CHIEF COMPLAINT: Seizure, hyperglycemia

PRESENT ILLNESS: 59yoF with h/o DM but not on medications, hypothyroidism,
Hyperlipidemia Coronary Artery Disease, and Hypertension
presented to OSH with Altered Mental Status and seizure found to
have HHS and transferred to [**Hospital1 18**] for further management. Per
the patient's daughter over the last few months the patient has
lost a lot of weight, not been able to go 5 mins without using
the bathroom, and has felt fatigued. she was started on a new
thyroid medication in the last few weeks. She was supposed to
see the doctor [**First Name (Titles) **] [**Last Name (Titles) 20212**] but postponed to today. However,
last night she was "not herself" but she said she was fine. This
morning her daughter still thought she was altered but the
patient insisted that she go to work this afternoon at 2pm.  at
6:30 a police officer drove the patient home and reported that
she had driven her car into a pole, was confused but had refused
to go to the hospital. Then the patient went to her room and
fell asleep, while her dtr went to get the car (about 1 hour).
After this the daughter insisted they go to the hospital. On the
car ride she began losing consciousness and as they arrived to
the hospital had a seizure. (documented as GTC by OSH). REceived
ativan and dilantin. Head CT normal.

MEDICAL HISTORY: Diabetes mellitus not on medication
Hypertension
"Holes in her heart s/p surgery"
Hypothyroidism
Hyperlipidemia
Coronary Artery Disease

MEDICATION ON ADMISSION: Lasix 20 mg po daily
Fosinopril 40 mg po daily
Levothyroxine 0.1 mg po daily
Lovastatin 20 mg po daily
Flucinonide cream 0.05%

ALLERGIES: Latex

PHYSICAL EXAM: Admission:
VS: Temp:97 BP:153 /67 HR:99 RR: O2sat 92% on AC 420X16 peep 5
FIo2 100
GEN: Intubated sedated
HEENT: PERRL at 2mm, anicteric, MMM, no jvd, no carotid bruits,
no thyromegaly or thyroid nodules
RESP: crackles at the right base
CV: RR, S1 and S2 wnl, no m/r/g  CVP 5
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: Intubated and sedated. Pupils 2mm and reactive. When
sedation off awake and fighting the tube
.
Discharge:
Vitals - Tm: 100.0 Tc:98.8 p:80 (72-97) bp:116/76
(108-118/68-74)rr20 98% RA.
GENERAL: elderly female appearing comfortable and in no acute
distress
HEENT: left trapezius tender and tense, no increased warmpth
CHEST: CTABL no wheezes, no rales, no ronchi
CV: S1 S2 Normal in quality and intensity RRR no murmurs rubs or
gallops
ABD: Overweight, non-distended, BS normoactive, soft, non-tender

FAMILY HISTORY: Mom with diabetes.

SOCIAL HISTORY: Lives with her daughter, works as a home health aide.
Non-smoker, non-drinker.
Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Systolic heart failure, unspecified,Other convulsions,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypercalcemia,Other iatrogenic hypotension,Intravenous anesthetics causing adverse effects in therapeutic use,Thrombocytopenia, unspecified,Obstructive sleep apnea (adult)(pediatric),Other chronic pulmonary heart diseases,Long-term (current) use of insulin
DMII hprosmlr uncontrold,Acute kidney failure NOS,Hyperosmolality,Ac DVT/emb distl low ext,Systolic hrt failure NOS,Convulsions NEC,Hypothyroidism NOS,Hyperlipidemia NEC/NOS,Crnry athrscl natve vssl,Hypertension NOS,Hypercalcemia,Iatrogenc hypotnsion NEC,Adv eff intraven anesth,Thrombocytopenia NOS,Obstructive sleep apnea,Chr pulmon heart dis NEC,Long-term use of insulin
Admission Date:  [**2117-2-12**]              Discharge Date:   [**2117-2-19**]

