CHIEF COMPLAINT: N/V/D

PRESENT ILLNESS: 72-year-old russian-speaking woman with HTN admitted with 1 day
of non-bloody diarrhea, non-bloody, non-bilious emesis, and
intermittent "pulling" epigastric pain of moderate intensity
which radiated to the RUQ after a wild mushroom ingestion. Was
walking near her home in [**Location (un) 745**] with her son (also currently
hospitalized in [**Hospital1 18**] ICU) when they saw some mushrooms by the
street in front of a house nearby. The patient had eaten
similar-appearing mushrooms in [**Location (un) 3156**] so felt that they would
be safe to eat. Describes mushrooms as having a [**Doctor Last Name 352**]-beige cap,
"not sponge mushrooms." She ate these around ~9 PM and then
~6:30 AM and 2 hours later developed symptoms. No fever, chills,
dizziness, lightheadedness, jaundice, hematemesis, hematochezia,
melena, numbness, weakness, or parasthesias. Presented to
[**Hospital3 1196**] where AST 152 ALT 155 AP 134 INR 1.2
PTT 35.1. Treated with activated charcoal 50 g (vomited up in
our ED), NAc 13 g IV. Transferred to [**Hospital1 18**] where initial VS 98.3
82 116/81 18 98%RA. ALT 279 AST 280 AP 130 Tbili 0.8 lipase 22
CO2 18 AG 14 WBC# 17K. EKG showed sinus rhythm with normal
intervals. Given compazine 10 mg IV, zofran 4 mg IV, 1 L NS.
Vital signs prior to transfer 98.2 80 153/67 14 96%RA.
Upon arrival in the MICU, feels well, denying abd pain or
nausea.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: MVI

ALLERGIES: Chocolate Flavor

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Vitals - T 98.2 BP 160/75 HR 87 RR16 02 sat 98%RA
GENERAL: Well-appearing, NAD
HEENT: sclera anicteric, charcoal coating on tongue, OP
otherwise clear
NECK: supple no JVD or lymphadenopathy
CARDIAC: reg rate nl S1S2 no m/r/g
LUNGS: R basilar crackles no wheeze/rales
ABDOMEN: soft nondistended mildly tender in midepigastrium no
rebound or guarding, guaiac neg per ED notes
EXT: warm, dry +PP no edema
DERM: no rash
NEURO: awake, alert, conversing appropriately

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Moved from [**Location (un) 3156**] to U.S. with her husband in [**2105-6-5**]. He
passed away 1 month later from cardiac disease. Never smoked.
ETOH at holidays.
Toxic effect of mushrooms eaten as food,Acute and subacute necrosis of liver,Unspecified essential hypertension,Chest pain, unspecified,Accidental poisoning from mushrooms and other fungi
Toxic effect mushrooms,Acute necrosis of liver,Hypertension NOS,Chest pain NOS,Acc poison-mushrooms
Admission Date:  [**2105-11-19**]              Discharge Date:   [**2105-11-27**]

Date of Birth:  [**2033-11-3**]             Sex:   F

Service: MEDICINE

Allergies:
Chocolate Flavor

Attending:[**First Name3 (LF) 943**]
Chief Complaint:
N/V/D

Major Surgical or Invasive Procedure:
central venous catheter placement [**2105-11-20**]
ERCP-guided nasobiliary tube placement was attempted on [**11-22**]
but was unsuccessful.


