CHIEF COMPLAINT: suicide attempt, EtOH withdrawal

PRESENT ILLNESS: Mr. [**Known lastname 23815**] is a 60 year old male with a history of depression,
anxiety, substance use, HCV, and prior suicide attempts who
presents with alcohol withdrawal after a suicide attempt earlier
today. He ran out of his psychiatric medications two weeks ago
and has felt increasingly suicidal since. He attempted to hang
himself with a belt from the ceiling and after kicking the chair
out from under himself the ceiling fell and he landed on the
ground. He then called a cab to bring him to the ED. He normally
drinks a quart to a half gallon of liquor. He drank about a
quart this morning. He endorses prior history of DTs and
seizures with alcohol withdrawal.
.
In the ED, initial vs were: Pain 0, T 98.8, HR 97, BP 180/111,
RR 22, O2 sat 98% RA. He was noted to have anisocoria and to be
tremulous. He had no dysphonia or dysphagia. Imaging of the head
and neck showed no fracture, ICH, or arterial abnormalities.
Patient was given valium 10 mg IV x 2 and 5 mg IV x 2. Vital
signs on transfer were: HR 81, BP 154/93, RR 13, 100%RA. He was
admitted to the ICU due to concern for severe alcohol
withdrawal.
.
On arrival to the ICU, the patient was tremulous and stated that
he felt so bad that he wanted to die. Later he denied any desire
to kill himself and stated that he simply wanted help.
.
Review of sytems:
(+) Per HPI. +2/10 chest pain and [**2102-3-30**] abdominal pain. +
chills, + shortness of breath. + pain with urination.
(-) Denies fever, recent weight loss or gain. Denies headache,
sinus tenderness, rhinorrhea or congestion. Denied cough. Denied
nausea, vomiting, diarrhea, constipation or abdominal pain. No
recent change in bowel or bladder habits. Denied arthralgias or
myalgias. No intercourse x 7 years.
.

MEDICAL HISTORY: 1. Reiter's syndrome
2. HCV
3. Hx IVDU, in methadone program, recent relapses
4. Hx Suicidality
5. Depression and anxiety
6. Mitral valve prolapse
7. Osteoarthritis, chronic pain
8. Hypertension
9. Bell's palsy
10. s/p Left lis franc ORIF

MEDICATION ON ADMISSION: Bupropion HCl SR 150 mg daily
Divalproex 500 mg TID
Gabapentin [Neurontin] 800 mg TID
Ibuprofen 800 mg TID - not taking
Ketoconazole [Nizoral] 2 % Shampoo daily - not using
Methadone 10 mg/mL Concentrate 3.4 mL(s) daily (74 mg daily per
patient)
Omeprazole 40 mg daily
Risperidone 3 mg QHS
Simvastatin 80 mg QHS
Trazodone 100 mg QHS - not taking
Venlafaxine [Effexor XR] 225 mg daily
Aspirin 325 mg daily
Diphenhydramine HCl 25-50 mg QHS - not taking

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 96.2 BP: 140/101 P: 82 R: 15 O2: 100% RA
General: Middle-aged Caucasian male, tremulous, appears
uncomfortable.
HEENT: Sclera anicteric, MM dry, oropharynx with thick, dry
secretions.
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: +BS, soft, mildly tender periumbilically and in the
epigastrium, no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A&O, CNII-XII intact, PERRL (4->2), moves all extremities

FAMILY HISTORY: Mother had an alcohol problem until she was 48 and has since
been sober. Mother also had colon cancer. Per OMR, depression in
maternal relatives.

