CHIEF COMPLAINT: medication overdose

PRESENT ILLNESS: 47 y/o M w/reported hx anxiety and depression, presented to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] hospital last night at midnight stating he had taken 20
Toprol tablets (100 mg each). He also reported taking 20
percocet tablets and 20 ativan tablets (2 mg each), all in a
suicide gesture. He reportedly did this around 9 pm. His wife
later found him "staggering around [**Location (un) **] square" and brought
him to the OSH at midnight.
.
While there, his HR was 77, BP 103/74. He received charcoal 50
grams x2, golytely, atropine 1 mg IV, glucagon 3.5 mg IV, and
was placed on the HIE protocol (0.5units/hour, D10 10 cc/kg/hr).
His acetaminophen level there was 57. Urine tox screen was
positive for benzodiazepines and opiates. He was transferred to
[**Hospital1 18**] for further monitoring.
.
In our ED, his HR ranged 49 to 51. Tox was consulted who
recommended discontinuing the insulin and D10 drips and
administering glucagon for symptomatic hypotension and
bradycardia.
.
Currently, he reports problems with his "stomach, bowels, and
urinary tract" which have been going on for 3 months. He states
he has chronic n/v/d and has had an extensive w/u which has been
negative. Otherwise, the only change from his baseline is that
he feels very sleepy.

MEDICAL HISTORY: # depression: requiring ECT, multiple suicide attempts and
hospitalizations in the past. Psychiatrist is Dr. [**First Name (STitle) **] in
[**Location (un) 32944**].
# lung nodule
# hyperlipidemia
# hx IV heroin use
# HTN
# Seizures: once in setting of using wellbutrin, once at another
time without known precipitant

MEDICATION ON ADMISSION: 1. Lexapro 20 mg daily
2. Lorazepam 2 mg PO  Q6H
3. Metoprolol 100 mg daily
4. Nifedipine ER 90 mg daily
5. Oxcarbazepine 300 mg PO BID
6. Penicillin V Potassium 500 mg PO Q6H
7. Percocet 5/325mg 1 tab q4-6 hours prn

ALLERGIES: Wellbutrin

PHYSICAL EXAM: T: 98.6 BP: 144/80 P: 59 R: 14 O2 sat: 97%RA
Gen: pleasant male in NAD, sitting quietly in bed
HEENT: NC, AT, perrl, anicteric, MM dry
Neck: supple
Lungs: bibasilar crackles, no wheezes or rhonchi
CV: regular rhythm, bradycardic, no m/r/g
Abd: soft, nt/nd, +bs
Ext: no edema, 2+ dp bilaterally
Neuro: pupils 1-2mm and reactive bilat. no tremor. tongue
midline withou fasciculations, no nystagmus. moving all 4
extremities symmectrically.

FAMILY HISTORY: denies

SOCIAL HISTORY: Lives at home with his wife from second marriage. He has 3
children ages 21,22, and 25. He dropped out of school in 10th
grade. Does not work. Smokes 1 ppd x years. Denies EtOH as he
has been sober for >5 years and is active in AA.  He has had
previous problems with alcohol, cocaine, and heroin. prior
detention in jeuvenile [**Doctor Last Name **] for stealing cars.  also at least 2
arrests as an adult.
Poisoning by other antihypertensive agents,Other, mixed, or unspecified drug abuse, continuous,Poisoning by aromatic analgesics, not elsewhere classified,Poisoning by benzodiazepine-based tranquilizers,Abnormality of gait,Major depressive affective disorder, single episode, unspecified,Anxiety state, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Periapical abscess without sinus,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics
Pois-antihyperten agent,Drug abuse NEC-contin,Pois-arom analgesics NEC,Pois-benzodiazepine tran,Abnormality of gait,Depress psychosis-unspec,Anxiety state NOS,Hypertension NOS,Hyperlipidemia NEC/NOS,Periapical abscess,Poison-analgesics
Admission Date:  [**2162-6-1**]              Discharge Date:   [**2162-6-2**]

