CHIEF COMPLAINT: Seizures

PRESENT ILLNESS: 57M with history of heavy EtOH abuse and depression, no prior
seizure history, presenting s/p seizure.  He is a heavy drinker
drinking [**3-1**] oz vodkas per day and has been drinking for >30
years. He is unemployed and sits at home drinking. However, he
has had a GI illness over the last few days resulting in [**10-10**]
episodes of vomiting bilious but not bloody and unable to keep
anything down as well as mild diarrhea, with mild RLQ abdominal
pain, and 6-8 episodes of small amounts of non bloody diarrhea.
On their way [**Hospital1 112433**], he told his brother [**Name (NI) **] that he
was not feeling well and was supporting himself on a barricade
on Yawkey. Then he turned his head and started to fall, while he
was bear-hugged and eased to the ground, sustaining abrasions to
his left knee (psoriatic plaque on right knee). Pt is unable to
characterize the type of seizure and does not remember what
happened.  However, he does note that blood was dripping out of
his mouth and tongue trauma was present. He was seizing for
about 3 minutes and then stopped. Per report, the patient was
post-ictal. EMT noted FSBG of 260.

MEDICAL HISTORY: Depression
HTN
EtOH abuse for >30 years
Psoriasis

MEDICATION ON ADMISSION: Remeron 7.5mg daily
Lisinopril 20mg daily
Prozac 20mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:
Vitals:  98.8 HR 100 BP 143/103 RR 20  97% on RA
General: Alert, oriented x3, no acute distress, with bilateral
upper extremity tremor
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP 6cm, no LAD
CV: Tachycardic, normal S1 + S2, no murmurs, rubs, gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-distended, bowel sounds present, no
organomegaly, no tenderness to palpation, no rebound or guarding

FAMILY HISTORY: Father passed away at age 84.  4v CABG
Mother alive at 82.  Healthy
Mother's brother and sister: Alcoholism

SOCIAL HISTORY: Lives at home with wife. Unemployed. Stays home most of day
drinking vodka ([**2-27**] drinks per day) and does work on his patio.
Never had an EtOH withdrawal seizure before.  No smoking or drug
use
Alcohol withdrawal delirium,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Other convulsions,Unspecified essential hypertension,Alcohol abuse, continuous,Depressive disorder, not elsewhere classified,Other psoriasis
Delirium tremens,Acute respiratry failure,Food/vomit pneumonitis,Acute kidney failure NOS,Convulsions NEC,Hypertension NOS,Alcohol abuse-continuous,Depressive disorder NEC,Other psoriasis
Name:  [**Known lastname 18446**],[**Known firstname **]                   Unit No:   [**Numeric Identifier 18447**]

Admission Date:  [**2101-6-16**]              Discharge Date:   [**2101-6-28**]

Date of Birth:  [**2043-10-30**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 18392**]
Addendum:
In regards to orthostatic hypotension: Resolved prior to
discharge. He was asymptomatic.

Discharge Disposition:
Home

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 18393**] MD [**MD Number(2) 18394**]

Completed by:[**2101-7-1**]

Admission Date:  [**2101-6-16**]              Discharge Date:   [**2101-6-28**]

Date of Birth:  [**2043-10-30**]             Sex:   M

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 15397**]
Chief Complaint:
Seizures


Major Surgical or Invasive Procedure:
Intubation


History of Present Illness:
57M with history of heavy EtOH abuse and depression, no prior
seizure history, presenting s/p seizure.  He is a heavy drinker
drinking [**3-1**] oz vodkas per day and has been drinking for >30
years. He is unemployed and sits at home drinking. However, he
has had a GI illness over the last few days resulting in [**10-10**]
episodes of vomiting bilious but not bloody and unable to keep
anything down as well as mild diarrhea, with mild RLQ abdominal
pain, and 6-8 episodes of small amounts of non bloody diarrhea.
On their way [**Hospital1 112433**], he told his brother [**Name (NI) **] that he
was not feeling well and was supporting himself on a barricade
on Yawkey. Then he turned his head and started to fall, while he
was bear-hugged and eased to the ground, sustaining abrasions to
his left knee (psoriatic plaque on right knee). Pt is unable to
characterize the type of seizure and does not remember what
happened.  However, he does note that blood was dripping out of
his mouth and tongue trauma was present. He was seizing for
about 3 minutes and then stopped. Per report, the patient was
post-ictal. EMT noted FSBG of 260.