Date of Birth:  [**2057-4-20**]             Sex:   F

Service: MEDICINE

Allergies:
Latex

Attending:[**First Name3 (LF) 348**]
Chief Complaint:
Seizure, hyperglycemia


Major Surgical or Invasive Procedure:
Central line placement


History of Present Illness:
59yoF with h/o DM but not on medications, hypothyroidism,
Hyperlipidemia Coronary Artery Disease, and Hypertension
presented to OSH with Altered Mental Status and seizure found to
have HHS and transferred to [**Hospital1 18**] for further management. Per
the patient's daughter over the last few months the patient has
lost a lot of weight, not been able to go 5 mins without using
the bathroom, and has felt fatigued. she was started on a new
thyroid medication in the last few weeks. She was supposed to
see the doctor [**First Name (Titles) **] [**Last Name (Titles) 20212**] but postponed to today. However,
last night she was "not herself" but she said she was fine. This
morning her daughter still thought she was altered but the
patient insisted that she go to work this afternoon at 2pm.  at
6:30 a police officer drove the patient home and reported that
she had driven her car into a pole, was confused but had refused
to go to the hospital. Then the patient went to her room and
fell asleep, while her dtr went to get the car (about 1 hour).
After this the daughter insisted they go to the hospital. On the
car ride she began losing consciousness and as they arrived to
the hospital had a seizure. (documented as GTC by OSH). REceived
ativan and dilantin. Head CT normal.

at OSH labs notable for glucose in 1400s and Na 139. ABG 7.19.
Then reportedly became apneic and was intubated at [**Hospital1 **]. Given
SC insulin and insulin gtt at 6 units /hr. Got 4L NS at OSH.
Never hemodynamically unstable

in the ED initial VS: T: AF, BP labile (80-90) when on propofol.
Received 2 more L NS.  PCXR showed infiltrate RLL. Patient was
given CTX/VANC/FLAGYL, continue the insulin gtt. na 150 despite
the glucose coming down. VS on transfer: T: HR 80 BP 100/54 100%
on AC 420X26 FiO2100 Peep 5. on arrival to floor patient was
awake and fighting the tube. She was unable to answer questions.
her family was not available to ask historical questions.

ROS per daughter no fevers, viral symptoms, cough, sick
contacts. Losing her hair recently and PCP changed her thyroid
medication to treat it.

Past Medical History:
Diabetes mellitus not on medication
Hypertension
"Holes in her heart s/p surgery"
Hypothyroidism
Hyperlipidemia
Coronary Artery Disease


Social History:
Lives with her daughter, works as a home health aide.
Non-smoker, non-drinker.


Family History:
Mom with diabetes.


Physical Exam:
Admission:
VS: Temp:97 BP:153 /67 HR:99 RR: O2sat 92% on AC 420X16 peep 5
FIo2 100
GEN: Intubated sedated
HEENT: PERRL at 2mm, anicteric, MMM, no jvd, no carotid bruits,
no thyromegaly or thyroid nodules
RESP: crackles at the right base
CV: RR, S1 and S2 wnl, no m/r/g  CVP 5
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: Intubated and sedated. Pupils 2mm and reactive. When
sedation off awake and fighting the tube
.
Discharge:
Vitals - Tm: 100.0 Tc:98.8 p:80 (72-97) bp:116/76
(108-118/68-74)rr20 98% RA.
GENERAL: elderly female appearing comfortable and in no acute
distress
HEENT: left trapezius tender and tense, no increased warmpth
CHEST: CTABL no wheezes, no rales, no ronchi
CV: S1 S2 Normal in quality and intensity RRR no murmurs rubs or
gallops
ABD: Overweight, non-distended, BS normoactive, soft, non-tender

EXT: no edema. RLE calf swelling, palpable cord posterior to
knee. Positive left sided homman's sign.


Pertinent Results:
Admission labs:
Labs at [**Hospital1 **]:
WBC 10.6, Hct 46, PLt 396
ABG: 7.19/61/175/23 on NRB
Na 139, K 6.2, Cl 97, CO2 22, Gluc 1432, BUN 62, Cr 1.8
Acetone positive
Alb 4.5
Tbili 1.6
Ca [**17**].1
ALT 87, AST 29
.
Labs at [**Hospital1 18**]:
ABG: 7.31 50 328 26 on 500X16, 100, 5
Na:154
K:5.0
Cl:116
Lactate:1.9
.
Na:150  Cl:109  BUN:55  GLUC:931   AGap=18
K:5.4  HCO3:23  Cr:1.6
Ca: 11.1 Mg: 3.7 P: 4.2
ALT: 39 AP: 88 Tbili: 0.5
AST: 31  Lip: 124

