK(CPK)-368* CK-MB-5 cTropnT-<0.01
[**2180-1-13**] 04:22AM BLOOD CK(CPK)-250* CK-MB-3 cTropnT-<0.01
.
[**2180-1-14**] ALT 36, AST 21
.
Labs on discharge:
WBC 11.6*, Hgb 13.1*, Hct 37.9*, MCV 92, Plt 220
Na 143, K 3.9, Cl 105, HCO3 22, BUN 11, Cr 0.7, Glu 99
Ca 8.5, Phos 3.8, Mg 1.8
.
UA: Yellow, clear, USG 1.020, Blood-NEG, Nitr-NEG, Prot-NEG,
Glu-NEG, Ket-TR, Bili-NEG, Urobil-NEG, pH-5.0, LE-NEG
.
MICRO:
[**2180-1-13**]: urine cx x2 NO GROWTH
.
IMAGING:
[**2180-1-12**] EKG: ST@100bpm, nl axis, nl intervals, evidence of old
anterior mi( qs v1-v3), poor r-wave progression, precordial Ts-
more upright than previous- compared to [**5-3**]
.
[**2180-1-12**] CXR: ET tube is in standard placement. Nasogastric tube
passes to the lower stomach and out of view. Lungs are low in
volume but clear. Pulmonary vasculature is engorged. Mediastinal
widening is probably due to combination of supine positioning,
vascular engorgement and fat deposition. The radiographic
appearance is not concerning. There is no pleural effusion or
indication of pneumothorax.
.
[**2180-1-12**] CXR: There is an endotracheal tube with the tip located
at the level of the medial clavicles. The heart size appears
within normal limits. The mediastinum may be widened. The hilar
regions are not fully seen. The pulmonary vasculature appears
within normal limits. There are curvilinear opacities adjacent
to the left side of the aortic arch as well as adjacent to the
right mediastinum, which could represent atelectasis. No
pneumothorax is seen. There are no pleural effusions. The
osseous structures appear unremarkable. IMPRESSION: Possible
widening of the mediastinum. Endotracheal tube with tip at level
of the medial clavicles.
.
[**2180-1-13**] CXR: The heart is borderline normal. The pulmonary
vasculature is engorged. There are no pleural effusions. There
is no pneumothorax. IMPRESSION: Low lung volumes. Mild CHF.
.
[**2180-1-13**] CT head: 1. No evidence of intracranial hemorrhage. 2.
Sinus mucosal thickening and retention cyst.


Brief Hospital Course:
44 y/o man with PMH significant for CAD s/p anteior MI, HTN,
ETOH abuse, and drug abuse admitted to [**Hospital1 18**] [**2180-1-12**] with a
multi drug overdose. Intubated for airway protection.
.
# Overdose: Mr. [**Known lastname **] presented with acute ETOH intoxication
in addition to being positive for benzos and barbituates on his
tox screen. He was initially intubated for airway protection,
but was able to be extubated w/o complications after 24 hrs. He
was given a banana bag for IVF in the [**Hospital Unit Name 153**], as well as MVI,
thiamine, and folate. He was on propofol once intubated, but
when extubated, he was put on a diazepam CIWA scale and
monitored closely for signs of withdrawal and/or DTs. He was
seen by social work for addictions consult, but the patient
states that he preferred to follow-up with his EtOH abuse group
at [**Hospital 882**] Hospital.
.
# CAD: Mr. [**Known lastname **] has a significant history of CAD s/p MI and
stent to his RCA. He remained CP free throughout his admission
and was continued on his cardiac regimen, including ASA, beta
blocker, ACE-i, and statin. Cardiac enzymes were checked x2 as
his CK was elevated, but troponins and CK-MB remained flat, at
<0.01 and <5 respectively. He has been on coumadin in the past
for a low EF, but because he is considered a fall risk and is
still actively drinking, his coumadin was held and further
recommendations as to coumadin use will be deferred to his
outpatient PCP.
.
# Hypercholesterolemia: He was continued on lipitor and zetia.
.
# Hematuria: Mr. [**Known lastname **] developed hematuria, with significant
RBCs on his UA. It was most likely secondary to foley trauma. A
UA was repeated on [**1-15**] once the foley catheter had been removed
and it showed resolution of his hematuria.
.
# Elevated LFTs: Mr. [**Known lastname **] had elevated transaminases on
admission, felt to be secondary to either his EtOH use (although
AST << ALT) or from his statin. His transaminitis was transient,
however, and his LFT's had normalized by discharge.
.
# Elevated CK: Mr. [**Known lastname **] was found to have an elevated CK on
admission, likely due to muscle injury after being found down.
Troponins were also checked and were negative, so it was an
isolated CK elevation. His CK trended down during his admission.