In ED, initial VS were T 98.6 P 129 BP 180/116 RR 24 97% RA. On
arrival, pt noted to have tremor but per report this is at his
baseline which he has had for the past 3-4 years; however, he
was noted to be hypertensive, tachycardic, and diaphoretic on
exam as well as restless Lungs and cardiac exam otherwise
normal. Pt was given banana bag, electrolyte repletion, IV
ativan 8mg total, and had head CT w/o con since the patient
reportedly fell one week ago and hit head. EKG performed which
showed sinus tach but otherwise unremarkable.  Patient's
clinical status improved in the ED including becoming less
hypertensive and tachycardic.  He is AO X 3 a little off. He had
two peripheral IVs placed.  VS on transfer were T 98.2 ??????F (36.8
??????C), Pulse 99, Respiratory Rate 22, BP 147/101, O2 Saturation
97.

On arrival to the MICU, patient's VS.  T 98.8 HR 100 BP 143/103
RR 20  97% on RA.  Pt states he is comfortable and without
complaints. His abdominal pain has improved and he states that
he has had no diarrhea or vomiting today.  He denies any visual
or auditory hallucinations.  He denies any previous history of
seizures or family history of seizures.

Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies headache, sinus tenderness, rhinorrhea or
congestion. Denies shortness of breath, cough, dyspnea or
wheezing. Denies chest pain, chest pressure, palpitations.
Denies constipation, abdominal pain, diarrhea, dark or bloody
stools. Denies dysuria, frequency, or urgency. Denies
arthralgias or myalgias. Denies rashes or skin changes.


Past Medical History:
Depression
HTN
EtOH abuse for >30 years
Psoriasis


Social History:
Lives at home with wife. Unemployed. Stays home most of day
drinking vodka ([**2-27**] drinks per day) and does work on his patio.
Never had an EtOH withdrawal seizure before.  No smoking or drug
use


Family History:
Father passed away at age 84.  4v CABG
Mother alive at 82.  Healthy
Mother's brother and sister: Alcoholism


Physical Exam:
ADMISSION EXAM:
Vitals:  98.8 HR 100 BP 143/103 RR 20  97% on RA
General: Alert, oriented x3, no acute distress, with bilateral
upper extremity tremor
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP 6cm, no LAD
CV: Tachycardic, normal S1 + S2, no murmurs, rubs, gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-distended, bowel sounds present, no
organomegaly, no tenderness to palpation, no rebound or guarding

GU: no foley
Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: CNII-XII intact, 5/5 strength upper/lower extremities,
grossly normal sensation, gait and reflexes deferred. + tremor,
worse with intention
Skin: Hot and dry with psoriatic plaques over right leg and left
abdomen

DISCHARGE EXAM:

Pertinent Results:
ADMISSION LABS
[**2101-6-16**] 06:15PM BLOOD WBC-16.2* RBC-4.71 Hgb-16.6 Hct-50.1
MCV-107* MCH-35.2* MCHC-33.0 RDW-13.9 Plt Ct-123*
[**2101-6-16**] 06:15PM BLOOD Neuts-64.4 Lymphs-28.7 Monos-5.7 Eos-0.3
Baso-0.8
[**2101-6-16**] 06:15PM BLOOD PT-11.3 PTT-28.1 INR(PT)-1.0
[**2101-6-16**] 06:15PM BLOOD Glucose-236* UreaN-23* Creat-1.8* Na-134
K-3.0* Cl-81* HCO3-13* AnGap-43*
[**2101-6-16**] 06:15PM BLOOD ALT-90* AST-78* LD(LDH)-301* AlkPhos-70
TotBili-1.4
[**2101-6-16**] 06:15PM BLOOD Albumin-5.4* Calcium-10.7* Phos-6.4*
Mg-1.8
[**2101-6-16**] 06:15PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2101-6-17**] 05:42AM BLOOD Type-[**Last Name (un) **] pO2-26* pCO2-44 pH-7.43
calTCO2-30 Base XS-2
[**2101-6-17**] 05:42AM BLOOD Lactate-1.0

