CHIEF COMPLAINT: Hypokalemia

PRESENT ILLNESS: 34F Hx bulemia difficult to treat x several years referred to ED
after outpatient workup revealed lab abnormalities. She has
noted that she has had increased lethargy, weakness, slight
nausea and lightheadedness over the past fews days Admitted to
floor for electrolyte correction. No complaints of
numbness/tingling, muscle pain. She had stopped taking her
potassium pills for an unclear amount of time. In addition, she
stopped her psychiatric medications a few months ago.
.
In the ED:
EKG: NSR @ rate of 66. Axis wnl. Intervals wnls. U waves present
- hence computer may be misreading the QT interval. No ST
changes.

MEDICAL HISTORY: * s/p breast implants ([**7-/2109**])
* s/p liposuction ([**2-/2110**])
* s/p rhinoplasty
* PCP [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1355**] @ [**Hospital 8**] Hospital
.
PSYCHIATRIC HISTORY:
* Diagnoses: polysubstance abuse, PTSD, depression, bulemia
* Multiple past psychiatric hospitalizations mostly at [**Hospital 8**]
Hospital.  Last hospitalization at [**Last Name (un) 3671**] Behavioral in the fall
of [**2119**].
* At least one past suicide attempt via significant overdose on
Tylenol #3, Percocet, and alcohol in [**2110**].  Hospitalized at
[**Hospital1 18**] at that time and had outpatient followup at [**Hospital1 18**] as well.
* Past med trials include Zoloft which the patient did find
helpful.
* Psychiatrist Dr. [**First Name8 (NamePattern2) 1743**] [**Last Name (NamePattern1) **] at [**Hospital 8**] Hospital ([**Telephone/Fax (1) 16539**]
* Therapist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 174**] at [**Hospital 8**] Hospital ([**Telephone/Fax (1) 16540**]

MEDICATION ON ADMISSION: 1. Citalopram 20 mg daily
2. Potassium chloride 40 mEq TID
3. Quetiapine 25 mg qHS
4. Topiramate 25 mg TID
* Patient was not taking any of these medications due to poor
non-adherence

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 96.8BP 110/80 HR 66
GEN: Very thin woman in NAD, well groomed answering questions
appropriately.
HEENT: Swelling at base of neck bilaterally. Nontender.
RESP: CTA-BL
CV: Reg Nml S1, S2, no M/R/G
ABD: Thin, ND/NT +BS, no rebound/guarding
EXT: No peripheral edema
SKIN: No lanugo or rashes

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Ms. [**Known lastname **] was born in [**Country 3992**] and the youngest of 5 children. Her
family moved to [**Location (un) 86**] 24 years ago due to political pressures.
She was placed in several [**Doctor Last Name **] homes and there are allegations
of sexual abuse. As of [**2110**], notes indicate that her famliy
lives in CA, and that she has no contact with them. She attended
high school through the 11th grade, obtained a GED and attended
some college. She now lives in a house in [**Location (un) 16541**] in [**Location (un) 583**]
with her boyfriend.  She was working as a barrista at Starbucks
until a couple of weeks ago.
Bulimia nervosa,Nutritional marasmus,Hyposmolality and/or hyponatremia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Orthostatic hypotension,Obsessive-compulsive disorders,Cannabis abuse, continuous,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Suicidal ideation
Bulimia nervosa,Nutritional marasmus,Hyposmolality,Acute kidney failure NOS,Urin tract infection NOS,Orthostatic hypotension,Obsessive-compulsive dis,Cannabis abuse-contin,Posttraumatic stress dis,Depressive disorder NEC,Suicidal ideation
Admission Date:  [**2120-7-2**]              Discharge Date:   [**2120-7-12**]

Date of Birth:  [**2085-11-12**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2641**]
Chief Complaint:
Hypokalemia

Major Surgical or Invasive Procedure:
none


History of Present Illness:
34F Hx bulemia difficult to treat x several years referred to ED
after outpatient workup revealed lab abnormalities. She has
noted that she has had increased lethargy, weakness, slight
nausea and lightheadedness over the past fews days Admitted to
floor for electrolyte correction. No complaints of
numbness/tingling, muscle pain. She had stopped taking her
potassium pills for an unclear amount of time. In addition, she
stopped her psychiatric medications a few months ago.
.
In the ED:
EKG: NSR @ rate of 66. Axis wnl. Intervals wnls. U waves present
- hence computer may be misreading the QT interval. No ST
changes.

