CHIEF COMPLAINT: agitation

PRESENT ILLNESS: 48yoM with h/o bipolar disorder and HTN, presented to [**Hospital1 18**] ED
[**2199-3-9**] with confusion and agitation to psychiatry, transferred
now to MICU with tachypnea, fever, tachycardia.
.
Patient initially presented to ED with pressured speech and
agitation after being found pacing and yelling in front of his
apartment. In ED T 100.6 HR 100 BP 184/95 RR 16 98%RA. He was
diagnosed with a UTI and treated with Cipro. CXR was
unremarkable. Lumbar puncture was bloody but without significant
WBC and negative gram stain. He was admitted to psychiatry
.
Today VS T 102.3 HR 106 BP 144/80 RR 40 96%RA. He was
complaining of low back pain and inability to urinate. Medical
consult was called and trasnferred patient to MICU. On arrival
patient was alert and responding appropriately to questions. He
complained of low back pain. He denied having bowel or bladder
incontinence, or lower extremity numbness. He also denied SOB,
chest pain, abdominal pain

MEDICAL HISTORY: PSYCHIATRIC HISTORY:
As above, pt. with long h/o bipolar disorder and multiple
inpatient admissions. See HPI for details.
Pt. stopped medications; psychiatrist on vacation.
Pt. with recent inpatient admissions to [**Hospital1 882**] and [**Hospital1 336**]. Pt.
has h/o assaults when manic. Pt. denies current HI/SI. Pt.
reports h/o x1 suicide attempt by overdose 20 years ago.

MEDICATION ON ADMISSION: Zyprexa 20mg daily
Seroquel 150mg QHS
Lithium 1800mg QHS

ALLERGIES: Haldol / Perphenazine / Droperidol

PHYSICAL EXAM: On Arrival to MICU:
T 101.4 HR 106 BP 148/88 RR 31 100%4Lnc
Gen: tachypneic, alert, moderately agitated
HEENT: PERRL, anicteric, MMM, OP clear
Neck: no LAD, JVP not appreciated
CV: tachy, regular rhythm, no murmurs
Resp: CTAB
Abd: +BS, soft, NT, ND, obese
Back: tender to palpation
Ext: no edema, 2+ radials and DPs bilaterally
Neuro: A&Ox3, CN II-XII intact, strength 5/5 throughout,
sensation intact to touch

FAMILY HISTORY: Mother = bipolar

SOCIAL HISTORY: Pt. never married, no children. Lives alone in geriatric section
Other staphylococcal septicemia,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Retention of urine, unspecified,Chronic kidney disease, unspecified,Unspecified essential hypertension,Bipolar I disorder, most recent episode (or current) manic, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Tobacco use disorder,Severe sepsis,Other specified cardiac dysrhythmias
Staphylcocc septicem NEC,Acute respiratry failure,Food/vomit pneumonitis,Urin tract infection NOS,Retention urine NOS,Chronic kidney dis NOS,Hypertension NOS,Bipol I currnt manic NOS,Elev transaminase/ldh,Tobacco use disorder,Severe sepsis,Cardiac dysrhythmias NEC
Admission Date:  [**2199-3-10**]              Discharge Date:   [**2199-3-18**]

Date of Birth:  [**2150-12-11**]             Sex:   M

Service: MEDICINE

Allergies:
Haldol / Perphenazine / Droperidol

Attending:[**First Name3 (LF) 2160**]
Chief Complaint:
agitation

Major Surgical or Invasive Procedure:
endotracheal intubation
peripherally inserted central venous catheter


