CHIEF COMPLAINT: Hyperglycemia

PRESENT ILLNESS: 58 year old male with Type II diabetes and CAD with 3VD,
presents with hyperglycemia. The patient reports that he was
taking his insulin regularly while he was living with his
sister. However, three weeks ago he moved out of his sisters
house and has been staying in the [**Hospital1 **] shelter while he
awaits section 8 housing. Two days ago, he was unable to get his
insulin syringes from his medical case manager since they were
misplaced. He figured he would need to see Dr. [**Last Name (STitle) 11528**] to
get more but didn't need them right away. He states that he
could not measure his finger sticks as his glucometer was
malfunctioning because it had been stored it in the
refridgerator at the [**Hospital1 **]. He figured his blood sugars were
likely high, so he went to the ED for FS check and to get a
prescription for insulin syringes (he had missed ~[**3-27**] NPH
doses). He denied recent, chest pain, tightness or shortness of
breath. He denies dysuria, but has experienced frequency or
urgency. He's been tolerating PO's well with no nausea, vomiting
or diarrhea. He denies any blurred vision, recurrent skin
infections but has felt slightly dizzy. In the ED, his FS was
782. He was started on an insulin drip and admitted to the ICU
for further management.

MEDICAL HISTORY: CAD with 3 vessel dz, s/p ? MI x2 secondary to cocaine, s/p Cath

MEDICATION ON ADMISSION: Atorvastatin 40 mg po qday
Isosorbide Mononitrate SR 30 mg qday
Nifedipine 90 mg SR qday
Nitroglycerin 0.3 mg SL prn
Aspirin 81 mg qday
Furosemide 20 mg qday
insulin: Humalin N 20units qAM, 15units qPM
Zoloft 50 mg qday
Toprol XL 200 mg qday
Lisinopril 40 mg qday
Prilosec OTC 20 mg qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical exam on admission:
VS: Temp: 97.8   BP: 210/115  HR: 60  RR: 11  O2 Sat 98% RA
GEN: NAD
HEENT-neck supple, PERRL, multiple scars on face, no elev JVP,
MMM
Lungs-CTA bilat
CV: RRR, nS1 prominent S2, no MRG
ABD:  soft, mild RUQ tenderness from "hunger pains" per pt, no
HSM
EXT:  2+rad and dp pulses bilat, rt 1st toe amputated
SKIN: warm and dry

FAMILY HISTORY: Family Hx: One brother with MI at age 54, multiple siblings with
DMII. Father died of lung CA in his 60's

SOCIAL HISTORY: Lived with sister but now in [**Name (NI) **] as above. Going to get his
GED and eventually hopes to work for the EPA. Prior smoker with
2ppd x 26yrs, quit 1 yr ago. Prior drug use with cocaine and
EtOH but sober for 19 months.
Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Acute kidney failure, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Lack of housing
DMII wo cmp nt st uncntr,Acute kidney failure NOS,Cor ath unsp vsl ntv/gft,Hypertension NOS,Hyperlipidemia NEC/NOS,Anemia NOS,Hx of past noncompliance,Lack of housing
Admission Date:  [**2196-2-22**]              Discharge Date:   [**2196-2-27**]

Date of Birth:  [**2137-7-10**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2932**]
Chief Complaint:
Hyperglycemia

Major Surgical or Invasive Procedure:
none

History of Present Illness:
58 year old male with Type II diabetes and CAD with 3VD,
presents with hyperglycemia. The patient reports that he was
taking his insulin regularly while he was living with his
sister. However, three weeks ago he moved out of his sisters
house and has been staying in the [**Hospital1 **] shelter while he
awaits section 8 housing. Two days ago, he was unable to get his
insulin syringes from his medical case manager since they were
misplaced. He figured he would need to see Dr. [**Last Name (STitle) 11528**] to
get more but didn't need them right away. He states that he
could not measure his finger sticks as his glucometer was
malfunctioning because it had been stored it in the
refridgerator at the [**Hospital1 **]. He figured his blood sugars were
likely high, so he went to the ED for FS check and to get a
prescription for insulin syringes (he had missed ~[**3-27**] NPH
doses). He denied recent, chest pain, tightness or shortness of
breath. He denies dysuria, but has experienced frequency or
urgency. He's been tolerating PO's well with no nausea, vomiting
or diarrhea. He denies any blurred vision, recurrent skin
infections but has felt slightly dizzy. In the ED, his FS was
782. He was started on an insulin drip and admitted to the ICU
for further management.