Past Medical History:
* s/p breast implants ([**7-/2109**])
* s/p liposuction ([**2-/2110**])
* s/p rhinoplasty
* PCP [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1355**] @ [**Hospital 8**] Hospital
.
PSYCHIATRIC HISTORY:
* Diagnoses: polysubstance abuse, PTSD, depression, bulemia
* Multiple past psychiatric hospitalizations mostly at [**Hospital 8**]
Hospital.  Last hospitalization at [**Last Name (un) 3671**] Behavioral in the fall
of [**2119**].
* At least one past suicide attempt via significant overdose on
Tylenol #3, Percocet, and alcohol in [**2110**].  Hospitalized at
[**Hospital1 18**] at that time and had outpatient followup at [**Hospital1 18**] as well.
* Past med trials include Zoloft which the patient did find
helpful.
* Psychiatrist Dr. [**First Name8 (NamePattern2) 1743**] [**Last Name (NamePattern1) **] at [**Hospital 8**] Hospital ([**Telephone/Fax (1) 16539**]
* Therapist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 174**] at [**Hospital 8**] Hospital ([**Telephone/Fax (1) 16540**]

Social History:
Ms. [**Known lastname **] was born in [**Country 3992**] and the youngest of 5 children. Her
family moved to [**Location (un) 86**] 24 years ago due to political pressures.
She was placed in several [**Doctor Last Name **] homes and there are allegations
of sexual abuse. As of [**2110**], notes indicate that her famliy
lives in CA, and that she has no contact with them. She attended
high school through the 11th grade, obtained a GED and attended
some college. She now lives in a house in [**Location (un) 16541**] in [**Location (un) 583**]
with her boyfriend.  She was working as a barrista at Starbucks
until a couple of weeks ago.

SUBSTANCE ABUSE HISTORY:
The patient reports daily marijuana use and she also abuses
Suboxone which she gets from her boyfriend.  She also has a
history of alcohol abuse though would not state exactly how much
she drinks.  She smokes cigarettes.


Family History:
noncontributory

Physical Exam:
VS: T: 96.8BP 110/80 HR 66
GEN: Very thin woman in NAD, well groomed answering questions
appropriately.
HEENT: Swelling at base of neck bilaterally. Nontender.
RESP: CTA-BL
CV: Reg Nml S1, S2, no M/R/G
ABD: Thin, ND/NT +BS, no rebound/guarding
EXT: No peripheral edema
SKIN: No lanugo or rashes

