CHIEF COMPLAINT: Thirst

PRESENT ILLNESS: Mr. [**Known lastname 30258**] is a 36 yo male with past medical history of asthma
and obesity who presented today to urgent care with polyuria and
polydipsia x 2 weeks. Approximately three weeks ago he had an
asthma attack, treated with prednisone x 5 days.  He noted
feeling sluggish and uncomfortable and discontinued the
medication.  He then noted increased thirst and frequent
urination over the next two weeks, with poor appetite and 20 lb
weight loss.  He drank mostly water during that time, with some
[**Location (un) 2452**] juice and milk.  Over the last week, his foreskin became
red, painful and swollen with white discharge.

MEDICAL HISTORY: Obesity
Asthma - well controlled with Singulair with rare exacerbations
Low back pain - sciatica [**1-29**] heavy lifting as a carpenter, now
improved

MEDICATION ON ADMISSION: Singulair 10mg 1 tab qHS
Proair HFA 90 mcg/actuation aerosol 1-2puffs q4-6h PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam on Admission:
General: Alert, oriented, obese male in no acute distress
HEENT: Sclera anicteric, dry mucus membranes, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foreskin red, swollen, white discharge.  no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: no rashes, lesions.  Tattoo of [**Country **] Rican flag on his
left forearm

FAMILY HISTORY: Mother with diabetes of unknown type, but diagnosed in middle
age.
Maternal grandparents both with diabetes.
? father with diabetes as well.

SOCIAL HISTORY: Lives in [**Location 3786**] with his wife and child.
He is taking [**Hospital1 656**] courses to become an electrician.
Formerly worked as a carpenter.
Denies tobacco, alcohol and illicit drugs.
Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Candidiasis of other urogenital sites,Asthma, unspecified type, unspecified,Obesity, unspecified
DMII ketoacd uncontrold,Acute kidney failure NOS,Hyposmolality,Candidias urogenital NEC,Asthma NOS,Obesity NOS
Admission Date:  [**2182-10-25**]              Discharge Date:   [**2182-10-27**]

Date of Birth:  [**2146-8-6**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2186**]
Chief Complaint:
Thirst

Major Surgical or Invasive Procedure:
iv Insulin


History of Present Illness:
Mr. [**Known lastname 30258**] is a 36 yo male with past medical history of asthma
and obesity who presented today to urgent care with polyuria and
polydipsia x 2 weeks. Approximately three weeks ago he had an
asthma attack, treated with prednisone x 5 days.  He noted
feeling sluggish and uncomfortable and discontinued the
medication.  He then noted increased thirst and frequent
urination over the next two weeks, with poor appetite and 20 lb
weight loss.  He drank mostly water during that time, with some
[**Location (un) 2452**] juice and milk.  Over the last week, his foreskin became
red, painful and swollen with white discharge.

Today, he had marked nausea and went to his PCP at [**Name9 (PRE) 2274**] at the
insistence of his wife.  There, he was noted to have serum
glucose of 500, 4+ urinary ketones and bicarb of 20. He was
given 10U of regular insulin and 15U of NPH in office in
addition to 1L of NS and was transferred to [**Hospital1 18**].

In [**Hospital1 18**] ED, initial VS: 96.7 109 164/98 18 99%RA. Initial
finger stick was 363 at 11:20pm. He was given 8 units of regular
insulin IV and started on insulin drip at 10 units per hour. He
also received 40mEq potassium chloride. ECG, CXR, UA
unremarkable. Repeat finger stick 299. VS prior to transfer:
98.4 129/73 92 16 97%RA. Repeat labs revealed persistent anion
gap of 20.

On the floor, FSBG was 160 and D5 1/2NS was started along with
insulin drip. Currently, he complains of fatigue, dry mouth, and
mild nausea.  He denies fever, chills, dysuria/urgency, flank
pain, or cough.

Review of systems:
(+) Per HPI
(-) Denies headache, sinus tenderness, rhinorrhea or congestion.
Denies cough, shortness of breath, or wheezing. Denies chest
pain, chest pressure, palpitations, or weakness. Denies
diarrhea, constipation, abdominal pain, or changes in bowel
habits. Denies arthralgias or myalgias.


Past Medical History:
Obesity
Asthma - well controlled with Singulair with rare exacerbations
Low back pain - sciatica [**1-29**] heavy lifting as a carpenter, now
improved

Social History:
Lives in [**Location 3786**] with his wife and child.
He is taking [**Hospital1 656**] courses to become an electrician.
Formerly worked as a carpenter.
Denies tobacco, alcohol and illicit drugs.