SOCIAL HISTORY: Lives alone. Former nurse, currently on disability. No tobacco.
[**1-30**] - [**1-28**] gallon EtOH daily. Denies recent ilicit drug use but
has past history of heroin use. States he bought klonopin 2 mg
#15 tabs off the street and took them all this past weekend to
"help me come down".
Alcohol withdrawal delirium,Suicidal ideation,Depressive disorder, not elsewhere classified,Reiter's disease,Unspecified viral hepatitis C without hepatic coma,Combinations of opioid type drug with any other drug dependence, continuous,Mitral valve disorders,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Abdominal pain, left lower quadrant,Other chronic pain,Dysuria,Suicide and self-inflicted injury by hanging
Delirium tremens,Suicidal ideation,Depressive disorder NEC,Reiter's disease,Hpt C w/o hepat coma NOS,Opioid/other dep-contin,Mitral valve disorder,Osteoarthros NOS-unspec,Anemia NOS,Abdmnal pain lt lwr quad,Chronic pain NEC,Dysuria,Injury-hanging
Admission Date:  [**2102-3-28**]              Discharge Date:   [**2102-3-30**]

Date of Birth:  [**2041-6-6**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1646**]
Chief Complaint:
suicide attempt, EtOH withdrawal

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 23815**] is a 60 year old male with a history of depression,
anxiety, substance use, HCV, and prior suicide attempts who
presents with alcohol withdrawal after a suicide attempt earlier
today. He ran out of his psychiatric medications two weeks ago
and has felt increasingly suicidal since. He attempted to hang
himself with a belt from the ceiling and after kicking the chair
out from under himself the ceiling fell and he landed on the
ground. He then called a cab to bring him to the ED. He normally
drinks a quart to a half gallon of liquor. He drank about a
quart this morning. He endorses prior history of DTs and
seizures with alcohol withdrawal.
.
In the ED, initial vs were: Pain 0, T 98.8, HR 97, BP 180/111,
RR 22, O2 sat 98% RA. He was noted to have anisocoria and to be
tremulous. He had no dysphonia or dysphagia. Imaging of the head
and neck showed no fracture, ICH, or arterial abnormalities.
Patient was given valium 10 mg IV x 2 and 5 mg IV x 2. Vital
signs on transfer were: HR 81, BP 154/93, RR 13, 100%RA. He was
admitted to the ICU due to concern for severe alcohol
withdrawal.
.
On arrival to the ICU, the patient was tremulous and stated that
he felt so bad that he wanted to die. Later he denied any desire
to kill himself and stated that he simply wanted help.
.
Review of sytems:
(+) Per HPI. +2/10 chest pain and [**2102-3-30**] abdominal pain. +
chills, + shortness of breath. + pain with urination.
(-) Denies fever, recent weight loss or gain. Denies headache,
sinus tenderness, rhinorrhea or congestion. Denied cough. Denied
nausea, vomiting, diarrhea, constipation or abdominal pain. No
recent change in bowel or bladder habits. Denied arthralgias or
myalgias. No intercourse x 7 years.
.


Past Medical History:
1. Reiter's syndrome
2. HCV
3. Hx IVDU, in methadone program, recent relapses
4. Hx Suicidality
5. Depression and anxiety
6. Mitral valve prolapse
7. Osteoarthritis, chronic pain
8. Hypertension
9. Bell's palsy
10. s/p Left lis franc ORIF


Social History:
Lives alone. Former nurse, currently on disability. No tobacco.
[**1-30**] - [**1-28**] gallon EtOH daily. Denies recent ilicit drug use but
has past history of heroin use. States he bought klonopin 2 mg
#15 tabs off the street and took them all this past weekend to
"help me come down".

Family History:
Mother had an alcohol problem until she was 48 and has since
been sober. Mother also had colon cancer. Per OMR, depression in
maternal relatives.


Physical Exam:
Vitals: T: 96.2 BP: 140/101 P: 82 R: 15 O2: 100% RA
General: Middle-aged Caucasian male, tremulous, appears
uncomfortable.
HEENT: Sclera anicteric, MM dry, oropharynx with thick, dry
secretions.
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: +BS, soft, mildly tender periumbilically and in the
epigastrium, no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A&O, CNII-XII intact, PERRL (4->2), moves all extremities

Psych: Responds minimally to questions. ??????I feel like I??????m
crawling out of my skin??????. Appears depressed. Endorses SI.

Exam on discharge 97.0 102/68 83 18 95RA
minimal tremulousness, abd soft and NT. awake, alert, and clear
thinking.