WBC: 10.9  Hgb:15.1  PLT:374 Hct:46.9
 N:84.2 L:10.6 M:4.2 E:0 Bas:1.1
.
[**2117-2-12**] 12:15AM BLOOD ALT-39 AST-31 AlkPhos-88 TotBili-0.5
[**2117-2-13**] 10:11PM BLOOD %HbA1c-19.4* eAG-510*
[**2117-2-14**] 05:59AM BLOOD Triglyc-278* HDL-45 CHOL/HD-3.8
LDLcalc-71
[**2117-2-12**] 03:48AM BLOOD TSH-4.7*
.
DISCHARGE:
[**2117-2-19**] 06:10AM BLOOD WBC-7.8 RBC-3.09* Hgb-9.9* Hct-29.0*
MCV-94 MCH-31.9 MCHC-34.0 RDW-15.9* Plt Ct-288
[**2117-2-19**] 06:10AM BLOOD PT-13.4 PTT-26.6 INR(PT)-1.1
[**2117-2-19**] 06:10AM BLOOD Glucose-99 UreaN-7 Creat-0.7 Na-139 K-4.0
Cl-107 HCO3-26 AnGap-10
[**2117-2-19**] 06:10AM BLOOD Calcium-8.3* Phos-3.5 Mg-2.3
.
.
MICRO
[**2117-2-16**] Urine culture Negative final
[**2117-2-16**] catheter tip Negative final
[**2117-2-15**] Blood Culture Negative final
[**2117-2-15**] Blood Culture Negative final
[**2117-2-14**] Urine culture Negative final
[**2117-2-13**] Blood Culture Negative final
[**2117-2-13**] Blood Culture Negative final
[**2117-2-12**] Blood Culture Negative final
[**2117-2-12**] Blood Culture Negative final

.
Imaging:
Lower ext dopplers [**2117-2-17**]
FINDINGS: Waveforms in the common femoral veins are symmetric
bilaterally with appropriate response to Valsalva maneuvers. In
the right lower extremity, the common femoral, proximal and mid
superficial femoral veins as well as proximal greater saphenous
are all normal with appropriate compressibility, and
wall-to-wall flow on color analysis. There is
non-compressibility of the distal portion of the superficial
femoral vein as well as of the popliteal vein, with absent flow
on color Doppler analysis, related to deep venous thrombosis in
those locations. Wall-to-wall flow and compressibility is noted
in the posterior tibial and peroneal veins in the right calf.
.
In the left lower extremity, the common femoral, proximal
greater saphenous, superficial femoral and popliteal veins are
normal with appropriate compressibility, wall-to-wall flow on
color analysis and response to waveform augmentation.
Wall-to-wall flow is also seen in the posterior tibial and
peroneal veins in the left calf.
.
IMPRESSION: Right popliteal and distal superficial femoral vein
thrombosis.
.
CXR [**2117-2-13**]
Moderate left pleural effusion has increased and left lower lobe
atelectasis or consolidation has improved. Right lung is grossly
clear. The heart is severely enlarged and dilated pulmonary
arteries are an indication of pulmonary arterial hypertension.
Right jugular line ends in the SVC. No pneumothorax.
.
ECHO [**2117-2-16**]
The left atrium is elongated. The right atrium is moderately
dilated. There is mild symmetric left ventricular hypertrophy
with normal cavity size and regional/global systolic function
(LVEF>55%). The right ventricular cavity is mildly dilated with
borderline normal free wall function. The diameters of aorta at
the sinus, ascending and arch levels are normal. The aortic
valve leaflets (3) appear structurally normal with good leaflet
excursion and no aortic regurgitation. The mitral valve leaflets
are mildly thickened. Moderate [2+] tricuspid regurgitation is
seen. There is moderate pulmonary artery systolic hypertension.
There is a very small pericardial effusion.
.
[**2117-2-12**] 6:12 AM
Nasogastric tube has been advanced into the stomach which is
somewhat less
distended with gas, and out of view. Left lower lobe atelectasis
is worsened, right atelectasis improved. Upper lungs clear.
Borderline cardiomegaly stable. Probable pulmonary hypertension.
Upper lungs clear. Right jugular line ends in the mid to low
SVC. No pneumothorax.
 .
[**2-13**]: left pleural effusion, likely pulm arterial hypertension
 .
CT Head from [**Hospital1 **]: Diffuse cerbral atrophy appropriate for
patient's age, right nasal ganglia calicifactions, no cerebral
ischemia, no ICH, No mass.
 .
CT C Spine: No acute fracture or malalignment. degenerative
changes C5-C7.

