tokens: Admission Date : 2012-06-07 Discharge Date : 2012-06-09 Date of Birth : 1963-12-03 Sex : M Service : MEDICINE Allergies : Patient recorded as having No Known Allergies to Drugs Attending : Christopher KJ Cater , M.D. Chief Complaint : Overdose Major Surgical or Invasive Procedure : NG tube History of Present Illness : Mr. Vazquez is a 48 year old man with a history of hepatitis C , bipolar disorder with suicide attempts in the past , recent CMED admit earlier in 4/05 who was found alert approximately one hour after taking an unspecified number of pills . Per report , there were empty bottles of Inderal and Klonopin found at bedside , as well as 02-26 full bottles of geodon , gabapentin , Lescol and paroxitine . The patient was reportedly alert at scene , and then became unresponsive in route to the hospital . In the Rita , the patient was intubated and given activated charcoal . His initial BP was 60/P with a pulse in the 60 s. He was given 4 amps of calcium gluconate , and started on a Calcium gtt . He was also given 5mg of glucagon and started on a glucagon drip with good response . His urine and serum tox screens were notable only for benzos , otherwise negative . He was seen by cardiology , and toxicology was consulted via telephone . He was admitted to the CMED , intubated for airway protection and started on both a calcium and glucagon drip . There was evidence of possible aspiration pneumonia on CXR , though he was extubated without incident on the AM of transfer to the medicine floor . CMED was made aware , and they are actively involved in his care . Past Medical History : Hep C Bipolar D/O with one suicide attempt by overdose several years ago Agoraphobia Panic disorder Narcissism No history of head trauma or seizure disorder Social History : Denies alcohol use . Has a history of cocaine abuse - in remission for 6 years , with one relapse 2.5 years ago . Has a history of qualude use since high school , also in remission . Denies use of AA/NA . Smokes 1ppd . Patient lives at home with his mother , father and brother . Reports that he has suffered from anxiety since childhood and needed to drop out of college . Unemployed and on disability . Waiting for a subsidized apartment . No current relationship . Family History : Denies . Physical Exam : Vitals : 99.3 67 ( 60-70 ) 99/53 ( 90-100 s) 96% on RA 3.7L + LOS Gen : caucasian man lying in bed , NAD HEENT : NCAT , PERRL , EOMI , no icterus , OP clear , MMM , no tongue fasciculations Neck : supple , no LAD , no JVD CV : RRR , nl s1 s2 , no m/g/r Lungs : ? decreased BS over left middle lung , otherwise CTA Abd : normal size , nd , no scars , nl bs , soft , nt , palp liver Ext : no c/c/e , no edema Neuro : no asterixis , CN II-XII intact , 5/5 strength throughout , sensation to LT intact throughout , gait deferred CMED : A+Ox3 , mood " great ," affect approp , speech stuttering , linear TP , no SI or HI Pertinent Results : Labs on admit : 2012-06-07 09:55 PM BLOOD WBC - 8.9 RBC - 4.94 Hgb - 15.8 Hct - 45.3 MCV - 92 MCH - 31.9 MCHC - 34.8 RDW - 12.4 Plt Ct - 175 2012-06-07 09:55 PM BLOOD Neuts - 49.9 * Lymphs - 42.4 * Monos - 5.5 Eos - 1.6 Baso - 0.6 2012-06-07 09:55 PM BLOOD Plt Ct - 175 2012-06-07 09:55 PM BLOOD PT - 12.8 PTT - 25.7 INR(PT) - 1.0 2012-06-07 09:55 PM BLOOD Glucose - 108 * UreaN - 13 Creat - 0.7 Na - 146 * K - 3.7 Cl - 109 * HCO3 - 30 * AnGap - 11 2012-06-07 09:55 PM BLOOD Albumin - 3.9 Calcium - 8.5 Phos - 4.2 Mg - 2.0 2012-06-07 09:55 PM BLOOD ALT - 44 * AST - 31 AlkPhos - 36 * TotBili - 0.2 2012-06-07 09:55 PM BLOOD ASA - NEG Ethanol - NEG Acetmnp - NEG Bnzodzp - NEG Barbitr - NEG Tricycl - NEG Labs today : 2012-06-08 09:30 AM BLOOD WBC - 10.1 RBC - 4.35 * Hgb - 14.2 Hct - 39.9 * MCV - 92 MCH - 32.6 * MCHC - 35.6 * RDW - 12.4 Plt Ct - 151 2012-06-08 09:30 AM BLOOD Glucose - 115 * UreaN - 14 Creat - 0.8 Na - 142 K - 4.1 Cl - 112 * HCO3 - 26 AnGap - 8 2012-06-08 09:30 AM BLOOD Calcium - 10.4 * Phos - 2.8 Mg - 1.8 2012-06-08 CXR : An endotracheal tube terminates just above the thoracic inlet approximately 6.5 cm above the carina . The nasogastric tube terminates within the stomach . Cardiac and mediastinal contours are within normal limits . There is a patchy area of increased opacity in the left retrocardiac region , which was not seen on the earlier study . Right lung is clear . Left costophrenic angle has been excluded from the study and cannot be assessed . There is no evidence of right pleural effusion or right pneumothorax . IMPRESSION : 1) Endotracheal tube is slightly proximal in location , and could be advanced approximately 1.5 cm for more optimal placement . 2) Patchy left retrocardiac opacity which may be due to patchy atelectasis , aspiration , or early pneumonia . Followup radiograph suggested Brief Hospital Course : A/P : 48yo man with h/o HCV , bipolar DO , h/o suicide attempts , a/w overdose of Inderal , Klonopin , Geodon , s/T Jackson stay with intubation for airway protection , with question of L retrocardiac infiltrate , now doing well . Overdose : - monitor on tele overnight - if HR drops , restart glucagon gtt - watch for BZD withdrawal , agitation Bipolar disorder : - appreciate CMED consult ; patient to be discharged to inpatient CMED facility once stable - suicide precautions Activity : OOB with assist FEN : house diet PPX : SC heparin , bowel regimen , nicotine patch CODE : full DISPO : transfer to inpatient CMED likely tomorrow Medications on Admission : Neurontin 800 mg tid Ziprasidone bid Propanolol 20 mg tid Klonopin 2 mg tid Paxil 30 mg qd Protonix 40 mg qd Folate 1 mg qd Lescol 40 qd Discharge Disposition : Home Discharge Diagnosis : Depression Discharge Condition : Depressed Discharge Instructions : Going to UMass Memorial Medical Center 4 . Followup Instructions : Please f / u with PCP D 2 weeks . Joseph Judy MD 35-943 Completed by : John Konderla MD 01-196 2012-06-09 @ 1707 Signed electronically by : DR. Felix Garcia on : FRI 2012-06-15 4:29 PM ( End of Report )