Pertinent Results:
Admission Labs:
[**2120-7-2**] 05:00PM   GLUCOSE-87 UREA N-17 CREAT-0.7 SODIUM-135
POTASSIUM-3.4 CHLORIDE-98 TOTAL CO2-33* ANION GAP-7*
[**2120-7-2**] 05:00PM   CALCIUM-8.7 PHOSPHATE-2.9 MAGNESIUM-2.2
[**2120-7-2**] 11:32AM   TYPE-ART PO2-84* PCO2-53* PH-7.41 TOTAL
CO2-35* BASE XS-6
[**2120-7-2**] 11:32AM   NA+-134* K+-3.5
[**2120-7-2**] 11:32AM   O2 SAT-94
[**2120-7-2**] 11:30AM   GLUCOSE-79 UREA N-14 CREAT-0.7 SODIUM-135
POTASSIUM-3.5 CHLORIDE-94* TOTAL CO2-35* ANION GAP-10
[**2120-7-2**] 11:30AM   CALCIUM-9.0 PHOSPHATE-2.7# MAGNESIUM-2.2
[**2120-7-2**] 02:30AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.020
[**2120-7-2**] 02:30AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-TR
GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-9.0*
LEUK-NEG
[**2120-7-2**] 02:30AM URINE  RBC-0 WBC-0-2 BACTERIA-OCC YEAST-RARE
EPI-[**12-31**]
[**2120-7-2**] 02:30AM URINE  HYALINE-<1
[**2120-7-2**] 02:10AM   GLUCOSE-100 UREA N-21* CREAT-1.2* SODIUM-137
POTASSIUM-2.7* CHLORIDE-78* TOTAL CO2-49* ANION GAP-13
[**2120-7-2**] 02:10AM   ALT(SGPT)-27 AST(SGOT)-39 ALK PHOS-80
AMYLASE-327* TOT BILI-0.6
[**2120-7-2**] 02:10AM   LIPASE-39
[**2120-7-2**] 02:10AM   ALBUMIN-5.0* CALCIUM-10.2 PHOSPHATE-4.3
MAGNESIUM-2.5
[**2120-7-2**] 02:10AM   COMMENTS-GREEN TOP
[**2120-7-2**] 02:10AM   GLUCOSE-92 NA+-140 K+-2.3* CL--74* TCO2-50*
[**2120-7-2**] 02:10AM   WBC-6.7 RBC-5.04 HGB-15.2 HCT-42.9 MCV-85
MCH-30.1 MCHC-35.4* RDW-13.1
[**2120-7-2**] 02:10AM   NEUTS-56.4 LYMPHS-36.9 MONOS-4.5 EOS-1.6
BASOS-0.6
[**2120-7-2**] 02:10AM   PLT COUNT-470*
[**2120-7-1**] 03:00PM   GLUCOSE-102
[**2120-7-1**] 03:00PM   UREA N-23* CREAT-1.0 SODIUM-135
POTASSIUM-2.2* CHLORIDE-79* TOTAL CO2-48* ANION GAP-10
[**2120-7-1**] 03:00PM   estGFR-Using this
[**2120-7-1**] 03:00PM   CALCIUM-10.2 PHOSPHATE-4.4 MAGNESIUM-2.6
[**2120-7-1**] 03:00PM   TSH-1.24
.
Discharge Labs:
[**2120-7-9**] 05:20AM BLOOD WBC-4.7 RBC-4.29 Hgb-13.2 Hct-36.8 MCV-86
MCH-30.7 MCHC-35.8* RDW-13.2 Plt Ct-313
.
MICRO:
[**2120-7-2**] 2:30 am URINE     Site: CLEAN CATCH

                            **FINAL REPORT [**2120-7-4**]**

   URINE CULTURE (Final [**2120-7-4**]):
      ESCHERICHIA COLI.    10,000-100,000 ORGANISMS/ML..
         PRESUMPTIVE IDENTIFICATION.
         Trimethoprim/Sulfa sensitivity testing confirmed by
[**First Name8 (NamePattern2) 3077**] [**Last Name (NamePattern1) 3060**].

                              SENSITIVITIES: MIC expressed in
MCG/ML

_________________________________________________________
                             ESCHERICHIA COLI
                             |
AMPICILLIN------------     8 S
AMPICILLIN/SULBACTAM--     4 S
CEFAZOLIN-------------   <=4 S
CEFEPIME--------------   <=1 S
CEFTAZIDIME-----------   <=1 S
CEFTRIAXONE-----------   <=1 S
CEFUROXIME------------    16 I
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------   <=1 S
IMIPENEM--------------   <=1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN--------  <=16 S
PIPERACILLIN----------   <=4 S
PIPERACILLIN/TAZO-----   <=4 S
TOBRAMYCIN------------   <=1 S
TRIMETHOPRIM/SULFA----   <=1 S
.