Date of Birth:  [**2114-6-19**]             Sex:   M

Service: MEDICINE

Allergies:
Wellbutrin

Attending:[**First Name3 (LF) 2485**]
Chief Complaint:
medication overdose

Major Surgical or Invasive Procedure:
none


History of Present Illness:
47 y/o M w/reported hx anxiety and depression, presented to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] hospital last night at midnight stating he had taken 20
Toprol tablets (100 mg each). He also reported taking 20
percocet tablets and 20 ativan tablets (2 mg each), all in a
suicide gesture. He reportedly did this around 9 pm. His wife
later found him "staggering around [**Location (un) **] square" and brought
him to the OSH at midnight.
.
While there, his HR was 77, BP 103/74. He received charcoal 50
grams x2, golytely, atropine 1 mg IV, glucagon 3.5 mg IV, and
was placed on the HIE protocol (0.5units/hour, D10 10 cc/kg/hr).
His acetaminophen level there was 57. Urine tox screen was
positive for benzodiazepines and opiates. He was transferred to
[**Hospital1 18**] for further monitoring.
.
In our ED, his HR ranged 49 to 51. Tox was consulted who
recommended discontinuing the insulin and D10 drips and
administering glucagon for symptomatic hypotension and
bradycardia.
.
Currently, he reports problems with his "stomach, bowels, and
urinary tract" which have been going on for 3 months. He states
he has chronic n/v/d and has had an extensive w/u which has been
negative. Otherwise, the only change from his baseline is that
he feels very sleepy.


Past Medical History:

# depression: requiring ECT, multiple suicide attempts and
hospitalizations in the past. Psychiatrist is Dr. [**First Name (STitle) **] in
[**Location (un) 32944**].
# lung nodule
# hyperlipidemia
# hx IV heroin use
# HTN
# Seizures: once in setting of using wellbutrin, once at another
time without known precipitant


Social History:
Lives at home with his wife from second marriage. He has 3
children ages 21,22, and 25. He dropped out of school in 10th
grade. Does not work. Smokes 1 ppd x years. Denies EtOH as he
has been sober for >5 years and is active in AA.  He has had
previous problems with alcohol, cocaine, and heroin. prior
detention in jeuvenile [**Doctor Last Name **] for stealing cars.  also at least 2
arrests as an adult.

Family History:
denies

Physical Exam:

T: 98.6 BP: 144/80 P: 59 R: 14 O2 sat: 97%RA
Gen: pleasant male in NAD, sitting quietly in bed
HEENT: NC, AT, perrl, anicteric, MM dry
Neck: supple
Lungs: bibasilar crackles, no wheezes or rhonchi
CV: regular rhythm, bradycardic, no m/r/g
Abd: soft, nt/nd, +bs
Ext: no edema, 2+ dp bilaterally
Neuro: pupils 1-2mm and reactive bilat. no tremor. tongue
midline withou fasciculations, no nystagmus. moving all 4
extremities symmectrically.

Pertinent Results:
[**2162-6-1**] 04:25AM   ASA-NEG ETHANOL-NEG ACETMNPHN-23.7
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2162-6-1**] 04:25AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2162-6-1**] 04:25AM   WBC-9.0 RBC-4.36* HGB-13.8* HCT-40.2 MCV-92
MCH-31.7 MCHC-34.4 RDW-15.3
[**2162-6-1**] 04:25AM   PLT COUNT-352
[**2162-6-1**] 04:25AM   NEUTS-56.8 LYMPHS-34.1 MONOS-5.1 EOS-3.1
BASOS-0.9
[**2162-6-1**] 04:25AM   GLUCOSE-67* UREA N-7 CREAT-1.0 SODIUM-135
POTASSIUM-3.9 CHLORIDE-101 TOTAL CO2-27 ANION GAP-11
[**2162-6-1**] 04:25AM   ALT(SGPT)-8 AST(SGOT)-15 CK(CPK)-38 ALK
PHOS-73 AMYLASE-36 TOT BILI-0.4