Pertinent Results:
[**3-28**] CT C-spine: IMPRESSION: No evidence of acute fracture.
[**3-28**] CT non-contrast head: IMPRESSION:
1. No acute intracranial process.
2. Mild paranasal sinus disease.
[**3-28**] CTA neck: Pending
[**3-28**] CXR: Pending

[**2102-3-28**] 12:53PM BLOOD WBC-7.8 RBC-3.97* Hgb-12.2* Hct-34.9*
MCV-88 MCH-30.7 MCHC-35.0 RDW-14.4 Plt Ct-230
[**2102-3-28**] 12:53PM BLOOD Neuts-78.4* Lymphs-16.3* Monos-3.1
Eos-1.9 Baso-0.2
[**2102-3-28**] 12:53PM BLOOD Glucose-87 UreaN-19 Creat-1.1 Na-141
K-3.6 Cl-106 HCO3-22 AnGap-17
[**2102-3-28**] 12:53PM BLOOD ALT-14 AST-23 CK(CPK)-231 AlkPhos-65
Amylase-53 TotBili-0.4
[**2102-3-28**] 08:56PM BLOOD CK(CPK)-144
[**2102-3-29**] 03:44AM BLOOD CK(CPK)-88
[**2102-3-28**] 12:53PM BLOOD Lipase-20
[**2102-3-28**] 12:53PM BLOOD CK-MB-3 cTropnT-<0.01
[**2102-3-28**] 08:56PM BLOOD CK-MB-3 cTropnT-<0.01
[**2102-3-29**] 03:44AM BLOOD CK-MB-2 cTropnT-<0.01
[**2102-3-29**] 03:44AM BLOOD Calcium-8.1* Phos-4.2 Mg-2.0
[**2102-3-28**] 12:53PM BLOOD ASA-NEG Ethanol-34* Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2102-3-28**] 03:35PM URINE bnzodzp-POS barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-POS
[**2102-3-28**] 03:35PM URINE Blood-SM Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-1 pH-5.0 Leuks-NEG
[**2102-3-28**] 03:35PM URINE RBC-0-2 WBC-0 Bacteri-NONE Yeast-NONE
Epi-0

Brief Hospital Course:
This is a 60 year old male with a history of depression,
anxiety, and substance use who presents with alcohol withdrawal
after an attempted suicide by hanging now with chest pain and
abdominal pain.

# Alcohol withdrawal. On arrival to the [**Hospital Unit Name 153**], patient was
uncomfortable, but not tachycardic.  He was given valium 10mg
IV, then valium 10mg PO q1hr for CIWA >10.  [**Last Name (un) **] received 5 doses
of PO valium for a total of 50 mg o/n.  In the morning, he
appears more comforatble and he was normotensive and not
tachycardic.  His dose was decreased to 5mg PO q2hr for CIWA >
10. At the time of discharge on valium 5 q6 with q3 prn. Still
no significant s/s of DT's. Only experiencing anxiety.  Social
work was consulted.

# Suicidal ideation/depression. Patient s/p suicide attempt. Has
prior history of suicide attempts. This decompensation appears
to be associated with running out of his psych meds. He has no
current prescriber or psychiatric follow-up despite attmpts from
psychiatry to arrange outpatient follow up for him.  A 1:1
sitter attended the patient overnight. His bupropion,
venlafaxine, valproate, trazodone and benadryl were held, and he
was given his home risperdone 3mg PO. Psychiatry was consulted
to help advise regarding psych meds. Risperdal was continued,
all other meds held. Transfer to [**Hospital1 **] 4 completed on [**3-30**].

# Chronic pain/methadone use - Patient not endorsing significant
pain currently. He was given his home dose of methdone that was
confirmed with his methadone clinic.  Neurontin was held on
admission and it was planned to discuss dosing with psychiatry.
Baycove was called and confirmed his dose of 74mg methadone
daily (can be given in divided doses [**Hospital1 **]).