Past Medical History:
CAD with 3 vessel dz, s/p ? MI x2 secondary to cocaine, s/p Cath

and 3vd in [**6-29**] with no intervention performed
Type 2 DM - diagnosed [**2172**]
Hypertension
Hyperlipidemia
CRF: baseline creat 2.5
Moderate Right RAS per cath in [**6-29**]
Anemia
Pancreatitis - last episode in [**2189**]
h/o hyperkalemia
Low back pain - mainly with changes in weather
h/o alcohol and drug abuse
h/o sexual dysfunction
s/p amputation of right great toe

Social History:
Lived with sister but now in [**Name (NI) **] as above. Going to get his
GED and eventually hopes to work for the EPA. Prior smoker with
2ppd x 26yrs, quit 1 yr ago. Prior drug use with cocaine and
EtOH but sober for 19 months.

Family History:
Family Hx: One brother with MI at age 54, multiple siblings with
DMII. Father died of lung CA in his 60's

Physical Exam:
Physical exam on admission:
VS: Temp: 97.8   BP: 210/115  HR: 60  RR: 11  O2 Sat 98% RA
GEN: NAD
HEENT-neck supple, PERRL, multiple scars on face, no elev JVP,
MMM
Lungs-CTA bilat
CV: RRR, nS1 prominent S2, no MRG
ABD:  soft, mild RUQ tenderness from "hunger pains" per pt, no
HSM
EXT:  2+rad and dp pulses bilat, rt 1st toe amputated
SKIN: warm and dry


Pertinent Results:
Laboratory studies on admission:
[**2196-2-22**]
WBC-5.0 HGB-12.0 HCT-35.8 MCV-89 RDW-13.0 PLT COUNT-297
NEUTS-55.0 LYMPHS-38.4 MONOS-4.5 EOS-1.8 BASOS-0.3
CALCIUM-8.8 PHOSPHATE-4.3 MAGNESIUM-2.5
GLUCOSE-782 UREA N-48 CREAT-3.1 SODIUM-118 POTASSIUM-7.3
CHLORIDE-84 TOTAL CO2-23
CK(CPK)-467 CK-MB-14 MB INDX-3.0 cTropnT-0.02
U/A: BLOOD-SM NITRITE-NEG PROTEIN-100 GLUCOSE-1000 KETONE-NEG
BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG
RBC-0-2 WBC-0-2 BACTERIA-NONE YEAST-NONE EPI-0
BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG
Tricycl-NEG

[**2196-2-24**]
Triglyc-74 HDL-65 CHOL/HD-2.4 LDLcalc-78

[**2196-2-26**]
CK(CPK)-121 CK-MB-5 cTropnT-0.03

Laboratory studies on discharge:
[**2196-2-27**] Hct-31.0

[**2-22**] EKG: Sinus rhythm. Left atrial abnormality. Left
ventricular hypertrophy with ST-T wave changes. Compared to the
previous tracing of [**2196-1-15**] no diagnostic interim change.

[**2-22**] CXR: Cardiomediastinal silhouette appears normal. The lungs
are clear. No effusions are seen. Blunting of the left
costophrenic angle is stable compared to [**2196-1-15**] and
indicates scarring. Multiple calcified granulomas are again
seen.

[**2-25**] transthoracic echocardiogram: The left atrium is normal in
size. No atrial septal defect is seen by 2D or color Doppler.
There is severe symmetric left ventricular hypertrophy. The left
ventricular cavity is small. Overall left ventricular systolic
function is normal (LVEF 60-70%); however, the basal segment of
the inferior free wall appears hypokinetic. There is no left
ventricular outflow obstruction at rest or with Valsalva. There
is no ventricular septal defect. Right ventricular chamber size
and free wall motion are normal. The ascending aorta is mildly
dilated. The aortic valve leaflets (3) appear structurally
normal with good leaflet excursion and no aortic regurgitation.
The mitral valve leaflets are structurally normal. There is no
mitral valve prolapse. Trivial mitral regurgitation is seen. The
left ventricular inflow pattern suggests impaired relaxation.
The pulmonary artery systolic pressure could not be determined.
There is no pericardial effusion.

[**2-26**] PMIBI: No anginal type symptoms or ischemic EKG changes.
Nuclear
report sent separately. Moderate, reversible perfusion
abnormality of the inferior wall, not significantly changed
compared to the study of [**2196-4-21**].