Brief Hospital Course:
34 yo female with hx of bulemia presents after findings of
hypokalemia and alkalosis on routine lab testing. On admission,
pt was started on the eating disorder protocol.  She had
aggressive repletion of electrolytes.  She was given IV fluid
200-250 cc boluses with resolution of ARF and alkalosis on HD 2.
Nutrition followed giving recommendations for repletion of
phosphate to avoid refeeding syndrome.  Pt was evaluated by
psychiatry on HD1.  They felt that the pt had very poor insight
into her illness. She was deemed to be medically incompetent.
She failed solid diet on HD2 and was changed to a liquid diet.
She failed the liquid diet on HD3 and NGT was place with
difficulty. Pt was fighting and saying "you can't feed me." She
was restrained with soft restraints and given ativan as
tolerated- avoiding hypotension,  Pt was felt to be too much
work for a regular medical floor and was transferred to the
MICU.
.
In the Micu, the patient was originally hypotensive which was
attributed to orthostatic hypotension, as she fell when she
stood up. She had no evidence for sepsis, bleeding, or
cardiogenic causes. The patient's pressure improved with IVF.
In terms of her eating disorder she was originally allowed to
eat what she wanted, but as she continued to vomit, she was
reinstated on the strict eating disorder protocol.  She had her
electrolytes closely followed and did not develop signs of
refeeding.  She was closely followed by nutrition and psych, and
the patient continued to try to leave but was not deemed to have
capacity per psych.  She was given haldol prn and ativan prn to
keep her calm and had a 1:1 sitter to monitor her behavior.
Finally, the patient was noted to have a UTI (e.coli) sensitive
to cipro and she remained afebrile and completed a 3 day course
of antibiotics.
.
The patient was transferred back to the medical floor.  She
initially continued to vomit her food, including an Ensure
protocol.  Her ativan was stopped due to patient agitation.  She
was continued on Haldol with good effect.  Serial EKGs were
taken and her QTc was stable.  On [**7-11**] she was able to hold down
3 consecutive meals.  Though her ideal body weight was at about
73% of normal, she was accepted to the in-patient psychiatry
unit.  On discharge her electrolytes were stable, except for a
minimal increase in her calcium for which her calcium carbonate
was stopped.
.
To Do:
1. Continue nutrition protocol
2. Continue psychiatric evaluation
3. Continue haldol as needed for agitation.  Serial EKGs will
need to be taken to monitor her QTc
4. Continue to monitor her electrolytes periodically


Medications on Admission:
1. Citalopram 20 mg daily
2. Potassium chloride 40 mEq TID
3. Quetiapine 25 mg qHS
4. Topiramate 25 mg TID
* Patient was not taking any of these medications due to poor
non-adherence


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q4-6H (every
4 to 6 hours) as needed.
2. Hexavitamin     Tablet Sig: One (1) Cap PO DAILY (Daily).
3. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
4. Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr
Transdermal DAILY (Daily).
5. Haloperidol 1 mg Tablet Sig: 2.5 Tablets PO BID (2 times a
day) as needed for agitation.
6. Pramoxine-Mineral Oil-Zinc 1-12.5 % Ointment Sig: One (1)
Appl Rectal [**Hospital1 **] PRN ().


Discharge Disposition:
Extended Care

Discharge Diagnosis:
eating disorder
hypokalemia
alkalosis


Discharge Condition:
stable


Discharge Instructions:
You were admitted with sever electrolyte abnormalities from your
eating disorder. This is a serious illness that requires long
term treatment.  You were put on a strict eating protocol while
on the medical floor.  Moreover, your electrolytes and heart
rhythm were monitored.  You will be discharged to an in-patient
psychiatric facility to further treat your illness.  You are
unable to leave under your own [**Location (un) **].
.
It is very important that you follow up with all of your
appointments.
.
Please present to the hospital or call your primary care
provider if you have fever/chills, chest pain/shortness of
breath, headache/dizzyness.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) 3707**] within the next week once
you are formally discharged. She is an eating disorder
specialist. Her phone number is ([**Telephone/Fax (1) 15205**].
{'Bulimia nervosa,Nutritional marasmus,Hyposmolality and/or hyponatremia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Orthostatic hypotension,Obsessive-compulsive disorders,Cannabis abuse, continuous,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Suicidal ideation'}