Family History:
Mother with diabetes of unknown type, but diagnosed in middle
age.
Maternal grandparents both with diabetes.
? father with diabetes as well.

Physical Exam:
Physical Exam on Admission:
General: Alert, oriented, obese male in no acute distress
HEENT: Sclera anicteric, dry mucus membranes, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foreskin red, swollen, white discharge.  no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: no rashes, lesions.  Tattoo of [**Country **] Rican flag on his
left forearm

Pertinent Results:
Labs:
[**2182-10-24**] 08:40PM BLOOD WBC-8.2 RBC-5.19 Hgb-15.2 Hct-43.9 MCV-85
MCH-29.2 MCHC-34.5 RDW-14.0 Plt Ct-175 Neuts-50.9 Lymphs-44.5*
Monos-3.1 Eos-0.8 Baso-0.6
[**2182-10-24**] 08:40PM BLOOD Glucose-421* UreaN-19 Creat-1.6* Na-132*
K-4.1 Cl-93* HCO3-18*
[**2182-10-24**] 11:00PM BLOOD Calcium-8.8 Phos-2.8 Mg-2.0
[**2182-10-25**] 04:56AM BLOOD Type-[**Last Name (un) **] Temp-36.7 Rates-/18 FiO2-21
pO2-57* pCO2-38 pH-7.36 calTCO2-22 Base XS--3 Intubat-NOT INTUBA
[**2182-10-25**] 04:56AM BLOOD Lactate-1.3
[**2182-10-24**] 11:00PM BLOOD CK(CPK)-242 CK-MB-4 cTropnT-<0.01
[**2182-10-25**] 03:35AM BLOOD CK(CPK)-249 CK-MB-3 cTropnT-<0.01
[**2182-10-24**] 11:00PM BLOOD %HbA1c-13.3* eAG-335*
[**2182-10-24**] 11:00PM BLOOD Acetone-LARGE
[**2182-10-25**] 03:35AM BLOOD antiDGP-PND
[**2182-10-25**] 03:35AM BLOOD ISLET CELL ANTIBODY-PND
[**2182-10-25**] 03:35AM BLOOD INSULIN ANTIBODIES-PND

[**2182-10-24**]
- EKG: Sinus rhythm. Normal tracing. No previous tracing
available for comparison.
- CXR: The lungs are well expanded and clear. The
cardiomediastinal silhouette, hilar contours, and pleural
surfaces are normal. No pleural effusions or pneumothoraces are
present.  IMPRESSION:  No acute intrathoracic process.





Brief Hospital Course:
Mr. [**Known lastname 30258**] is a 36 yo male with past medical history of asthma
and obesity who presented with polyuria and polydipsia x 2
weeks.

# Diabetes/DKA.  This is the initialy diagnosis of diabetes for
this patient.  The grossly elevated blood glucose is likely
worsened by recent use of prednisone for asthma exacerbation and
possible mild URI (nasal congestion).  Initial serum glucose
(500s), + urine and blood ketones.  Normal WBC, CXR, EKG with
negative troponin.  On admission, he was on D5 ?????? NS to avoid
cerebral edema [**1-29**] rapid drop of glucose < 250 with insulin,
insulin gtt, and electrolyte repletion.  His anion gap closed on
[**2182-10-25**] and was transitioned to NPH 15 units [**Hospital1 **] and ISS with
oral intake [**First Name8 (NamePattern2) **] [**Last Name (un) **] recommendations.  Hgb A1C is found to be
13.3 suggesting on-going hyperglycemia for a period of time.  He
remained hyperglycemic on [**2182-10-26**] but with ISS adjusted.
Patient was educated on use of glucometer and insulin self
administration. He was started on diabetic diet and was
encouraged to increase his physical activities for weight loss.
  He was discharged with Insulin NPH 20 u QAM and 20 u QHS,
accompanied with an insulin sliding scale.  He will contact his
primary care doctor or the [**Last Name (un) **] for follow up control of his
diabetes.

# Balanitis.  Possibly occurred in the setting of recent steroid
use and underlying diabetes/hyperglycemia.  Improved with
clotrimazole [**Hospital1 **] (D1 [**2182-10-25**]) for a total of 7 day course.
Plan is to continue observation with clotrimazole and hygiene.
If persistent symptoms, will plan to culture the discharge, UA,
Uc, and KOH for miscroscopy for urethritis

#Asthma.  Chronic and stable since last exacerbation.  Continue
Singulair 10 mg qHS and prn albuterol inhaler.

