CHIEF COMPLAINT: "Swallowed razor blade and tacks."

PRESENT ILLNESS: 38M with extensive psychiatric history, multiple past ingestions
presenting after ingestion of razor blade, tacks, and pieces of
metal can.  The patient is well-known to the MICU team from his
previous admission [**Date range (3) 63381**].  The patient has a history
of multiple auto-ingestions which are not believed to be suicide
attempts but rather means of hospital admission, which he
prefers to living on the street.  The patient was followed by GI
and surgery last admission and there was no intervention
necessary at that time.  The patient was evaluated by psychiatry
last admission and psychiatric admission was not indicated as he
had axis II disorders but does not have an acute axis I disorder
that is amenable to treatment.
.
On admission he notes diffuse abdominal pain and nausea but
denies vomiting.  Complains of three loose stools the day prior
to admission but denies melena, hematochezia.  Denies
lightheadedness, chest pain or shortness of breath.  Denies
SI/HI.  Last cocaine use was three days prior to admission.
.
In the ED:
- Urine toxicology positive for cocaine
- Morphine 2mg IV for abdominal pain, ondansetron 4mg IV for
nausea
- PA/lateral CXR/KUB negative for free air, no widened
mediastinum, objects seen as below
- Seen by GI; plan for urgent EGD

MEDICAL HISTORY: PMHx:
1. Multiple "suicide attempts" characterized by swallowing glass
and razor blades
2. Bipolar disorder
3. Depression
4. Status post splenectomy

MEDICATION ON ADMISSION: 1. Protonix 40mg [**Hospital1 **]
2. Seroquel 50mg [**Hospital1 **]
3. Depakote 1000mg QD
.
Allergies: Haldol causes dystonic reaction

ALLERGIES: Haldol

PHYSICAL EXAM: VS: T: 98.3 BP: 141/92 HR: 76 RR: 14 O2: 95% on RA
HEENT: NC/AT, sclera anicteric, PERRLA, EOMI, no pharyngeal
injection or exudate, dentition fair
NECK: Supple, no LAD, no thyromegaly
CV: RRR, nl S1, S2, no MRG
PULM: CTAB
ABD: Diffusely tender to palpation but not with extensive
pressure with stethoscope, NABS, soft, ND, no HSM, no R/G
SKIN: Warm, no rashes
EXT: No CCE
NEURO: CN II-XII intact, moving all extremities well

FAMILY HISTORY: Father alcoholic
Sister with depression and multiple psychiatric hospitalizations

SOCIAL HISTORY: Smokes [**1-30**] PPD, recreational cocaine and marijuana use;
occasional EtOH use.  The patient is homeless.  The patient is a
level 3 sex offender.
Foreign body in stomach,Cocaine abuse, unspecified,Suicide and self-inflicted injury by other specified means,Lack of housing,Bipolar I disorder, most recent episode (or current) depressed, unspecified
Foreign body in stomach,Cocaine abuse-unspec,Injury-NEC,Lack of housing,Bipol I cur depres NOS
Admission Date:  [**2198-10-16**]              Discharge Date:   [**2198-10-19**]

Date of Birth:  [**2159-12-27**]             Sex:   M

Service: MEDICINE

Allergies:
Haldol

Attending:[**First Name3 (LF) 2297**]
Chief Complaint:
"Swallowed razor blade and tacks."

Major Surgical or Invasive Procedure:
Upper Endoscopy

History of Present Illness:
38M with extensive psychiatric history, multiple past ingestions
presenting after ingestion of razor blade, tacks, and pieces of
metal can.  The patient is well-known to the MICU team from his
previous admission [**Date range (3) 63381**].  The patient has a history
of multiple auto-ingestions which are not believed to be suicide
attempts but rather means of hospital admission, which he
prefers to living on the street.  The patient was followed by GI
and surgery last admission and there was no intervention
necessary at that time.  The patient was evaluated by psychiatry
last admission and psychiatric admission was not indicated as he
had axis II disorders but does not have an acute axis I disorder
that is amenable to treatment.
.
On admission he notes diffuse abdominal pain and nausea but
denies vomiting.  Complains of three loose stools the day prior
to admission but denies melena, hematochezia.  Denies
lightheadedness, chest pain or shortness of breath.  Denies
SI/HI.  Last cocaine use was three days prior to admission.
.
In the ED:
- Urine toxicology positive for cocaine
- Morphine 2mg IV for abdominal pain, ondansetron 4mg IV for
nausea
- PA/lateral CXR/KUB negative for free air, no widened
mediastinum, objects seen as below
- Seen by GI; plan for urgent EGD


Past Medical History:
PMHx:
1. Multiple "suicide attempts" characterized by swallowing glass
and razor blades
2. Bipolar disorder
3. Depression
4. Status post splenectomy


Social History:
Smokes [**1-30**] PPD, recreational cocaine and marijuana use;
occasional EtOH use.  The patient is homeless.  The patient is a
level 3 sex offender.