Brief Hospital Course:
59 yo female with h/o DM admitted with HHS and seizure.
.
# Hyper osmolar hyperglucemic state:  The patient has a history
of an elevated BS in clinic a year ago which per her daughter
resolved without treatment.  She had not been on medications for
diabetes.  Per her daughter she had symptoms of polyuria and
weight loss for several months prior to presentation suggestive
of hyperglycemia.  Prior to admission at [**Hospital1 18**], patient was
intubated for airway protection. She was started on an insulin
gtt in the ED which was uptitrated according to [**Last Name (un) **] protocol.
While in the ICU, she was promptly extubated and treated with
insulin drip and IVNS. Her hypokalemia and fluid deficit where
repleted with frequent monitoring.  She was started on a D5 gtt
once her BS became <200 to maintain BS 200-300.  After a two
admission to the ICU, patient was called out to the general
medical floor.
.
Regarding cause of HHS, most likely this was a slowly developing
hyperglycemia in the setting of uncontrolled diabetes.  No
underlying infection or acute insult was detected.  Blood and
urine cultures were sent and are pending.  CXR did show an
infiltrate which was consitent with aspiration, and per her
daughter she had no clinical symptoms pointing towards PNA.

# Diabetes Mellitus: Ha1C is 19. After admission to general
medical floor from ICU, she was stabalized on an insulin regimen
consisting of glargine at bedtime and prandial humalog with
correction factor. She was given diabetes teaching with the
staff Hatian Creole interpreter and was able to draw up insulin
and administer it without difficulty. She is believed to have
Flatbush diabetes and will need to be on insulin in the acute
phase but may be able to transition to oral agents after two
months. It is recommended that C-peptide be checked in two
months time to determine native insulin production and guide
decision to begin oral hypoglycemics. She was discharged with a
plan for outpatient follow up with the [**Hospital **] clinic.
.
# Respiratory: Patient was intubated secondary to change in
mental status due to her seizure for airway protection.  On CXR
has evidence of aspiration with right hilar fluffy infiltrate,
however per her daughter she had no clinical history of
pneumonia prior to her acute event.  She remained intubated
overnight and the morning of [**2-12**] her sedation was weaned and she
was successfully extubated.  She was initially treated with
vanc, ceftriaxone, and flagyl for a persumed aspiration PNA and
these were continued in the setting of her transient
hypotension.  However following extubation, she was without a
leukocytosis or fever and was normotensive once her sedation was
weaned so antibiotics were stopped after extubation on [**2-12**].
.
# Deep vein thrombosis: Beginning HD 4, patient had recurrent
low grade fevers. Infectious work up including CXR, UA and Urine
culture, Blood culture, central line tip culture were all
negative. Lower extremity doplers showed right lower extremity
DVT and patient was started on Enoxaparin and warfarin. Deep
vein thrombosis was explained to patient using the staff Hatian
Creole interpreter and she stated understanding of DVT, risk of
pulmonary embolism and importance of anticoagulation and
frequent INR checks. She was taught how to administer
enoxaparin. She will need to continue enoxaparin until INR is
[**3-11**], and will need to continue warfarin x 3 months, final day
[**2117-5-13**]. She was discharged with a plan for outpatient follow
up in three days and INR checks.
.
# Hypernatremia: Likely in the setting of dehydration from
severe hyperglycemia and corrected is actually higher (164). [**Month (only) 116**]
be reason for seizure as well.  Initially worsened from
admission due to decrease in serum glucose. Hypernatremia was
corrected slowly in in the ICU with D5 1/2NS and D5 to decrease
the risk of cerebral edema. On transfer to the general medical
floor, her sodium had corrected.
.
# Seizure: Likely from hypernatremia/hyperosmolar state.  No
reoccurance of seizure in the ICU or for remainder of hospital
stay.
.
# Acute Kidney Injury: Unknown baseline. Patient with Cr of 1.6
on admission.  Trended down to 1.0 with volume resuscitation.
Likely secondary to prerenal/volume depleption.
.
# Hypercalcemia: Mild and in setting of acute illness and
hyperosmolar state creating intravascular free water depletion.
Normalized with volume resuscitation.
.
# Transient Hypotension: Thought to be related to sedation with
propofol.  Resolved with weaning sedation and extubation.
.
# Hypothyroidism: dose is confirmed with PCP as new dose.
.
Comm:  with patient and family [**Name (NI) 88336**] [**Telephone/Fax (1) 88337**]
Code:  Full