History of Present Illness:
72-year-old russian-speaking woman with HTN admitted with 1 day
of non-bloody diarrhea, non-bloody, non-bilious emesis, and
intermittent "pulling" epigastric pain of moderate intensity
which radiated to the RUQ after a wild mushroom ingestion. Was
walking near her home in [**Location (un) 745**] with her son (also currently
hospitalized in [**Hospital1 18**] ICU) when they saw some mushrooms by the
street in front of a house nearby. The patient had eaten
similar-appearing mushrooms in [**Location (un) 3156**] so felt that they would
be safe to eat. Describes mushrooms as having a [**Doctor Last Name 352**]-beige cap,
"not sponge mushrooms." She ate these around ~9 PM and then
~6:30 AM and 2 hours later developed symptoms. No fever, chills,
dizziness, lightheadedness, jaundice, hematemesis, hematochezia,
melena, numbness, weakness, or parasthesias. Presented to
[**Hospital3 1196**] where AST 152 ALT 155 AP 134 INR 1.2
PTT 35.1. Treated with activated charcoal 50 g (vomited up in
our ED), NAc 13 g IV. Transferred to [**Hospital1 18**] where initial VS 98.3
82 116/81 18 98%RA. ALT 279 AST 280 AP 130 Tbili 0.8 lipase 22
CO2 18 AG 14 WBC# 17K. EKG showed sinus rhythm with normal
intervals. Given compazine 10 mg IV, zofran 4 mg IV, 1 L NS.
Vital signs prior to transfer 98.2 80 153/67 14 96%RA.
Upon arrival in the MICU, feels well, denying abd pain or
nausea.


Past Medical History:
Hypertension

Social History:
 Moved from [**Location (un) 3156**] to U.S. with her husband in [**2105-6-5**]. He
passed away 1 month later from cardiac disease. Never smoked.
ETOH at holidays.

Family History:
Noncontributory.

Physical Exam:
ADMISSION PHYSICAL EXAM:
Vitals - T 98.2 BP 160/75 HR 87 RR16 02 sat 98%RA
GENERAL: Well-appearing, NAD
HEENT: sclera anicteric, charcoal coating on tongue, OP
otherwise clear
NECK: supple no JVD or lymphadenopathy
CARDIAC: reg rate nl S1S2 no m/r/g
LUNGS: R basilar crackles no wheeze/rales
ABDOMEN: soft nondistended mildly tender in midepigastrium no
rebound or guarding, guaiac neg per ED notes
EXT: warm, dry +PP no edema
DERM: no rash
NEURO: awake, alert, conversing appropriately


Pertinent Results:
===========
IMAGING
===========
.
[**11-19**] RUQ U/S
IMPRESSION:
1. Diffuse fatty infiltration of the liver. Please note that
more severe
forms of hepatic fibrosis/cirrhosis cannot be excluded.
2. Cholelithiasis. No evidence of acute cholecystitis.
3. Normal color flow and waveforms within the hepatic arteries,
portal veins, and hepatic veins as described above.
4. Likely hepatomegaly.
.
[**2105-11-19**]: CXR PA and LAT:
IMPRESSION: Low lung volumes, with right lung base likely
atelectasis. Mild cardiomegaly, without CHF.
.
[**2105-11-19**] ERCP: Limited ERCP with opacification of only the
common bile duct which appears normal.
.

[**11-20**] TTE
The left atrium is mildly dilated. There is mild symmetric left
ventricular hypertrophy. The left ventricular cavity size is
normal. Due to suboptimal technical quality, a focal wall motion
abnormality cannot be fully excluded. Overall left ventricular
systolic function is normal (LVEF>55%). Right ventricular
chamber size and free wall motion are normal. The aortic valve
leaflets (3) are mildly thickened. The mitral valve leaflets are
mildly thickened. No mitral regurgitation is seen. The tricuspid
valve leaflets are mildly thickened. There is borderline
pulmonary artery systolic hypertension. There is a
trivial/physiologic pericardial effusion.
.
===================
ADMISSION LABS
===================