Family History:
Father alcoholic
Sister with depression and multiple psychiatric hospitalizations


Physical Exam:
VS: T: 98.3 BP: 141/92 HR: 76 RR: 14 O2: 95% on RA
HEENT: NC/AT, sclera anicteric, PERRLA, EOMI, no pharyngeal
injection or exudate, dentition fair
NECK: Supple, no LAD, no thyromegaly
CV: RRR, nl S1, S2, no MRG
PULM: CTAB
ABD: Diffusely tender to palpation but not with extensive
pressure with stethoscope, NABS, soft, ND, no HSM, no R/G
SKIN: Warm, no rashes
EXT: No CCE
NEURO: CN II-XII intact, moving all extremities well

Pertinent Results:
EKG: NSR at 75.  Normal axis and intervals.  No ST-T wave
changes.
.
ABDOMEN (SUPINE & ERECT Study Date of [**2198-10-16**] 2:25 AM
UPRIGHT AND SUPINE VIEWS OF THE ABDOMEN.
No evidence of free air under the hemidiaphragms.  Unremarkable
bowel gas pattern seen without evidence of obstruction.
Compared to prior study, several of the previously seen foreign
bodies no longer identified.  A linear metallic density again
seen overlying the left upper abdomen.  Two tacs is seen
overlying the right lower quadrant.
IMPRESSION:  No evidence of free air under the diaphragms.
Metallic foreign bodies seen overlying the abdomen as described.
 Correlate with possible ingestion.
.
CHEST (PA & LAT) Study Date of [**2198-10-16**] 2:24 AM
FRONTAL AND LATERAL CHEST RADIOGRAPHS
Cardiac and mediastinal contours appear stable.  Pulmonary
vascularity appears unremarkable.  No focal consolidations or
pleural effusions.  Linear metallic density again seen overlying
the left upper abdomen, unchanged from prior.
IMPRESSION:  No evidence of acute cardiopulmonary process.
Metallic density again seen in left upper abdomen.
.
PORTABLE ABDOMEN  [**2198-10-19**] 5:52 AM
COMPARISON: [**2198-10-18**] at 1823 hours.

SINGLE SUPINE VIEW OF THE ABDOMEN AT 6:32 A.M.: Again seen is a
linear metallic structure overlying the left upper quadrant,
unchanged since at least [**2196-9-7**]. No other foreign
material is currently visible overlying any loops of bowel. The
hemidiaphragms are excluded from this study.

IMPRESSION: No current evidence of foreign body in the large or
small bowel.
.
[**2198-10-16**] 02:25AM   GLUCOSE-96 UREA N-12 CREAT-0.9 SODIUM-141
POTASSIUM-4.2 CHLORIDE-102 TOTAL CO2-27 ANION GAP-16
[**2198-10-16**] 02:25AM   WBC-9.8# RBC-4.46* HGB-14.3 HCT-40.7 MCV-91
MCH-32.0 MCHC-35.0 RDW-14.1
[**2198-10-16**] 02:25AM   NEUTS-71.6* LYMPHS-22.6 MONOS-4.9 EOS-0.5
BASOS-0.3
[**2198-10-16**] 02:25AM   PLT COUNT-329
[**2198-10-16**] 02:25AM   PT-11.0 PTT-26.1 INR(PT)-0.9
[**2198-10-16**] 03:00AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-POS amphetmn-NEG mthdone-NEG
.
[**2198-10-19**] 06:25AM BLOOD Hct-36.3*

Brief Hospital Course:
38 year old man with history of previous ingestions.  Please see
the discharge summary dated [**2198-10-12**] for a more complete
detailing of his psychiaric evaluation.
.
Patient was admitted after self reported ingestion of a razor
blade, tacks, and pieces of a metal can.  He was seen by surgery
upon admission; no surgical intervention was deemed appropiate.
GI elected to scope him and removed multiple foreign bodies from
his stomach.  At least one metal fragment was not able to be
removed.  Serial KUBs and abdominal exams were followed while
the patient was in house.  Before discharge the patient had a
bowel movement and a repeat KUB showed no evidence of metalic
objects in the abdomen.