Medications on Admission:
Lasix 20 mg po daily
Fosinopril 40 mg po daily
Levothyroxine 0.1 mg po daily
Lovastatin 20 mg po daily
Flucinonide cream 0.05%


Discharge Medications:
1. enoxaparin 100 mg/mL Syringe Sig: Ninety (90) mg Subcutaneous
Q12H (every 12 hours) for 7 days.
Disp:*1260 mg* Refills:*0*
2. furosemide 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
3. levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. lovastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
5. Coumadin 2.5 mg Tablet Sig: Two (2) Tablet PO once a day:
Your doctor may adjust this based on your blood tests.
Disp:*60 Tablet(s)* Refills:*0*
6. insulin glargine 100 unit/mL Solution Sig: Thirty Five (35)
units Subcutaneous at bedtime.
Disp:*1 bottle* Refills:*0*
7. Humalog 100 unit/mL Solution Sig: Per instructions below
units Subcutaneous three times a day: 14 units with breakfast
12 units with lunch
12 units with dinner
.
Disp:*1 bottle* Refills:*0*
8. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*
9. lisinopril 2.5 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*0*
10. FreeStyle Lite Meter     Kit Sig: One (1)  Miscellaneous
four times a day.
Disp:*1 kit* Refills:*2*
11. FreeStyle Lite Strips     Strip Sig: One (1) strip
Miscellaneous four times a day for 14 days.
Disp:*56 strips* Refills:*0*
12. syringe (disposable)     Syringe Sig: 0.5 cc Miscellaneous
five times a day: [**6-21**]" 31 guage.
Disp:*120 syringes* Refills:*0*
13. lancets     Misc Sig: One (1) lancet Miscellaneous four
times a day.
Disp:*120 lancets* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
Primary
Diabetes Mellitus
.
Secondary
Hyperosmolar Hyperglycemic state
Seizure
Deep vein thrombosis


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


Discharge Instructions:
Ms [**Known lastname 88338**],
 It was a pleasure taking care of you in your hospital stay at
[**Hospital1 **]. As you know, you had very high blood
sugars, confusion and seizures. You were admitted to the
intensive care unit where you were briefly on a ventilator to
help you breath. We treated your high sugars with insulin and
will be giving you insulin prescriptions to help you control
your sugars at home.
.
You also developed a blood clot in your leg, a deep vein
thrombosis. You will need to thin your blood with injections of
lovenox and pills of coumadin. You will need to have your
coumadin level checked frequently by your primary care provider.
[**Name10 (NameIs) 357**] continue to take both of these medications until your
primary care privider tells you to stop.
.
New medications
Coumadin 10mg by mouth Daily for blood thinning
Lovenox 90mg subcutenously twice a day for blood thinning
Humalog Insulin 12 Units with lunch and dinner
Humalog Insulin 14 Units with breakfast
Glargine insulin 35 Units at bedtime


Followup Instructions:
Please make an appointment to
.
Name: [**Last Name (LF) **],[**First Name3 (LF) **] C
Address: [**Street Address(2) 88339**], [**Location (un) **],[**Numeric Identifier 38978**]
Phone: [**Telephone/Fax (1) 88340**]
Appointment: Monday [**2-22**] 2PM.
**You can walk in to see your doctor between the hours of
2PM-6PM.**
Please bring in your discharge summary to this appointment for
Dr. [**First Name (STitle) **] to review. Thanks.
.
Name: [**Last Name (LF) **], [**Name8 (MD) 32440**] MD
Location: [**Last Name (un) **] DIABETES CENTER
Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 2378**]
Appointment: Tuesday [**2-23**] at 9AM
Please call MassHealth insurance as soon as possible to choose
your plan. Their number is [**Telephone/Fax (1) 88341**]. If you do not fix your
insurance, this appointment will be self pay.
{'Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Systolic heart failure, unspecified,Other convulsions,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypercalcemia,Other iatrogenic hypotension,Intravenous anesthetics causing adverse effects in therapeutic use,Thrombocytopenia, unspecified,Obstructive sleep apnea (adult)(pediatric),Other chronic pulmonary heart diseases,Long-term (current) use of insulin'}