#Acute Renal Failure.  Likely pre-renal from dehydration/DKA.
Resolved, although unclear what the baseline is.  Creatinine
improving 1.6->1.0 with rehydration.

#Potassium Depletion.  He received potassium repletion during
DKA with close monitoring of his other electrolytes.

# Hyponatremia.  When corrected sodium with glucose, patient
actually has normal sodium level.  Will continue to monitor.

#. FEN: diabetic diet, replete electrolytes as necessary, hold
off on IVF for now as glucose improves
#. Prophylaxis: bowel regimen, physical activity
#. Communication: Patient & wife
#. Code: Full (discussed with patient)


Medications on Admission:
Singulair 10mg 1 tab qHS
Proair HFA 90 mcg/actuation aerosol 1-2puffs q4-6h PRN

Discharge Medications:
1. montelukast 10 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
2. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:
1-2 Puffs Inhalation Q4H (every 4 hours) as needed for SOB or
wheeze.
3. Humulin N 100 unit/mL Suspension Sig: Twenty (20) units
Subcutaneous QAM: before breakfast.
Disp:*0 2* Refills:*2*
4. Humulin N 100 unit/mL Suspension Sig: Twenty (20) units
Subcutaneous QHS.
Disp:*0 2* Refills:*2*
5. insulin syringe-needle,dispos. 1 mL 29 x [**12-29**]  Syringe Sig:
Two (2) packs Miscellaneous once a month.
Disp:*0 2* Refills:*2*
6. clotrimazole 1 % Cream Sig: One (1) Appl Topical [**Hospital1 **] (2 times
a day) for 7 days.
Disp:*1 0* Refills:*0*
7. Humalog 100 unit/mL Solution Sig: Two (2) bottles
Subcutaneous once a month.
Disp:*0 2* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Diabetic Ketoacidosis and New Onset diabetes


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
You were admitted with new onset diabetes.  You were admitted to
the intensive care unit briefly for diabetic ketoacidosis and
then were started on iv fluids and iv insulin drip.  Once your
sugars were in better control, you were sent to the floor and
instructed on how to administer the insulin and how to check
your sugar levels.
   Please follow the insulin regimen detailed by the [**Last Name (un) **]
doctors.  Feel free to contact Dr. [**Last Name (STitle) 978**] of [**Last Name (un) **] for blood
sugars below 80 and above 200.

Followup Instructions:
Please follow with Dr. [**Last Name (STitle) 978**]
{'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Candidiasis of other urogenital sites,Asthma, unspecified type, unspecified,Obesity, 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: Thirst

PRESENT ILLNESS: Mr. [**Known lastname 30258**] is a 36 yo male with past medical history of asthma
and obesity who presented today to urgent care with polyuria and
polydipsia x 2 weeks. Approximately three weeks ago he had an
asthma attack, treated with prednisone x 5 days.  He noted
feeling sluggish and uncomfortable and discontinued the
medication.  He then noted increased thirst and frequent
urination over the next two weeks, with poor appetite and 20 lb
weight loss.  He drank mostly water during that time, with some
[**Location (un) 2452**] juice and milk.  Over the last week, his foreskin became
red, painful and swollen with white discharge.

MEDICAL HISTORY: Obesity
Asthma - well controlled with Singulair with rare exacerbations
Low back pain - sciatica [**1-29**] heavy lifting as a carpenter, now
improved

MEDICATION ON ADMISSION: Singulair 10mg 1 tab qHS
Proair HFA 90 mcg/actuation aerosol 1-2puffs q4-6h PRN

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam on Admission:
General: Alert, oriented, obese male in no acute distress
HEENT: Sclera anicteric, dry mucus membranes, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: foreskin red, swollen, white discharge.  no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema
Skin: no rashes, lesions.  Tattoo of [**Country **] Rican flag on his
left forearm

FAMILY HISTORY: Mother with diabetes of unknown type, but diagnosed in middle
age.
Maternal grandparents both with diabetes.
? father with diabetes as well.

SOCIAL HISTORY: Lives in [**Location 3786**] with his wife and child.
He is taking [**Hospital1 656**] courses to become an electrician.
Formerly worked as a carpenter.
Denies tobacco, alcohol and illicit drugs. 

### Response:
{'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Hyposmolality and/or hyponatremia,Candidiasis of other urogenital sites,Asthma, unspecified type, unspecified,Obesity, unspecified'}