# Chest pain - EKG unremarkable. Differential included cardiac
vs. GI vs. vascular. Cardiac biomarkers were negative x 3.  CXR
was unremarkable.  Given EtOH history, it was thought that this
was likely GI related and he was treated with prn maalox with
resolution of his symptoms. He was on a home dose of aspirin of
325 mg. On review of his records I could find no indication for
this. He has never had a stroke, MI, or AF. His simvastatin dose
should remain at 80 mg, but can be held until discharge home.

# Dysuria - There was no evidence of UTI on UA. Patient has not
been sexually active recently. Dysuria could be secondary to
Reiter's syndrome given [**Hospital 228**] medical history.

# Anemia - Patient's Hct was at baseline, stable throughout his
ICU stay. Prior iron/folate/b12 studies were normal.

Code: FULL CODE
DISPO: to [**Hospital1 **] 4

Medications on Admission:
Bupropion HCl SR 150 mg daily
Divalproex 500 mg TID
Gabapentin [Neurontin] 800 mg TID
Ibuprofen 800 mg TID - not taking
Ketoconazole [Nizoral] 2 % Shampoo daily - not using
Methadone 10 mg/mL Concentrate 3.4 mL(s) daily (74 mg daily per
patient)
Omeprazole 40 mg daily
Risperidone 3 mg QHS
Simvastatin 80 mg QHS
Trazodone 100 mg QHS - not taking
Venlafaxine [Effexor XR] 225 mg daily
Aspirin 325 mg daily
Diphenhydramine HCl 25-50 mg QHS - not taking


Discharge Medications:
1. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Risperidone 2 mg Tablet Sig: 1.5 Tablets PO HS (at bedtime).

4. Methadone 10 mg Tablet Sig: Seventy Five (75) MG PO DAILY
(Daily): can be given in divided doses.
5. Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
6. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day:
to be restarted at the time of discharge.
7. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
8. Valium 5 mg Tablet Sig: One (1) Tablet PO every six (6)
hours: with taper.
9. Valium 5 mg Tablet Sig: One (1) Tablet PO every four (4)
hours as needed for anxiety, s/s of etoh w/d.


Discharge Disposition:
Extended Care

Discharge Diagnosis:
Primary Diagnosis: 291.0 DRUG WITHDRAWAL, ALCOHOL W/ DELERIUM
TREMENS
Secondary Diagnosis: 311 DEPRESSION, NOS
Secondary Diagnosis: V62.84 SUICIDAL IDEATION
Secondary Diagnosis: 789.04 PAIN, ABDOMINAL-LLQ
Secondary Diagnosis: 285.9 ANEMIA, UNSPECIFIED
Secondary Diagnosis: 099.3 REITER'S SYNDROME


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


Discharge Instructions:
Patient being discharged to [**Hospital1 **] 4. Home discharge instructions
to be completed at a later date.

Followup Instructions:
Department: [**Hospital3 249**]
When: THURSDAY [**2102-4-20**] at 1:45 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 250**]
Building: [**Hospital6 29**] [**Location (un) 895**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage

Department: ORTHOPEDICS
When: MONDAY [**2102-6-5**] at 10:00 AM
With: [**Name6 (MD) 13978**] [**Name8 (MD) **], MD [**Telephone/Fax (1) 1228**]
Building: [**Hospital6 29**] [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{"Alcohol withdrawal delirium,Suicidal ideation,Depressive disorder, not elsewhere classified,Reiter's disease,Unspecified viral hepatitis C without hepatic coma,Combinations of opioid type drug with any other drug dependence, continuous,Mitral valve disorders,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Abdominal pain, left lower quadrant,Other chronic pain,Dysuria,Suicide and self-inflicted injury by hanging"}


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: suicide attempt, EtOH withdrawal