Brief Hospital Course:
58 year old male with type II diabetes, 2-vessel coronary artery
disease presents with hyperglycemia in the setting of not having
access to insulin syringes. Hospital course was complicated by
atypical jaw pain.

1) Hyperglycemia/Type II diabetes poorly controlled with
complications: The patient was initially admitted to the
intensive care unit on an insulin drip. He was restarted on his
home dose of NPH and weaned off the insulin drip and transferred
to the general floor. His HgbA1C was noted to be 14. His
fingersticks remained labile following transfer to the floor,
however, overall they were improved and he was continued on his
home insulin regimen. He was provided with a new glucometer, as
well as prescriptions for insulin, test strips, and insulin
needles/syringes. He will check his fingersticks at least [**2-27**]
times a day, record the values, and bring them to his next PCP
[**Name Initial (PRE) **].

2) 3 vessel coronary artery disease: On [**2-24**], while walking to
the bathroom, the patient had an episode of fatigue and right
jaw pain, which he felt was "his heart." At baseline, he uses
nitroglycerin approximately once every 10 months, although his
typical anginal symptom is chest pain. EKG showed subtle lateral
lead STTW changes and his symptoms were relieved with 4 SLNTG.
He was placed on a heparin drip while his enzymes were cycled
and his Imdur was increased to 60 mg daily. This TnT rose to
0.03, although his MB fraction was negative. The cardiology
service was consulted, who recommended a persantine MIBI to
evaluate for change from his ETT MIBI [**3-/2195**] indicating a need
for repeat catheterization (prior cath [**6-29**] had shown
non-intervenable 3VD). He had a PMIBI [**2-26**], which showed a
moderate, reversible perfusion abnormality of the inferior wall,
not significantly changed compared to the study of [**2195-4-22**].
Therefore, the cardiology service recommended continued medical
management, with nitrate, beta-blocker, statin, aspirin, and ACE
inhibitor. The patient will follow-up with his cardiologist Dr.
[**Last Name (STitle) **] as an outpatient.

3) Anemia: At time of discharge, the patient's hematocrit was
stable at 31, although
decreased from admission (35.8, likely hemoconcentrate). Prior
iron studies, vitamin B12 level, and folate level were not
consistent with deficiency. SPEP and UPEP this admission were
without monoclonal bands. Further work-up for occult bleeding
(colonoscopy) may be considered as an outpatient at the
discretion of the patient's PCP.

4) Chronic renal insufficiency: At time of discharge, the
patient's creatinine was 2.6, his baseline. His urine
protein/creatinine ratio was 4, consistent with nephrotic-range
proteinuria, likely due to a combination of Type II diabtes,
hypertension, and RAS. Outpatient referral to a nephrologist may
be considered.

5) Hypertension: The patient was continued on Toprol LX,
lisinopril, and nifedipien. As mentioned above, his Imdur dose
was increased.

Medications on Admission:
Atorvastatin 40 mg po qday
Isosorbide Mononitrate SR 30 mg qday
Nifedipine 90 mg SR qday
Nitroglycerin 0.3 mg SL prn
Aspirin 81 mg qday
Furosemide 20 mg qday
insulin: Humalin N 20units qAM, 15units qPM
Zoloft 50 mg qday
Toprol XL 200 mg qday
Lisinopril 40 mg qday
Prilosec OTC 20 mg qday

Discharge Medications:
1. Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24HR
Sig: One (1) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*30 Tablet Sustained Release 24HR(s)* Refills:*1*
3. Nifedipine 90 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
4. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: One (1) Tablet,
Sublingual Sublingual PRN (as needed): take as directed.
Disp:*60 Tablet, Sublingual(s)* Refills:*0*
5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO once a day.
6. Furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Insulin NPH Human Recomb 100 unit/mL Suspension Sig: Twenty
(20) units Subcutaneous QAM: and 15 units QPM.
Disp:*qs 1 month supply* Refills:*2*
8. Sertraline 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

9. Metoprolol Succinate 100 mg Tablet Sustained Release 24HR
Sig: Two (2) Tablet Sustained Release 24HR PO DAILY (Daily).
Disp:*60 Tablet Sustained Release 24HR(s)* Refills:*2*
10. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY
(Daily).
Disp:*60 Tablet(s)* Refills:*1*
11. Prilosec OTC 20 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO once a day.
12. Insulin Syringe Ultrafine [**1-26**] mL 29 x [**1-26**]   Syringe Sig: One
(1)  Miscellaneous twice a day: as directed.
Disp:*60 syringe/needle* Refills:*1*
13. One Touch Test     Strip Sig: One (1) test strip
Miscellaneous as directed.
Disp:*90 strips* Refills:*2*

Discharge Disposition:
Home

Discharge Diagnosis:
Primary: hyperglycemia
Secondary: Type II diabetes, coronary artery disease,
hyperlipidemia, anemia, hypertension, chronic renal
insufficiency.