URINE STUDIES
[**2101-6-17**] 05:51AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.009
[**2101-6-17**] 05:51AM URINE Blood-SM  Nitrite-NEG Protein-30
Glucose-150 Ketone-TR Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG
[**2101-6-17**] 05:51AM URINE RBC-<1 WBC-<1 Bacteri-FEW Yeast-NONE
Epi-0
[**2101-6-17**] 05:51AM URINE CastHy-3*

STUDIES
CXR: IMPRESSION: No acute cardiopulmonary process noted,
possible opacity in right apex concerning for aspiration.
HEAD CT: IMPRESSION:  No acute intracranial process.  Volume
loss out of proportion to patient's age.
EKG:  NSR, no ischemic change.


Brief Hospital Course:
57-year-old male with history of heavy EtOH abuse who stopped
drinking prior to admission secondary to a GI illness with
multple episodes of vomiting who then presented with a seizure.

1. Seizure: The likely etiology was thought to be alcohol
withdrawal seizure. CT head negative, glucose adequate, tox
screen benign and not lab abnormalities to suggest alternative
etiology. He was treated for alcohol withdrawal (see below) and
improved. He had no further seizures in the hospital.

2. EtOH abuse and EtOH withdrawal: He has a significant EtOH
history and presented in withdrawal. The seizure likely was a
complication of this. He was treated with ativan (later switched
to valium) CIWA scale. His symptoms improved. At the time of
discharge he had no withdrawal symptoms and was without tremor.
The patient endorsed a desire to treat alcoholism and will be
discharged to detoxification/alcohol treatment centerXXX

3. Respiratory failure: The patient was intubated for
respiratory failure and inability to protect airway. He was
extubated without problem. [**Name (NI) **] was treated for aspiration
pneumonia with vancomycin/zosyn and later switched to
levofloxacin. Initially he had chest pain and cough which
resolved with treatment. At discharge he was saturating on room
air without respiratory complaints.

4. Acute kidney injury: Upon presentation creatinine was 1.8.
With hydration went to 1.1. Likely secondary to recent GI
illness.

5. Orthostatic hypotension: XXXXX

6. Hypertension: Treated with ACE inihibitor and metoprolol
tartrate. Improved.

7. Weakness: The patient had significant deconditioning. He
improved rapidly with physicial therapy.

8. GI illness: Resolved upon admission.

9. Depression: Stable during admission. He is on fluoxetine and
mirtazipime.

- Patient was full code

TRANSITIONAL ISSUES
- needs treatment for alcohol abuse.
- needs additional physical therapy

Medications on Admission:
Remeron 7.5mg daily
Lisinopril 20mg daily
Prozac 20mg daily


Discharge Medications:
1. fluoxetine 20 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
2. mirtazapine 15 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime).

3. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

4. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
5. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
6. miconazole nitrate 2 % Powder Sig: One (1) Appl Topical TID
(3 times a day): apply to buttocks area on rash.
Disp:*QS QS* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Alcohol withdrawal
Seizure
Pneumonia

Secondary:
Psoriasis
Rash
Orthostatic hypotension
Hypertension


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


Discharge Instructions:
You were admitted for a seizure. The cause of this was thought
to be due to alcoholic withdrawal. You were treated for
alcoholic withdrawal in the hospital. It is essential that you
follow up with your plans for treatment of your alcohol abuse.
Please contact [**Location (un) 22870**] Crisis [**Name (NI) 112434**] Program at
[**Telephone/Fax (1) 112435**] to set up treatment.