PRESENT ILLNESS: Mr. [**Known lastname 23815**] is a 60 year old male with a history of depression,
anxiety, substance use, HCV, and prior suicide attempts who
presents with alcohol withdrawal after a suicide attempt earlier
today. He ran out of his psychiatric medications two weeks ago
and has felt increasingly suicidal since. He attempted to hang
himself with a belt from the ceiling and after kicking the chair
out from under himself the ceiling fell and he landed on the
ground. He then called a cab to bring him to the ED. He normally
drinks a quart to a half gallon of liquor. He drank about a
quart this morning. He endorses prior history of DTs and
seizures with alcohol withdrawal.
.
In the ED, initial vs were: Pain 0, T 98.8, HR 97, BP 180/111,
RR 22, O2 sat 98% RA. He was noted to have anisocoria and to be
tremulous. He had no dysphonia or dysphagia. Imaging of the head
and neck showed no fracture, ICH, or arterial abnormalities.
Patient was given valium 10 mg IV x 2 and 5 mg IV x 2. Vital
signs on transfer were: HR 81, BP 154/93, RR 13, 100%RA. He was
admitted to the ICU due to concern for severe alcohol
withdrawal.
.
On arrival to the ICU, the patient was tremulous and stated that
he felt so bad that he wanted to die. Later he denied any desire
to kill himself and stated that he simply wanted help.
.
Review of sytems:
(+) Per HPI. +2/10 chest pain and [**2102-3-30**] abdominal pain. +
chills, + shortness of breath. + pain with urination.
(-) Denies fever, recent weight loss or gain. Denies headache,
sinus tenderness, rhinorrhea or congestion. Denied cough. Denied
nausea, vomiting, diarrhea, constipation or abdominal pain. No
recent change in bowel or bladder habits. Denied arthralgias or
myalgias. No intercourse x 7 years.
.

MEDICAL HISTORY: 1. Reiter's syndrome
2. HCV
3. Hx IVDU, in methadone program, recent relapses
4. Hx Suicidality
5. Depression and anxiety
6. Mitral valve prolapse
7. Osteoarthritis, chronic pain
8. Hypertension
9. Bell's palsy
10. s/p Left lis franc ORIF

MEDICATION ON ADMISSION: Bupropion HCl SR 150 mg daily
Divalproex 500 mg TID
Gabapentin [Neurontin] 800 mg TID
Ibuprofen 800 mg TID - not taking
Ketoconazole [Nizoral] 2 % Shampoo daily - not using
Methadone 10 mg/mL Concentrate 3.4 mL(s) daily (74 mg daily per
patient)
Omeprazole 40 mg daily
Risperidone 3 mg QHS
Simvastatin 80 mg QHS
Trazodone 100 mg QHS - not taking
Venlafaxine [Effexor XR] 225 mg daily
Aspirin 325 mg daily
Diphenhydramine HCl 25-50 mg QHS - not taking

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals: T: 96.2 BP: 140/101 P: 82 R: 15 O2: 100% RA
General: Middle-aged Caucasian male, tremulous, appears
uncomfortable.
HEENT: Sclera anicteric, MM dry, oropharynx with thick, dry
secretions.
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: +BS, soft, mildly tender periumbilically and in the
epigastrium, no rebound tenderness or guarding
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Neuro: A&O, CNII-XII intact, PERRL (4->2), moves all extremities

FAMILY HISTORY: Mother had an alcohol problem until she was 48 and has since
been sober. Mother also had colon cancer. Per OMR, depression in
maternal relatives.

SOCIAL HISTORY: Lives alone. Former nurse, currently on disability. No tobacco.
[**1-30**] - [**1-28**] gallon EtOH daily. Denies recent ilicit drug use but
has past history of heroin use. States he bought klonopin 2 mg
#15 tabs off the street and took them all this past weekend to
"help me come down". 

### Response:
{"Alcohol withdrawal delirium,Suicidal ideation,Depressive disorder, not elsewhere classified,Reiter's disease,Unspecified viral hepatitis C without hepatic coma,Combinations of opioid type drug with any other drug dependence, continuous,Mitral valve disorders,Osteoarthrosis, unspecified whether generalized or localized, site unspecified,Anemia, unspecified,Abdominal pain, left lower quadrant,Other chronic pain,Dysuria,Suicide and self-inflicted injury by hanging"}
