40 year old woman with a h/o alcoholism c/b
   DTs/seizures 2 years ago, polysubstance abuse including IV heroin,
   cocaine, crack (last use 2 years ago), heroin inhalation (last use 2
   days ago), hep C, presents for voluntary admission for detox. The
   patient would like to undergo detoxification so she can take care of
   her children. She also complains of abdominal pain, [**12-24**], lower
   quadrants, radiating to the back since yesterday. She cannot describe
   any relationship with food as she has not eaten anything. She says the
   pain has worsened since yesterday. She also complains of nausea,
   vomitting (bilious but nonbloody), and diarrhea (no black or red
   stools). Her last drink was 9am on [**3154-2-15**]. Recently stopped her
   methadone 1 week ago in an effort to quit drug abuse.
   .
   In the ED she was 98.6 101 149/96 20 96. She was [**Doctor Last Name 2062**] 16-25 on CIWA.
   
   ROS:
   (+)
   Reports DOE, orthopnea. Also describes weight gain since given birth to
   her child 17 months ago, she attributes this to her recent pregnancy.
   She complains of tremors and also complains of a moderate headache
   that's been stable.
   .
   (-)
   Denies CP, fevers, chills, or cough, palpitations, edema, joint pains,
   rashes, AVH, SI, or HI.
   
   Past Medical History:
   -Alcoholism (drinks baseline 1 pint of liquor/day, past week drinking 1
   liter of vodka/day)
   -Polysubstance abuse - including cocaine, IV heroin, and crack 2 years
   ago, snorting heroin 2 days ago.
   -Hep C, never treated, unknown severity, genotype, etc
   -Infectious endocarditis in her 20s, 6 wks of abx no surgeries
   -No h/o STDs, HIV neg 3 weeks ago
   -Hep B immunized
   Family History:
   Alcoholism in mother, father, and sister. Father also used cocaine and
   sister also used ecstasy.
   Occupation: Formerly worked at Investment Firm Quality Control Dept
   
   Physical Examination
   Vitals: T: 99.6 BP: 152/96 P: 99 R: 27 O2: 99%RA
   General: Alert, oriented x3, anxious, labile with at times
   inappropriate laughter mixed with anxiety, obese woman.
   HEENT: Sclera anicteric, MMM, oropharynx clear
   Neck: supple, JVP difficult to assess given habitus
   Lungs: Clear to auscultation bilaterally, no wheezes, rales, ronchi
   CV: Tachycardic, regular rhythm, normal S1 + S2, no murmurs, rubs,
   gallops
   Abdomen:  soft, diffuse tenderness to palpation, obese, non-distended,
   bowel sounds present, no rebound tenderness or guarding, no
   organomegaly. During the exam she complains of severe tenderness but a
   few minutes later is laughing and sitting comfortably in bed.
   Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema
   Labs 
   PT / PTT / INR:13.7/29.4/1.2, ALT / AST:106/249, Alk Phos /
   T Bili:145/3.0, Amylase / Lipase:135/221, Differential-Neuts:57.3 %,
   Lymph:34.1 %, Mono:7.0 %, Eos:0.8 %, Lactic Acid:1.8 mmol/L,
   Albumin:4.1 g/dL, LDH:329 IU/L, Ca++:8.2 mg/dL, Mg++:1.7 mg/dL, PO4:2.5
   mg/dL