You also were treated for a pneumonia while you were here. You
do not need further treatment for the pneumonia.

You have a rash on your back and buttocks. Please keep your
dermatology appointment on [**7-4**] for further evaluation and
management of these rashes. The appointment is listed below.

Please resume your home medications. The following medications
have been added to your regimen:
- START Thiamine
- START Multivitamin
- START miconazole for rash

Followup Instructions:
Please call and set up an appointment with your PCP. [**Name10 (NameIs) **] you
have not seen her at her new location they want you to set up
the appointment. Please set it up for 1-2 weeks from discharge.
Her contact information is below:
Name: [**Name (NI) **],[**First Name7 (NamePattern1) **] [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **]
Location: [**Location (un) **] FAMILY MEDICINE
Address: [**Doctor Last Name 88494**] [**Apartment Address(1) 37164**], [**Location (un) **],[**Numeric Identifier 77413**]
Phone: [**0-0-**]

Department: DERMATOLOGY
When: MONDAY [**2101-7-4**] at 2:30 PM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 2762**], MD [**Telephone/Fax (1) 1971**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Alcohol withdrawal delirium,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Other convulsions,Unspecified essential hypertension,Alcohol abuse, continuous,Depressive disorder, not elsewhere classified,Other psoriasis'}


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: Seizures

PRESENT ILLNESS: 57M with history of heavy EtOH abuse and depression, no prior
seizure history, presenting s/p seizure.  He is a heavy drinker
drinking [**3-1**] oz vodkas per day and has been drinking for >30
years. He is unemployed and sits at home drinking. However, he
has had a GI illness over the last few days resulting in [**10-10**]
episodes of vomiting bilious but not bloody and unable to keep
anything down as well as mild diarrhea, with mild RLQ abdominal
pain, and 6-8 episodes of small amounts of non bloody diarrhea.
On their way [**Hospital1 112433**], he told his brother [**Name (NI) **] that he
was not feeling well and was supporting himself on a barricade
on Yawkey. Then he turned his head and started to fall, while he
was bear-hugged and eased to the ground, sustaining abrasions to
his left knee (psoriatic plaque on right knee). Pt is unable to
characterize the type of seizure and does not remember what
happened.  However, he does note that blood was dripping out of
his mouth and tongue trauma was present. He was seizing for
about 3 minutes and then stopped. Per report, the patient was
post-ictal. EMT noted FSBG of 260.

MEDICAL HISTORY: Depression
HTN
EtOH abuse for >30 years
Psoriasis

MEDICATION ON ADMISSION: Remeron 7.5mg daily
Lisinopril 20mg daily
Prozac 20mg daily

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: ADMISSION EXAM:
Vitals:  98.8 HR 100 BP 143/103 RR 20  97% on RA
General: Alert, oriented x3, no acute distress, with bilateral
upper extremity tremor
HEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL
Neck: supple, JVP 6cm, no LAD
CV: Tachycardic, normal S1 + S2, no murmurs, rubs, gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: soft, non-distended, bowel sounds present, no
organomegaly, no tenderness to palpation, no rebound or guarding

FAMILY HISTORY: Father passed away at age 84.  4v CABG
Mother alive at 82.  Healthy
Mother's brother and sister: Alcoholism

SOCIAL HISTORY: Lives at home with wife. Unemployed. Stays home most of day
drinking vodka ([**2-27**] drinks per day) and does work on his patio.
Never had an EtOH withdrawal seizure before.  No smoking or drug
use 

### Response:
{'Alcohol withdrawal delirium,Acute respiratory failure,Pneumonitis due to inhalation of food or vomitus,Acute kidney failure, unspecified,Other convulsions,Unspecified essential hypertension,Alcohol abuse, continuous,Depressive disorder, not elsewhere classified,Other psoriasis'}
