CHIEF COMPLAINT: Overdose of Robatussen

PRESENT ILLNESS: 18 yo male with hx signif for depression and substance abuse
admitted after suspected overdose on robitussin. Recently had
inpt psych stay at [**Hospital3 **] for suspected suicidal
ideation on [**2183-1-18**]. Presented s/p drinking 3 x 4oz bottles of
dextromethorphan HBR. Pt became confused, hallucination,
tachycardic, diaphoretic. At [**Location (un) **] he had a Temp 101.4, HR
130, 150/90. Agitated, confused, diaphoretic, dilated pupils and
had min response to 4 mg ativan. EKG with R' 3mm and QRS 110
which is unchanged from baseline. In the ED he was given 2mg of
ativanx4 and activated charcoal and transferred to the ICU

MEDICAL HISTORY: 1. depression- on no medications, outpatient psychiatrist, Dr.
[**First Name (STitle) 7363**], in [**Location (un) 620**] ([**Telephone/Fax (1) 61371**], office [**Telephone/Fax (1) 61372**])
2. Substance abuse- Patient drinks occassionally with
friends. These times (once per week) he can drink heavily and
black out. He does not drink every day. He uses narcotic drugs
occassionally, taken illegally from his work at [**Company 4916**]
pharmacy.
No history of withdrawal symptoms, IV usage, or detox.
H/o DT s, w/drawal sz s, blackouts, detox tx, IV usage?
alcohol intoxication [**2182-9-15**] requiring intubation

MEDICATION ON ADMISSION: Trazadone
Seroquel

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: Tm 99.8  HR 75, BP 121/69, on RA
Gen: In bed, slow to respond, voice monitone, NAD
Heent: pupuls dilated, reactive
CV: rrr, no m,r,g
Pulm: clear, gynocomastia noted
abd: soft, nt/nd, nabs
Ext: no edema noted
Psych: patient unwilling to talk to me at length, but seems
underwhelmed by recent events.  denies any SI/HI at this time

FAMILY HISTORY: 

SOCIAL HISTORY: High School student, lives with Father. [**Name (NI) **] abuse as
described above. Was working at [**Company 4916**] Pharmacy, was fired 6
weeks ago.  Per report was stealing meds. Per father, patient
has poor realtionship with Mother who was just remarried.
Poisoning by antitussives,Accidental poisoning by agents primarily acting on the smooth and skeletal muscles and respiratory system,Other, mixed, or unspecified drug abuse, continuous
Poisoning-antitussives,Acc poisn-muscl/resp agt,Drug abuse NEC-contin
Admission Date:  [**2183-3-5**]              Discharge Date:   [**2183-3-7**]

Date of Birth:  [**2164-11-27**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2641**]
Chief Complaint:
Overdose of Robatussen

Major Surgical or Invasive Procedure:
none


History of Present Illness:
18 yo male with hx signif for depression and substance abuse
admitted after suspected overdose on robitussin. Recently had
inpt psych stay at [**Hospital3 **] for suspected suicidal
ideation on [**2183-1-18**]. Presented s/p drinking 3 x 4oz bottles of
dextromethorphan HBR. Pt became confused, hallucination,
tachycardic, diaphoretic. At [**Location (un) **] he had a Temp 101.4, HR
130, 150/90. Agitated, confused, diaphoretic, dilated pupils and
had min response to 4 mg ativan. EKG with R' 3mm and QRS 110
which is unchanged from baseline. In the ED he was given 2mg of
ativanx4 and activated charcoal and transferred to the ICU

Past Medical History:
1. depression- on no medications, outpatient psychiatrist, Dr.
[**First Name (STitle) 7363**], in [**Location (un) 620**] ([**Telephone/Fax (1) 61371**], office [**Telephone/Fax (1) 61372**])
2. Substance abuse- Patient drinks occassionally with
friends. These times (once per week) he can drink heavily and
black out. He does not drink every day. He uses narcotic drugs
occassionally, taken illegally from his work at [**Company 4916**]
pharmacy.
No history of withdrawal symptoms, IV usage, or detox.
H/o DT s, w/drawal sz s, blackouts, detox tx, IV usage?
alcohol intoxication [**2182-9-15**] requiring intubation

Social History:
High School student, lives with Father. [**Name (NI) **] abuse as
described above. Was working at [**Company 4916**] Pharmacy, was fired 6
weeks ago.  Per report was stealing meds. Per father, patient
has poor realtionship with Mother who was just remarried.