History of Present Illness:
48yoM with h/o bipolar disorder and HTN, presented to [**Hospital1 18**] ED
[**2199-3-9**] with confusion and agitation to psychiatry, transferred
now to MICU with tachypnea, fever, tachycardia.
.
Patient initially presented to ED with pressured speech and
agitation after being found pacing and yelling in front of his
apartment. In ED T 100.6 HR 100 BP 184/95 RR 16 98%RA. He was
diagnosed with a UTI and treated with Cipro. CXR was
unremarkable. Lumbar puncture was bloody but without significant
WBC and negative gram stain. He was admitted to psychiatry
.
Today VS T 102.3 HR 106 BP 144/80 RR 40 96%RA. He was
complaining of low back pain and inability to urinate. Medical
consult was called and trasnferred patient to MICU. On arrival
patient was alert and responding appropriately to questions. He
complained of low back pain. He denied having bowel or bladder
incontinence, or lower extremity numbness. He also denied SOB,
chest pain, abdominal pain


Past Medical History:
PSYCHIATRIC HISTORY:
As above, pt. with long h/o bipolar disorder and multiple
inpatient admissions. See HPI for details.
Pt. stopped medications; psychiatrist on vacation.
Pt. with recent inpatient admissions to [**Hospital1 882**] and [**Hospital1 336**]. Pt.
has h/o assaults when manic. Pt. denies current HI/SI. Pt.
reports h/o x1 suicide attempt by overdose 20 years ago.

PAST MEDICAL HISTORY:
HTN
s/p asystole x 2 during ECT at [**Hospital 882**] hospital last year
tardive dyskinesia from Risperdal
EPS from Haldol

ALLERGIES (INCLUDE REACTION, IF KNOWN):Trilafon = N.M.S.

SUBSTANCE ABUSE HISTORY (INCLUDE HISTORY OF D.T.'S, WITHDRAWAL
SEIZURES, BLACKOUTS, DETOX TREATMENT, I.V. USAGE):
Pt. has a h/o some alcohol abuse but no known recent history. No

h/o detox. Pt. smokes cigarettes.


Social History:
Pt. never married, no children. Lives alone in geriatric section

8 housing.
Pt. finished H.S. and took courses at vocational program at BU
Center for [**Hospital 7637**] Rehabilitation, but did not complete two
internships due to illness.


Family History:
Mother = bipolar

Physical Exam:
On Arrival to MICU:
T 101.4 HR 106 BP 148/88 RR 31 100%4Lnc
Gen: tachypneic, alert, moderately agitated
HEENT: PERRL, anicteric, MMM, OP clear
Neck: no LAD, JVP not appreciated
CV: tachy, regular rhythm, no murmurs
Resp: CTAB
Abd: +BS, soft, NT, ND, obese
Back: tender to palpation
Ext: no edema, 2+ radials and DPs bilaterally
Neuro: A&Ox3, CN II-XII intact, strength 5/5 throughout,
sensation intact to touch


Pertinent Results:
[**2199-3-10**] CTA chest/abd:
1. 1.8 cm low density left renal lesion which is not completely
a cyst and is indeterminate, further evaluation with MRI is
recommended.
2. Bibasilar airspace opacities which may be secondary to
atelectasis versus aspiration versus infection, clinical
correlation is recommended.
3. No CT evidence of pyelonephritis. No evidence of
intra-abdominal abscess.
4. No evidence of pulmonary embolism.


Brief Hospital Course:
In brief, the patient is a 48 male with bipolar disorder, HTN
presenting with agitation, fever and respiratory distress.
.
1. Fever/tachycardia/tachypnea/leukocytosis: The patient
initially presented with symptoms consistent with acute mania.
Following admission to the psychiatry service, he developed
notable tachypnea, fever, and tachycardia.  The patient had been
started on ciprofloxacin for a UTI prior to the admission.  He
was transfered to the ED and subsequently to the MICU for
management of the potential sepsis. The patient was intubated
for respiratory distress/airway protection. Microbiology data
revealed coag negative staph on the day of evaluation in the ED.
 He received ceftriaxone and vancomycin as empiric therapy.  A
TTE (although limited) showed normal MV and AV w/o vegetations.
Follow-up blood cultures were negative.  The patient
self-extubated without complication and by time of discharge was
breathing and oxygenating normally on room air.  The likely
original source was a UTI followed by manic episode from
medicine non-adherence then aspiration pneumonitis that
resolved. He received a total course of empiric antibiotics of 9
days.