[**2105-11-19**] 08:15AM BLOOD WBC-11.7* RBC-4.30 Hgb-13.0 Hct-39.0
MCV-91 MCH-30.1 MCHC-33.2 RDW-15.0 Plt Ct-276
[**2105-11-19**] 08:15AM BLOOD Neuts-83.0* Lymphs-13.0* Monos-3.2
Eos-0.4 Baso-0.4
[**2105-11-19**] 12:18PM BLOOD PT-30.7* PTT-64.2* INR(PT)-3.1*
[**2105-11-21**] 02:28PM BLOOD Fibrino-258
[**2105-11-21**] 02:28PM BLOOD FDP-10-40*
[**2105-11-19**] 08:15AM BLOOD Glucose-165* UreaN-17 Creat-0.9 Na-141
K-3.9 Cl-109* HCO3-18* AnGap-18
[**2105-11-19**] 08:15AM BLOOD ALT-279* AST-280* AlkPhos-130*
TotBili-0.8
[**2105-11-19**] 12:30PM BLOOD ALT-491* AST-536* CK(CPK)-183*
AlkPhos-136* TotBili-1.1
[**2105-11-19**] 05:32PM BLOOD ALT-1249* AST-1289* AlkPhos-137*
TotBili-1.4
[**2105-11-19**] 10:03PM BLOOD ALT-3256* AST-3480* AlkPhos-147*
TotBili-1.4
[**2105-11-20**] 01:45PM BLOOD ALT-9360* AST-9640* LD(LDH)-8960*
AlkPhos-142* TotBili-1.3
[**2105-11-19**] 08:15AM BLOOD Lipase-22
[**2105-11-20**] 09:47AM BLOOD CK-MB-5 cTropnT-<0.01
[**2105-11-19**] 08:15AM BLOOD Albumin-4.6 Calcium-8.9 Phos-3.3 Mg-2.1
[**2105-11-19**] 05:32PM BLOOD Calcium-9.4 Phos-2.9 Mg-2.3 Iron-294*
Cholest-199
[**2105-11-19**] 05:32PM BLOOD calTIBC-332 Ferritn-1125* TRF-255
[**2105-11-21**] 02:28PM BLOOD D-Dimer-8198*
[**2105-11-20**] 06:09AM BLOOD %HbA1c-6.1*
[**2105-11-19**] 05:32PM BLOOD Triglyc-32 HDL-65 CHOL/HD-3.1 LDLcalc-128
[**2105-11-20**] 09:47AM BLOOD IgM HBc-NEGATIVE
[**2105-11-19**] 12:30PM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE HAV
Ab-POSITIVE IgM HAV-NEGATIVE
[**2105-11-19**] 05:32PM BLOOD AMA-NEGATIVE
[**2105-11-19**] 05:32PM BLOOD [**Doctor First Name **]-NEGATIVE
[**2105-11-19**] 05:32PM BLOOD CEA-1.6 AFP-3.0
[**2105-11-19**] 05:32PM BLOOD IgG-1443 IgA-288 IgM-87
[**2105-11-19**] 05:32PM BLOOD HIV Ab-NEGATIVE
[**2105-11-19**] 05:32PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2105-11-19**] 12:30PM BLOOD HCV Ab-NEGATIVE
[**2105-11-20**] 02:13PM BLOOD Type-[**Last Name (un) **] pO2-79* pCO2-31* pH-7.41
calTCO2-20* Base XS--3
[**2105-11-19**] 10:35AM BLOOD Lactate-1.6
[**2105-11-19**] 12:28PM BLOOD Lactate-2.0
[**2105-11-19**] CA19-9 6 (wnl)
[**2105-11-19**] Ceruloplasmin 29 (wnl)
[**2105-11-19**] 05:32PM BLOOD VITAMIN D 25 HYDROXY- 28 (wnl)
[**2105-11-19**] 11:55AM URINE Color-Pink Appear-Cloudy Sp [**Last Name (un) **]->1.030
[**2105-11-19**] 11:55AM URINE Blood-TR Nitrite-NEG Protein-30
Glucose-NEG Ketone-15 Bilirub-NEG Urobiln-0.2 pH-5.0 Leuks-NEG
[**2105-11-19**] 11:55AM URINE RBC-0 WBC-0 Bacteri-MANY Yeast-NONE Epi-0
[**2105-11-19**] 11:55AM URINE AmorphX-MANY
[**2105-11-19**] 05:32PM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG
[**2105-11-19**]  Urine Culture neg
[**2105-11-19**] RPR NR
[**2105-11-19**] Rubella IgG/IgM pos
[**2105-11-19**] VZV IgG pos
[**2105-11-19**] CMV IgG pos
[**2105-11-19**] EBV IgG pos, IgM neg
.
======================
DISCHARGE LABS
======================