.
# Seizure history: He was continued on his outpatient dose of
depakote.
.
# Psych hx: He was continued on sertraline, mirtazapine at his
outpatient doses.
.
# HTN: He was continued on his beta blocker and ACE-i.
.
# FEN: He was given a regular, cardiac diet. IVF while in the
[**Hospital Unit Name 153**], stopped once he was tolerating adequate POs. Electrolytes
were checked regularly and repleted prn.
.
# PPX: SC heparin; Bowel regimen; PPI; CIWA scale; Fall
precautions.
.
# Code: Full
.
# Dispo: To his mother's home, with f/u at [**Hospital 882**] Hospital. .



Medications on Admission:
1. ASA 325 mg daily
2. Atenolol 100 mg daily
3. Lisinopril 20 mg daily
4. Lipitor 80 mg daily
5. Zetia 10 mg daily

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. Mirtazapine 15 mg Tablet Sig: Three (3) Tablet PO HS (at
bedtime).
5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
6. Divalproex 500 mg Tablet, Delayed Release (E.C.) Sig: One (1)
Tablet, Delayed Release (E.C.) PO TID (3 times a day).
7. Sertraline 100 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
8. Ibuprofen 400 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours) as needed for knee pain.
9. Ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

10. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO BID
(2 times a day).
11. Multivitamin     Capsule Sig: One (1) Cap PO DAILY (Daily).

12. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

13. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Disposition:
Home

Discharge Diagnosis:
EtOH intoxication and withdrawal
Altered mental status
Coronary artery disease
Transaminitis


Discharge Condition:
Stable, tolerating PO's.


Discharge Instructions:
Follow-up with your PCP at [**Name9 (PRE) 882**] Hospital.
All medications as prescribed.
Return if you have any fevers, or any new concerning symptoms.
Refrain from using alcohol.

Followup Instructions:
With your PCP at [**Name9 (PRE) 882**] Hospital.
With your support group at [**Hospital 882**] Hospital
{'Poisoning by other opiates and related narcotics,Sedative, hypnotic or anxiolytic abuse, continuous,Alcohol withdrawal,Accidental poisoning by other opiates and related narcotics,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Unspecified essential hypertension,Esophageal reflux'}


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: Etoh intoxication

PRESENT ILLNESS: 44 yo white male with h/o etoh abuse and CAD was found down at
the [**Location (un) **] Mall.  He was speaking but was slow to respond.  He
took an unknown amount of valium/clonipin and ETOH.  His
fingerstick at the time was 361.  Per family pt has had a
problem with alcohol on and off, pain meds since approx five
years.  He also abuses klonipin and valium.  Family denies any
history of withdrawl seizures or DTs.
.
On arrival to the ED, he was tachycardic (p100) and hypertensive
(150/90).  4.8mg of narcan was given with little effect and he
was intubated for airway protection.  He also received charcoal.
 His BP improved to 113/56 after intubation.

MEDICAL HISTORY: CAD s/p anterior MI with stent to LAD- [**4-3**] at BUMC c/b
pericarditis.
Hypertension
Hypercholesterolemia
Gastroesophageal reflux disease
Depression
ETOH and drug abuse
.
PSHX:
Status post right knee surgery
Status panniculectomy [**2173**]

MEDICATION ON ADMISSION: 1. ASA 325 mg daily
2. Atenolol 100 mg daily
3. Lisinopril 20 mg daily
4. Lipitor 80 mg daily
5. Zetia 10 mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: t97.4, 118/63, 89, 15, 99%
AC: TV 650x14, 5, 100%
Unresponsive to name and rub.  Intubated, large while male.
PERRL 4-->3, +corneal reflex
Neck supple.
Nl s1/s2- but transmitted upper airway sounds make exam
difficult.
CTA- transmitted sounds, no rales
large, soft, +bs
no edema, well perfused, difficult to elicit dtrs, no [**Name2 (NI) 6954**]
.
Post-extubation, PE on transfer to floor:
Tm- 99.6 99.6 126/73 90 23 99% RA
Gen- Obese man resting on the bed. Alert and oriented. NAD. Does
have difficulty giving details of the history.
HEENT- NC AT. EOMI. Anicteric sclera. MMM. No lesions in the
oropharynx.
Cardiac- RRR. S1 S2. No m,r,g.
Pulm- Faint crackles in the left base.
Abdomen- Obese. Soft. NT. ND. POsitive bowel sounds.
Extremities- Warm. No c/c/e. 1+ DP pulses bilaterally.

FAMILY HISTORY: Unknown

SOCIAL HISTORY: ETOH and drug abuse.
H/o tobacco- many years tobacco, denies current use.
Moved out of mother's house last week.  lives in [**Company **] now. 

### Response:
{'Poisoning by other opiates and related narcotics,Sedative, hypnotic or anxiolytic abuse, continuous,Alcohol withdrawal,Accidental poisoning by other opiates and related narcotics,Coronary atherosclerosis of native coronary artery,Percutaneous transluminal coronary angioplasty status,Old myocardial infarction,Unspecified essential hypertension,Esophageal reflux'}