[**2162-6-1**]: EKG #1 sinus brady with QT/QTc 528/488.58
[**2162-6-1**]: EKG #2 sinus brady with QT/QTc 482/469.15

Brief Hospital Course:
In brief the patient is a 47 y/o male w/hx depression, p/w
beta-blocker, acetaminophen, and benzodiazepine overdose.
.
1. Overdose: In terms of beta-blocker, the patient was not
bradycardic upon arrival to [**Hospital1 18**]. He was monitored for
signficant bradycardia without events nor need for repeat
glucagon.   In terms of acetaminophen, at 12 hours out from his
ingestion his level is 23, which is in the no hepatic toxicity
area of the nomogram. Also, his LFTs are completely normal. He
was not thought to be a candidate for n-acetylcysteine to
prevent hepatic toxicity. He already received charcoal x2. In
terms of the benzo overdose, he was never significantly sedated.
Repeat urine and blood tox screens were negative for
benzodiazepines. He was followed by the toxicology consult
service but needed no specific intervention.  Regarding this
suicide attempt he was evaluated by the psychiatry service who
recommended an inpatient psychiatric admission.  A Section 12
was completed. A TSH, RPR, folate and B12 were pending at the
time of discharge.
.
2. Dental Abscess: The patient will complete his prior
prescribed therapy.
.
3. Hypertension: The patient's blood pressure was normal
throughout his hospital stay.  He can follow-up with his primary
care physician to have his anti-hypertensives resumed or
changed.
.
4. Depression/Anxiety: He was evaluated by the psychiatry
service as above. He will be discharged for inpatient
psychiatric eval and therapy.  His Lexapro was discontinued
pending further evaluation.
.
5. FEN: Regular diet.
.
6. Ppx: SQ heparin.
.
7. Dispo: Patient was discharged in stable condition ready for
inpatient psychiatric care.

Medications on Admission:
1. Lexapro 20 mg daily
2. Lorazepam 2 mg PO  Q6H
3. Metoprolol 100 mg daily
4. Nifedipine ER 90 mg daily
5. Oxcarbazepine 300 mg PO BID
6. Penicillin V Potassium 500 mg PO Q6H
7. Percocet 5/325mg 1 tab q4-6 hours prn


Discharge Medications:
1. Oxcarbazepine 300 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
2. Penicillin V Potassium 500 mg Tablet Sig: One (1) Tablet PO
Q6H (every 6 hours) as needed for dental abscess for 6 days.
3. Ativan 2 mg Tablet Sig: One (1) Tablet PO four times a day.
4. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every eight (8)
hours as needed for pain.
5. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every 6-8 hours
as needed for pain.


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 26615**] Hospital - [**Location (un) 5028**]

Discharge Diagnosis:
Primary:
Suicide Attempt
Major depression
.
Secondary:
Hypertension
polysubstance abuse
hyperlipidemia


Discharge Condition:
good. stable vital signs. section 12 for transfer to inpatient
psychiatry facility.


Discharge Instructions:
You have been evaluated and treated for a medication overdose
and suicide attempt.  The acute intoxication was managed with
drug antidotes and supportive care.
.
Regarding your depression, it was felt that you would benefit
from an inpatient psychiatric admission to further treat your
depression particularly with regard to this suicide attempt.
.
Please the medication changes as described.
.
If you develop any new or concerning symptoms particularly
dizziness or passing out, chest pain, shortness of breath, or
fever to >101F; please contact the medical professionals at the
psychiatric facility.