COMPLETE BLOOD COUNT   WBC  RBC  Hgb   Hct   MCV MCH MCHC RDW
Plt Ct
[**2105-11-27**] 05:25AM    9.6 3.40* 10.5* 30.6* 90 30.9 34.4 15.4
180
PT/INR: 14.2/1.2
RENAL & GLUCOSE       Glu BUN Creat Na  K  Cl HCO3 AnGap
[**2105-11-27**] 05:25AM    95 15  0.9  139 4.2 104 27 12
ALT AST  AlkPhos TotBili
799* 66*  171*   2.5*


Brief Hospital Course:
The patient is a 72 year-old female with a history of untreated
hypertension, who presented with GI distress and LFT
abnormalities after mushroom ingestion.
.
#Amanita mushroom ingestion complicated by acute severe
hepatitis: Patient presented with hepatitis due to ingestion of
amanita mushrooms.  Initially received activated
charcoal, N-acetylcysteine, high-dose penicillin, cimetidine,
and oral milk thistle. Transplant surgery consulted in
preparation for possible transplant requirement. LFT's and
synthetic dysfunction trended up, peaked on HD#2, then declined.
ERCP-guided nasobiliary tube placement was attempted on [**11-22**]
but was unsuccessful due to technical and anatomic issues. IV
silibinin (milk thistle was started [**11-19**]) and stopped on
[**2105-11-25**] with INR at 1.2. The patient's symtoms resolved
completely, and all liver function tests continued to trend down
at discharge.  She was discharged home with a follow-up
appointment at the Liver center in three days.
.
#. Hypertension: Patient reported a history of untreated
hypertension.  While
inpatient, she was hypertensive with SBP ranging from 140-170s.
She remained asymptomatic and was started on metoprolol and
lisinopril with improvement in her hypertension.  She was
instructed to have blood pressure checked as an outpatient, with
medication adjustments as needed.

#Chest pain - Seen in consultation by cardiology who recommended
coronary CTA for preoperative evaluation should a transplant be
required. Statin therapy deferred given acute hepatitis. Would
likely benefit from aspirin therapy and outpatient stress
testing given report of frequent anginal symptoms.

Medications on Admission:
MVI

Discharge Medications:
1. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
Disp:*60 Tablet(s)* Refills:*2*
2. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnoses:
Hepatitis secondary to Amanita toxicity
Hypertension


Discharge Condition:
Good; Afebrile, hemodynamically stable, ambulatory and improved


Discharge Instructions:
You were admitted to the hospital with nausea, vomiting and
diarrhea following ingestion of poisonous mushrooms.  You were
found to have worsening abnormalities of your liver function
tests, and were treated with Acetylcysteine and IV Silibunin.
Your symptoms resolved, and your liver function tests have
improved to near-normal levels.  Additionally, you were found to
have high blood pressure and were started on two new
medications.  You will need to have your blood pressure checked
as an outpatient, and may need to increase this medication.
.
.
We started you on two new medications for your high blood
pressure:
START Lisinopril
START Metoprolol
Please take these medication as prescribed and have your blood
pressure checked as an outpatient.
.
Please do not use any acetaminophen (Tylenol) or alcohol until
your liver function recovers and your doctor [**First Name (Titles) 84935**] [**Last Name (Titles) 84936**].
Please avoid any future accidental ingestions and do not eat any
mushrooms picked in the wild.
.
If you experience fever, chills, nausea, vomiting, diarrhea,
blood in your stools, dizziness, or if your skin turns yellow
please return to the hospital or call Dr.[**Name (NI) 948**] office at
([**Telephone/Fax (1) 1582**].