2. Bipolar disorder: The patient was followed by the psychiatry
service throughout his hosptial stay.  He was not actively manic
during his stay on the medicine service.  He was discharged on a
modified regimen of anti-psychotics and mood stabilizer
medication compared to his prior regimen.  He will follow-up
with his primary psychiatrist within one week from discharge and
begin a partial hospitalization program following discharge.
.
3. CARDIAC: The patient had no chest pain during or prior to the
admission but had with EKG evidence of old anteroseptal infarct.
He had 3 sets of negative cardiac enzymes.  A TTE revealed
preserved BiV function.  His LDL was at goal.  His blood
pressure was controlled with beta-blockade.  He was started on
low-dose aspirin therapy.  In follow-up with his new PCP he can
be considered for ETT to evaluated for reversible ischemic
myocardium.
.
4. Elevated Transaminases: Incidental note was made of mild
transaminase elevation which should be repeated as an outpatient
and evaluated as needed.
.
5. Renal Lesion: Incidental note of renal mass was made on the
CT scan of the torso.  The lesion should be follow-up with MRI
to better characterize.

6. F/E/N: The patient received a low sodium diet and
electrolytes were repleted as needed.

7. PPx: The patient received SC heparin, PPI
.
8. Code: Full
.
9. Communication: mother [**Name (NI) **] [**Name (NI) 1124**] [**Telephone/Fax (1) 108639**]
Sister-also [**Name (NI) **] [**Known lastname 1124**] [**Last Name (NamePattern1) 108640**]: [**Telephone/Fax (1) 108641**]
.
10. Dispo: The patient was discharged to home with primary
psychiatrist follow-up, referral to partial hospitalization and
referral to initiate new primary medicine care.

Medications on Admission:
Zyprexa 20mg daily
Seroquel 150mg QHS
Lithium 1800mg QHS


Discharge Medications:
1. Lithium Carbonate 600 mg Capsule Sig: One (1) Capsule PO at
bedtime.
Disp:*30 Capsule(s)* Refills:*2*
2. Olanzapine 10 mg Tablet Sig: Two (2) Tablet PO at bedtime.
Disp:*60 Tablet(s)* Refills:*2*
3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*60 Tablet, Chewable(s)* Refills:*2*
4. Toprol XL 200 mg Tablet Sustained Release 24HR Sig: One (1)
Tablet Sustained Release 24HR PO once a day.
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
UTI
Bipolar disorder type I
Aspiration Pneumonitis
.
Secondary:
Hypertension


Discharge Condition:
good. tolerating oral medications. afebrile with stable vital
signs.


Discharge Instructions:
You were evaluated and treated for a UTI and an aspiration
pneumonitis which resolved.  Your symptoms of mania when you
came to the hospital could have been exacerbated by the medical
condition that you had.  It is essential that you take all of
your medications as prescribed to prevent relapses of your
bipolar symptoms.

Please take the medications as they are prescribed to you.  The
bipolar medicines have changed, you should only take the
medicines as they are prescribed to you.

Please make and attend the recommended follow-up appointments as
described below.
.
If you develop any new or concerning symptom particularly
agitation, excessive energy, talkativeness, chest pain, or
shortness of breath; please seek medical attention.

You have been referred to [**Hospital3 **] at [**Hospital3 **]
[**Hospital 1225**] Medical Center to initiate general medical care. The
number is [**Telephone/Fax (1) 250**]. Please call to schedule an appointment
with the first available provider.
[**Name10 (NameIs) **] should tell your new medicine doctor that you should have
your LFTs checked periodically while you are on your
medications.
Please also discuss with your new primary care doctor [**First Name (Titles) **] [**Last Name (Titles) 108642**] testing of a kidney mass that you have on a scan done
this time.