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: Hypokalemia

PRESENT ILLNESS: 34F Hx bulemia difficult to treat x several years referred to ED
after outpatient workup revealed lab abnormalities. She has
noted that she has had increased lethargy, weakness, slight
nausea and lightheadedness over the past fews days Admitted to
floor for electrolyte correction. No complaints of
numbness/tingling, muscle pain. She had stopped taking her
potassium pills for an unclear amount of time. In addition, she
stopped her psychiatric medications a few months ago.
.
In the ED:
EKG: NSR @ rate of 66. Axis wnl. Intervals wnls. U waves present
- hence computer may be misreading the QT interval. No ST
changes.

MEDICAL HISTORY: * s/p breast implants ([**7-/2109**])
* s/p liposuction ([**2-/2110**])
* s/p rhinoplasty
* PCP [**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 1355**] @ [**Hospital 8**] Hospital
.
PSYCHIATRIC HISTORY:
* Diagnoses: polysubstance abuse, PTSD, depression, bulemia
* Multiple past psychiatric hospitalizations mostly at [**Hospital 8**]
Hospital.  Last hospitalization at [**Last Name (un) 3671**] Behavioral in the fall
of [**2119**].
* At least one past suicide attempt via significant overdose on
Tylenol #3, Percocet, and alcohol in [**2110**].  Hospitalized at
[**Hospital1 18**] at that time and had outpatient followup at [**Hospital1 18**] as well.
* Past med trials include Zoloft which the patient did find
helpful.
* Psychiatrist Dr. [**First Name8 (NamePattern2) 1743**] [**Last Name (NamePattern1) **] at [**Hospital 8**] Hospital ([**Telephone/Fax (1) 16539**]
* Therapist Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 174**] at [**Hospital 8**] Hospital ([**Telephone/Fax (1) 16540**]

MEDICATION ON ADMISSION: 1. Citalopram 20 mg daily
2. Potassium chloride 40 mEq TID
3. Quetiapine 25 mg qHS
4. Topiramate 25 mg TID
* Patient was not taking any of these medications due to poor
non-adherence

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: T: 96.8BP 110/80 HR 66
GEN: Very thin woman in NAD, well groomed answering questions
appropriately.
HEENT: Swelling at base of neck bilaterally. Nontender.
RESP: CTA-BL
CV: Reg Nml S1, S2, no M/R/G
ABD: Thin, ND/NT +BS, no rebound/guarding
EXT: No peripheral edema
SKIN: No lanugo or rashes

FAMILY HISTORY: noncontributory

SOCIAL HISTORY: Ms. [**Known lastname **] was born in [**Country 3992**] and the youngest of 5 children. Her
family moved to [**Location (un) 86**] 24 years ago due to political pressures.
She was placed in several [**Doctor Last Name **] homes and there are allegations
of sexual abuse. As of [**2110**], notes indicate that her famliy
lives in CA, and that she has no contact with them. She attended
high school through the 11th grade, obtained a GED and attended
some college. She now lives in a house in [**Location (un) 16541**] in [**Location (un) 583**]
with her boyfriend.  She was working as a barrista at Starbucks
until a couple of weeks ago. 

### Response:
{'Bulimia nervosa,Nutritional marasmus,Hyposmolality and/or hyponatremia,Acute kidney failure, unspecified,Urinary tract infection, site not specified,Orthostatic hypotension,Obsessive-compulsive disorders,Cannabis abuse, continuous,Posttraumatic stress disorder,Depressive disorder, not elsewhere classified,Suicidal ideation'}