Followup Instructions:
You will be evaluated by the psychiatric medical providers at
the inpatient psychiatry facility.
.
Prior to discharge from the facility, please have someone
schedule an appointment with your primary medical doctor and
your primary psychiatrist.
{'Poisoning by other antihypertensive agents,Other, mixed, or unspecified drug abuse, continuous,Poisoning by aromatic analgesics, not elsewhere classified,Poisoning by benzodiazepine-based tranquilizers,Abnormality of gait,Major depressive affective disorder, single episode, unspecified,Anxiety state, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Periapical abscess without sinus,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics'}


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: medication overdose

PRESENT ILLNESS: 47 y/o M w/reported hx anxiety and depression, presented to [**First Name8 (NamePattern2) **]
[**Last Name (NamePattern1) **] hospital last night at midnight stating he had taken 20
Toprol tablets (100 mg each). He also reported taking 20
percocet tablets and 20 ativan tablets (2 mg each), all in a
suicide gesture. He reportedly did this around 9 pm. His wife
later found him "staggering around [**Location (un) **] square" and brought
him to the OSH at midnight.
.
While there, his HR was 77, BP 103/74. He received charcoal 50
grams x2, golytely, atropine 1 mg IV, glucagon 3.5 mg IV, and
was placed on the HIE protocol (0.5units/hour, D10 10 cc/kg/hr).
His acetaminophen level there was 57. Urine tox screen was
positive for benzodiazepines and opiates. He was transferred to
[**Hospital1 18**] for further monitoring.
.
In our ED, his HR ranged 49 to 51. Tox was consulted who
recommended discontinuing the insulin and D10 drips and
administering glucagon for symptomatic hypotension and
bradycardia.
.
Currently, he reports problems with his "stomach, bowels, and
urinary tract" which have been going on for 3 months. He states
he has chronic n/v/d and has had an extensive w/u which has been
negative. Otherwise, the only change from his baseline is that
he feels very sleepy.

MEDICAL HISTORY: # depression: requiring ECT, multiple suicide attempts and
hospitalizations in the past. Psychiatrist is Dr. [**First Name (STitle) **] in
[**Location (un) 32944**].
# lung nodule
# hyperlipidemia
# hx IV heroin use
# HTN
# Seizures: once in setting of using wellbutrin, once at another
time without known precipitant

MEDICATION ON ADMISSION: 1. Lexapro 20 mg daily
2. Lorazepam 2 mg PO  Q6H
3. Metoprolol 100 mg daily
4. Nifedipine ER 90 mg daily
5. Oxcarbazepine 300 mg PO BID
6. Penicillin V Potassium 500 mg PO Q6H
7. Percocet 5/325mg 1 tab q4-6 hours prn

ALLERGIES: Wellbutrin

PHYSICAL EXAM: T: 98.6 BP: 144/80 P: 59 R: 14 O2 sat: 97%RA
Gen: pleasant male in NAD, sitting quietly in bed
HEENT: NC, AT, perrl, anicteric, MM dry
Neck: supple
Lungs: bibasilar crackles, no wheezes or rhonchi
CV: regular rhythm, bradycardic, no m/r/g
Abd: soft, nt/nd, +bs
Ext: no edema, 2+ dp bilaterally
Neuro: pupils 1-2mm and reactive bilat. no tremor. tongue
midline withou fasciculations, no nystagmus. moving all 4
extremities symmectrically.

FAMILY HISTORY: denies

SOCIAL HISTORY: Lives at home with his wife from second marriage. He has 3
children ages 21,22, and 25. He dropped out of school in 10th
grade. Does not work. Smokes 1 ppd x years. Denies EtOH as he
has been sober for >5 years and is active in AA.  He has had
previous problems with alcohol, cocaine, and heroin. prior
detention in jeuvenile [**Doctor Last Name **] for stealing cars.  also at least 2
arrests as an adult. 

### Response:
{'Poisoning by other antihypertensive agents,Other, mixed, or unspecified drug abuse, continuous,Poisoning by aromatic analgesics, not elsewhere classified,Poisoning by benzodiazepine-based tranquilizers,Abnormality of gait,Major depressive affective disorder, single episode, unspecified,Anxiety state, unspecified,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Periapical abscess without sinus,Suicide and self-inflicted poisoning by analgesics, antipyretics, and antirheumatics'}