Physical Exam:
PE: Tm 99.8  HR 75, BP 121/69, on RA
Gen: In bed, slow to respond, voice monitone, NAD
Heent: pupuls dilated, reactive
CV: rrr, no m,r,g
Pulm: clear, gynocomastia noted
abd: soft, nt/nd, nabs
Ext: no edema noted
Psych: patient unwilling to talk to me at length, but seems
underwhelmed by recent events.  denies any SI/HI at this time

Pertinent Results:
[**2183-3-5**] 03:56AM URINE  bnzodzpn-NEG barbitrt-NEG opiates-NEG
cocaine-NEG amphetmn-NEG mthdone-NEG
[**2183-3-5**] 03:47AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5
LEUK-NEG
[**2183-3-5**] 05:21PM   GLUCOSE-90 UREA N-8 CREAT-0.9 SODIUM-141
POTASSIUM-3.6 CHLORIDE-106 TOTAL CO2-24 ANION GAP-15
[**2183-3-5**] 05:21PM   CK(CPK)-156
[**2183-3-5**] 05:21PM   CALCIUM-9.4 PHOSPHATE-2.3* MAGNESIUM-2.1
[**2183-3-5**] 05:21PM   WBC-10.9 RBC-4.32* HGB-13.9* HCT-38.4* MCV-89
MCH-32.1* MCHC-36.1* RDW-12.7
[**2183-3-5**] 05:21PM   PLT COUNT-317
[**2183-3-5**] 02:31AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG

Brief Hospital Course:
.
.
1. Ingestion - The patient's urine tox and serum tox were both
negative. His ECG was without significant changes. His history
and presentation was consistent with dextromethorphan
intoxication.  His agitation was treated with ativan prn.  The
patient was tachycardic in the intensive care unit, and required
4 point restraints. The following morning, he uneventfully came
off restraints, and was counseled on his poor decision making in
regards to his drug abuse.  The patient was seen by psychiatry
who recommended inpatient psychiatric evaluation and treatment.
Prior to discharge, it was determined by the medical team that
the patient was medically stable for discharge as evidenced by
stable vitals, normal EKG, and unremarkable physical exam.
.
2. Depression - Psychiatry followed the patient throughout his
hospital course.  It was not clear if this was a suicide attempt
or just an attempt at intoxication.  He will need an extensive
psychiatric evaluation.
.


Medications on Admission:
Trazadone
Seroquel


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Nicotine 21 mg/24 hr Patch 24HR Sig: One (1) Patch 24HR
Transdermal DAILY (Daily).


Discharge Disposition:
Extended Care

Facility:
[**Hospital3 8063**] - [**Location (un) **]

Discharge Diagnosis:
Robatussin Overdose


Discharge Condition:
stable

Discharge Instructions:
You need to stop abusing both prescription and over the counter
medications.  These medications can be lethal at the doses you
take.  We suggest counseling and getting involved in a program
to help you make better decisions in regard to drug use.  You
should also stay away from alcohol.

Followup Instructions:
Psychiatric Care as an inpatient
[**Hospital **] Rehab and counseling
{'Poisoning by antitussives,Accidental poisoning by agents primarily acting on the smooth and skeletal muscles and respiratory system,Other, mixed, or unspecified drug abuse, continuous'}


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: Overdose of Robatussen

PRESENT ILLNESS: 18 yo male with hx signif for depression and substance abuse
admitted after suspected overdose on robitussin. Recently had
inpt psych stay at [**Hospital3 **] for suspected suicidal
ideation on [**2183-1-18**]. Presented s/p drinking 3 x 4oz bottles of
dextromethorphan HBR. Pt became confused, hallucination,
tachycardic, diaphoretic. At [**Location (un) **] he had a Temp 101.4, HR
130, 150/90. Agitated, confused, diaphoretic, dilated pupils and
had min response to 4 mg ativan. EKG with R' 3mm and QRS 110
which is unchanged from baseline. In the ED he was given 2mg of
ativanx4 and activated charcoal and transferred to the ICU

MEDICAL HISTORY: 1. depression- on no medications, outpatient psychiatrist, Dr.
[**First Name (STitle) 7363**], in [**Location (un) 620**] ([**Telephone/Fax (1) 61371**], office [**Telephone/Fax (1) 61372**])
2. Substance abuse- Patient drinks occassionally with
friends. These times (once per week) he can drink heavily and
black out. He does not drink every day. He uses narcotic drugs
occassionally, taken illegally from his work at [**Company 4916**]
pharmacy.
No history of withdrawal symptoms, IV usage, or detox.
H/o DT s, w/drawal sz s, blackouts, detox tx, IV usage?
alcohol intoxication [**2182-9-15**] requiring intubation

MEDICATION ON ADMISSION: Trazadone
Seroquel

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: PE: Tm 99.8  HR 75, BP 121/69, on RA
Gen: In bed, slow to respond, voice monitone, NAD
Heent: pupuls dilated, reactive
CV: rrr, no m,r,g
Pulm: clear, gynocomastia noted
abd: soft, nt/nd, nabs
Ext: no edema noted
Psych: patient unwilling to talk to me at length, but seems
underwhelmed by recent events.  denies any SI/HI at this time

FAMILY HISTORY: 

SOCIAL HISTORY: High School student, lives with Father. [**Name (NI) **] abuse as
described above. Was working at [**Company 4916**] Pharmacy, was fired 6
weeks ago.  Per report was stealing meds. Per father, patient
has poor realtionship with Mother who was just remarried. 

### Response:
{'Poisoning by antitussives,Accidental poisoning by agents primarily acting on the smooth and skeletal muscles and respiratory system,Other, mixed, or unspecified drug abuse, continuous'}