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: Seizure, hyperglycemia

PRESENT ILLNESS: 59yoF with h/o DM but not on medications, hypothyroidism,
Hyperlipidemia Coronary Artery Disease, and Hypertension
presented to OSH with Altered Mental Status and seizure found to
have HHS and transferred to [**Hospital1 18**] for further management. Per
the patient's daughter over the last few months the patient has
lost a lot of weight, not been able to go 5 mins without using
the bathroom, and has felt fatigued. she was started on a new
thyroid medication in the last few weeks. She was supposed to
see the doctor [**First Name (Titles) **] [**Last Name (Titles) 20212**] but postponed to today. However,
last night she was "not herself" but she said she was fine. This
morning her daughter still thought she was altered but the
patient insisted that she go to work this afternoon at 2pm.  at
6:30 a police officer drove the patient home and reported that
she had driven her car into a pole, was confused but had refused
to go to the hospital. Then the patient went to her room and
fell asleep, while her dtr went to get the car (about 1 hour).
After this the daughter insisted they go to the hospital. On the
car ride she began losing consciousness and as they arrived to
the hospital had a seizure. (documented as GTC by OSH). REceived
ativan and dilantin. Head CT normal.

MEDICAL HISTORY: Diabetes mellitus not on medication
Hypertension
"Holes in her heart s/p surgery"
Hypothyroidism
Hyperlipidemia
Coronary Artery Disease

MEDICATION ON ADMISSION: Lasix 20 mg po daily
Fosinopril 40 mg po daily
Levothyroxine 0.1 mg po daily
Lovastatin 20 mg po daily
Flucinonide cream 0.05%

ALLERGIES: Latex

PHYSICAL EXAM: Admission:
VS: Temp:97 BP:153 /67 HR:99 RR: O2sat 92% on AC 420X16 peep 5
FIo2 100
GEN: Intubated sedated
HEENT: PERRL at 2mm, anicteric, MMM, no jvd, no carotid bruits,
no thyromegaly or thyroid nodules
RESP: crackles at the right base
CV: RR, S1 and S2 wnl, no m/r/g  CVP 5
ABD: nd, +b/s, soft, nt, no masses or hepatosplenomegaly
EXT: no c/c/e
SKIN: no rashes/no jaundice
NEURO: Intubated and sedated. Pupils 2mm and reactive. When
sedation off awake and fighting the tube
.
Discharge:
Vitals - Tm: 100.0 Tc:98.8 p:80 (72-97) bp:116/76
(108-118/68-74)rr20 98% RA.
GENERAL: elderly female appearing comfortable and in no acute
distress
HEENT: left trapezius tender and tense, no increased warmpth
CHEST: CTABL no wheezes, no rales, no ronchi
CV: S1 S2 Normal in quality and intensity RRR no murmurs rubs or
gallops
ABD: Overweight, non-distended, BS normoactive, soft, non-tender

FAMILY HISTORY: Mom with diabetes.

SOCIAL HISTORY: Lives with her daughter, works as a home health aide.
Non-smoker, non-drinker. 

### Response:
{'Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Acute kidney failure, unspecified,Hyperosmolality and/or hypernatremia,Acute venous embolism and thrombosis of deep vessels of distal lower extremity,Systolic heart failure, unspecified,Other convulsions,Unspecified acquired hypothyroidism,Other and unspecified hyperlipidemia,Coronary atherosclerosis of native coronary artery,Unspecified essential hypertension,Hypercalcemia,Other iatrogenic hypotension,Intravenous anesthetics causing adverse effects in therapeutic use,Thrombocytopenia, unspecified,Obstructive sleep apnea (adult)(pediatric),Other chronic pulmonary heart diseases,Long-term (current) use of insulin'}