Followup Instructions:
1. Primary psychiatry: Dr. [**Last Name (un) 108643**] will call you to
schedule a follow-up appointment this week.  His phone number is
[**Telephone/Fax (1) 108644**].
2. Partial Hospitalization Program - Intake appointment: [**Hospital 1680**]
[**Hospital **] Hospital at [**Street Address(2) **]. in [**Location (un) **].  The appointment
is with [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] on [**2199-3-19**] at 9:30 am.
3. Primary Care Physician: [**Name10 (NameIs) **] have been referred to [**Hospital **] at [**Hospital3 **] [**Hospital 1225**] Medical Center to initiate
general medical care.  The number is [**Telephone/Fax (1) 250**].  Please call
to schedule an appointment with the first available provider.
[**Name10 (NameIs) **] should tell your new medicine doctor that you should have
your LFTs checked periodically while you are on your
medications. Please also discuss with your new primary care
doctor [**First Name (Titles) **] [**Last Name (Titles) 108645**] testing of a kidney mass that you have on a
scan done this time.
{'Other staphylococcal septicemia,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Retention of urine, unspecified,Chronic kidney disease, unspecified,Unspecified essential hypertension,Bipolar I disorder, most recent episode (or current) manic, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Tobacco use disorder,Severe sepsis,Other specified cardiac dysrhythmias'}


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: agitation

PRESENT ILLNESS: 48yoM with h/o bipolar disorder and HTN, presented to [**Hospital1 18**] ED
[**2199-3-9**] with confusion and agitation to psychiatry, transferred
now to MICU with tachypnea, fever, tachycardia.
.
Patient initially presented to ED with pressured speech and
agitation after being found pacing and yelling in front of his
apartment. In ED T 100.6 HR 100 BP 184/95 RR 16 98%RA. He was
diagnosed with a UTI and treated with Cipro. CXR was
unremarkable. Lumbar puncture was bloody but without significant
WBC and negative gram stain. He was admitted to psychiatry
.
Today VS T 102.3 HR 106 BP 144/80 RR 40 96%RA. He was
complaining of low back pain and inability to urinate. Medical
consult was called and trasnferred patient to MICU. On arrival
patient was alert and responding appropriately to questions. He
complained of low back pain. He denied having bowel or bladder
incontinence, or lower extremity numbness. He also denied SOB,
chest pain, abdominal pain

MEDICAL HISTORY: PSYCHIATRIC HISTORY:
As above, pt. with long h/o bipolar disorder and multiple
inpatient admissions. See HPI for details.
Pt. stopped medications; psychiatrist on vacation.
Pt. with recent inpatient admissions to [**Hospital1 882**] and [**Hospital1 336**]. Pt.
has h/o assaults when manic. Pt. denies current HI/SI. Pt.
reports h/o x1 suicide attempt by overdose 20 years ago.

MEDICATION ON ADMISSION: Zyprexa 20mg daily
Seroquel 150mg QHS
Lithium 1800mg QHS

ALLERGIES: Haldol / Perphenazine / Droperidol

PHYSICAL EXAM: On Arrival to MICU:
T 101.4 HR 106 BP 148/88 RR 31 100%4Lnc
Gen: tachypneic, alert, moderately agitated
HEENT: PERRL, anicteric, MMM, OP clear
Neck: no LAD, JVP not appreciated
CV: tachy, regular rhythm, no murmurs
Resp: CTAB
Abd: +BS, soft, NT, ND, obese
Back: tender to palpation
Ext: no edema, 2+ radials and DPs bilaterally
Neuro: A&Ox3, CN II-XII intact, strength 5/5 throughout,
sensation intact to touch

FAMILY HISTORY: Mother = bipolar

SOCIAL HISTORY: Pt. never married, no children. Lives alone in geriatric section 

### Response:
{'Other staphylococcal septicemia,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Urinary tract infection, site not specified,Retention of urine, unspecified,Chronic kidney disease, unspecified,Unspecified essential hypertension,Bipolar I disorder, most recent episode (or current) manic, unspecified,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Tobacco use disorder,Severe sepsis,Other specified cardiac dysrhythmias'}