Patient was also seen by psychiatry while in house - as he had
been before - and was deemed safe for discharge -> please see
CCC notes for further details.

[**2198-10-19**] pt. was doing well, tolerating PO, ambulating without
difficulty, urinating and passing stool without problem and
hematocrit was stable.  Pt. was discharged to home.


Medications on Admission:
1. Protonix 40mg [**Hospital1 **]
2. Seroquel 50mg [**Hospital1 **]
3. Depakote 1000mg QD
.
Allergies: Haldol causes dystonic reaction

Discharge Medications:
1. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
2. Divalproex 500 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily).
3. Quetiapine 100 mg Tablet Sig: Three (3) Tablet PO QHS (once a
day (at bedtime)).


Discharge Disposition:
Home

Discharge Diagnosis:
Foreign body ingestion
Suicide attempts
Bipolar disorder
Depression
s/p splenectomy


Discharge Condition:
Stable.


Discharge Instructions:
Please return to the ED for chest pain, shortness of breath,
blood per rectum or vomiting blood or any other concerning
symptom.

Followup Instructions:
Please see your PCP [**Name Initial (PRE) **]/or Psychiatrist as necessary
{'Foreign body in stomach,Cocaine abuse, unspecified,Suicide and self-inflicted injury by other specified means,Lack of housing,Bipolar I disorder, most recent episode (or current) depressed, unspecified'}


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: "Swallowed razor blade and tacks."

PRESENT ILLNESS: 38M with extensive psychiatric history, multiple past ingestions
presenting after ingestion of razor blade, tacks, and pieces of
metal can.  The patient is well-known to the MICU team from his
previous admission [**Date range (3) 63381**].  The patient has a history
of multiple auto-ingestions which are not believed to be suicide
attempts but rather means of hospital admission, which he
prefers to living on the street.  The patient was followed by GI
and surgery last admission and there was no intervention
necessary at that time.  The patient was evaluated by psychiatry
last admission and psychiatric admission was not indicated as he
had axis II disorders but does not have an acute axis I disorder
that is amenable to treatment.
.
On admission he notes diffuse abdominal pain and nausea but
denies vomiting.  Complains of three loose stools the day prior
to admission but denies melena, hematochezia.  Denies
lightheadedness, chest pain or shortness of breath.  Denies
SI/HI.  Last cocaine use was three days prior to admission.
.
In the ED:
- Urine toxicology positive for cocaine
- Morphine 2mg IV for abdominal pain, ondansetron 4mg IV for
nausea
- PA/lateral CXR/KUB negative for free air, no widened
mediastinum, objects seen as below
- Seen by GI; plan for urgent EGD

MEDICAL HISTORY: PMHx:
1. Multiple "suicide attempts" characterized by swallowing glass
and razor blades
2. Bipolar disorder
3. Depression
4. Status post splenectomy

MEDICATION ON ADMISSION: 1. Protonix 40mg [**Hospital1 **]
2. Seroquel 50mg [**Hospital1 **]
3. Depakote 1000mg QD
.
Allergies: Haldol causes dystonic reaction

ALLERGIES: Haldol

PHYSICAL EXAM: VS: T: 98.3 BP: 141/92 HR: 76 RR: 14 O2: 95% on RA
HEENT: NC/AT, sclera anicteric, PERRLA, EOMI, no pharyngeal
injection or exudate, dentition fair
NECK: Supple, no LAD, no thyromegaly
CV: RRR, nl S1, S2, no MRG
PULM: CTAB
ABD: Diffusely tender to palpation but not with extensive
pressure with stethoscope, NABS, soft, ND, no HSM, no R/G
SKIN: Warm, no rashes
EXT: No CCE
NEURO: CN II-XII intact, moving all extremities well

FAMILY HISTORY: Father alcoholic
Sister with depression and multiple psychiatric hospitalizations

SOCIAL HISTORY: Smokes [**1-30**] PPD, recreational cocaine and marijuana use;
occasional EtOH use.  The patient is homeless.  The patient is a
level 3 sex offender. 

### Response:
{'Foreign body in stomach,Cocaine abuse, unspecified,Suicide and self-inflicted injury by other specified means,Lack of housing,Bipolar I disorder, most recent episode (or current) depressed, unspecified'}