Followup Instructions:
Liver Center on Monday [**2105-11-30**] at 9:45 AM with [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].
Phone:[**Telephone/Fax (1) 2422**].  This is located in the [**Hospital **] medical office
building.
.
Provider: [**First Name8 (NamePattern2) 2353**] [**Last Name (NamePattern1) 4758**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2105-12-10**] 1:45.  This is your new primary care
provider, [**Name10 (NameIs) **] she is Russian-speaking.  This appointment is
located in the [**Hospital Ward Name 23**] Clinical Building.
.
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], MD Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2105-12-8**] 8:30, in the [**Hospital **] medical office building.
{'Toxic effect of mushrooms eaten as food,Acute and subacute necrosis of liver,Unspecified essential hypertension,Chest pain, unspecified,Accidental poisoning from mushrooms and other fungi'}


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: N/V/D

PRESENT ILLNESS: 72-year-old russian-speaking woman with HTN admitted with 1 day
of non-bloody diarrhea, non-bloody, non-bilious emesis, and
intermittent "pulling" epigastric pain of moderate intensity
which radiated to the RUQ after a wild mushroom ingestion. Was
walking near her home in [**Location (un) 745**] with her son (also currently
hospitalized in [**Hospital1 18**] ICU) when they saw some mushrooms by the
street in front of a house nearby. The patient had eaten
similar-appearing mushrooms in [**Location (un) 3156**] so felt that they would
be safe to eat. Describes mushrooms as having a [**Doctor Last Name 352**]-beige cap,
"not sponge mushrooms." She ate these around ~9 PM and then
~6:30 AM and 2 hours later developed symptoms. No fever, chills,
dizziness, lightheadedness, jaundice, hematemesis, hematochezia,
melena, numbness, weakness, or parasthesias. Presented to
[**Hospital3 1196**] where AST 152 ALT 155 AP 134 INR 1.2
PTT 35.1. Treated with activated charcoal 50 g (vomited up in
our ED), NAc 13 g IV. Transferred to [**Hospital1 18**] where initial VS 98.3
82 116/81 18 98%RA. ALT 279 AST 280 AP 130 Tbili 0.8 lipase 22
CO2 18 AG 14 WBC# 17K. EKG showed sinus rhythm with normal
intervals. Given compazine 10 mg IV, zofran 4 mg IV, 1 L NS.
Vital signs prior to transfer 98.2 80 153/67 14 96%RA.
Upon arrival in the MICU, feels well, denying abd pain or
nausea.

MEDICAL HISTORY: Hypertension

MEDICATION ON ADMISSION: MVI

ALLERGIES: Chocolate Flavor

PHYSICAL EXAM: ADMISSION PHYSICAL EXAM:
Vitals - T 98.2 BP 160/75 HR 87 RR16 02 sat 98%RA
GENERAL: Well-appearing, NAD
HEENT: sclera anicteric, charcoal coating on tongue, OP
otherwise clear
NECK: supple no JVD or lymphadenopathy
CARDIAC: reg rate nl S1S2 no m/r/g
LUNGS: R basilar crackles no wheeze/rales
ABDOMEN: soft nondistended mildly tender in midepigastrium no
rebound or guarding, guaiac neg per ED notes
EXT: warm, dry +PP no edema
DERM: no rash
NEURO: awake, alert, conversing appropriately

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Moved from [**Location (un) 3156**] to U.S. with her husband in [**2105-6-5**]. He
passed away 1 month later from cardiac disease. Never smoked.
ETOH at holidays. 

### Response:
{'Toxic effect of mushrooms eaten as food,Acute and subacute necrosis of liver,Unspecified essential hypertension,Chest pain, unspecified,Accidental poisoning from mushrooms and other fungi'}