Discharge Condition:
Stable


Discharge Instructions:
1) Please follow-up as below.
2) Please take all medications as prescribed
- your Imdur (isosorbide mononitrate has been increased to 60 mg
daily)
3) Please check your fingersticks 2-3 times a day (before meals,
at bedtime) and record these values to bring to your primary
care physician at your next appointment so he can adjust your
NPH dose as needed. If your fingerstick is persistently >250,
call your primary care physician.
3) Please see your primary care physician or come to the
emergency room if you develop chest pain, shortness of breath,
nausea, vomiting, or other symptoms that concern you.

Followup Instructions:
1) Primary Care
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10134**], MD Phone:[**Telephone/Fax (1) 7976**]
Date/Time:[**2196-3-9**] 2:45 p.m.
2) Cardiology: Please call to schedule an appointment with Dr.
[**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] ([**Telephone/Fax (1) 2386**]) to be seen within 2-4 weeks
following discharge.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 2937**]

Completed by:[**2196-2-27**]
{'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Acute kidney failure, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Lack of housing'}


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: Hyperglycemia

PRESENT ILLNESS: 58 year old male with Type II diabetes and CAD with 3VD,
presents with hyperglycemia. The patient reports that he was
taking his insulin regularly while he was living with his
sister. However, three weeks ago he moved out of his sisters
house and has been staying in the [**Hospital1 **] shelter while he
awaits section 8 housing. Two days ago, he was unable to get his
insulin syringes from his medical case manager since they were
misplaced. He figured he would need to see Dr. [**Last Name (STitle) 11528**] to
get more but didn't need them right away. He states that he
could not measure his finger sticks as his glucometer was
malfunctioning because it had been stored it in the
refridgerator at the [**Hospital1 **]. He figured his blood sugars were
likely high, so he went to the ED for FS check and to get a
prescription for insulin syringes (he had missed ~[**3-27**] NPH
doses). He denied recent, chest pain, tightness or shortness of
breath. He denies dysuria, but has experienced frequency or
urgency. He's been tolerating PO's well with no nausea, vomiting
or diarrhea. He denies any blurred vision, recurrent skin
infections but has felt slightly dizzy. In the ED, his FS was
782. He was started on an insulin drip and admitted to the ICU
for further management.

MEDICAL HISTORY: CAD with 3 vessel dz, s/p ? MI x2 secondary to cocaine, s/p Cath

MEDICATION ON ADMISSION: Atorvastatin 40 mg po qday
Isosorbide Mononitrate SR 30 mg qday
Nifedipine 90 mg SR qday
Nitroglycerin 0.3 mg SL prn
Aspirin 81 mg qday
Furosemide 20 mg qday
insulin: Humalin N 20units qAM, 15units qPM
Zoloft 50 mg qday
Toprol XL 200 mg qday
Lisinopril 40 mg qday
Prilosec OTC 20 mg qday

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical exam on admission:
VS: Temp: 97.8   BP: 210/115  HR: 60  RR: 11  O2 Sat 98% RA
GEN: NAD
HEENT-neck supple, PERRL, multiple scars on face, no elev JVP,
MMM
Lungs-CTA bilat
CV: RRR, nS1 prominent S2, no MRG
ABD:  soft, mild RUQ tenderness from "hunger pains" per pt, no
HSM
EXT:  2+rad and dp pulses bilat, rt 1st toe amputated
SKIN: warm and dry

FAMILY HISTORY: Family Hx: One brother with MI at age 54, multiple siblings with
DMII. Father died of lung CA in his 60's

SOCIAL HISTORY: Lived with sister but now in [**Name (NI) **] as above. Going to get his
GED and eventually hopes to work for the EPA. Prior smoker with
2ppd x 26yrs, quit 1 yr ago. Prior drug use with cocaine and
EtOH but sober for 19 months. 

### Response:
{'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Acute kidney failure, unspecified,Coronary atherosclerosis of unspecified type of vessel, native or graft,Unspecified essential hypertension,Other and unspecified hyperlipidemia,Anemia, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Lack of housing'}
