CHIEF COMPLAINT: nausea/vomiting

PRESENT ILLNESS: 36yo F with IDDM and gastroparesis s/p gastric pacemaker in
[**6-22**], p/w N/V X 1 day, unable to tolerate POs. She was in her
USOH (on tube feeds with daily vomiting and self-administered
IVF boluses - per PCP note in [**2164-8-19**]). One day pta she had
increased po intake "binged". Since that time, she has been
unable to tolerate po's. In the ED, found to be hypertensive
203/107 with blood glucose of 427 by fingerstick, 363 on chem &.
At that timeshe was treated with 10 u insulin IV, blood glucose
decreased to 251, however it remained labile throughout her ED
stay (427 [rec'd 10 u reg]-->251-->327 [rec'd 10 u
reg]-->339-->280). In the ED she developed an anion gap and DKA
treatment was started with insulin gtt at 2 u/hr. Nausea was
also difficult to control s/p 12.5 anzemetX2, serial doses of
ativan. She also required MSO4 for abdominal pain. Her blood
pressure was controlled with 5 mg lopressor X3 iv, then 10 mg
hydral IV x2 (for bp's 170's at that time). She also recieved
approx 5 L NS total in the ED. She currently has ongoing nausea
but denied any fevers, hills, diarrhea, dysuria, but does think
her port-a-cath may be infected, and was recently seen for this
(BCx drawn by VN per report but not in computer). Admitted for
further monitoring.

MEDICAL HISTORY: Diabetes, diagnosed in [**2145**], type 1, Dx at age 17, followed at
[**Last Name (un) **]
 Severe gastroparesis treated previously with a GJ tube, which
 was then removed due to patient intolerance.  The patient has
 been through multiple medical therapies and has failed all of
 these. Now s/p gastric pacer and J tube placement in [**6-22**].
Mild retinopathy
Bilateral cataracts
Hypertension
Anxiety/Depression
Panic attacks
Anemia
Hypercholesterolemia
Dilaudid addiction

MEDICATION ON ADMISSION: Meds @ Home:
Ambien 10 mg qhs
ASPIRIN 81MG qd
ATENOLOL 75MG qd
CLONAZEPAM 0.75MG TID:PRN
CLONAZEPAM 1.5MG TID
CLONIDINE 0.1MG [**Hospital1 **]
DEXTROAMPHETAMINE 7.5MG qd
LANTUS 20??? units qhs
Humalog sliding scale
LISINOPRIL 40MG qd
MORPHINE 15MG qd:prn
MOTRIN Elixir 600 mg TID:PRN via Jtube
PRILOSEC 20MG [**Hospital1 **]
ZELNORM 6MG [**Hospital1 **]
ZOFRAN 8MG TID
XANAX PRN
VALIUM PRN

ALLERGIES: Phenergan / Reglan

PHYSICAL EXAM: VS: T 99.1, BP 114/43, HR 67, RR 29, Sat 99%
Gen: sleepy but arousable, actively wretching after arousal
Skin: w/d/i, hyperpigmented macules scattered over back
HEENT: PERRL, eomi, mmm, o/p clear, portacath in place
Heart: RRR, no m/r/g, nl S1 and S2
Lungs: good air movement, CTA B
Abd: scar from prev J tube, s, diffusely tender, nd, active bs
Extrem: no c/c/e
Neuro/Psych: AAO x 3, appears anxious, further testing deferred
2.2 active emesis

FAMILY HISTORY: Brother with diabetes, sister with Crohn disease, father with
type 2 diabetes, uncle on mother's side who died from myocardial
infarction at age 50, maternal grandmother who died from
myocardial infarction at age 50.

SOCIAL HISTORY: The patient is a nonsmoker and nondrinker. She has never used IV
drugs.  She lives with her parents but was previously living in
[**State 108**] and moved up here in order to obtain care for
gastroparesis.
Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Gastroparesis,Background diabetic retinopathy,Anemia of other chronic disease,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Dysthymic disorder,Hypopotassemia,Candidiasis of vulva and vagina,Eating disorder, unspecified
DMI keto nt st uncntrld,Gastroparesis,Diabetic retinopathy NOS,Anemia-other chronic dis,Hyperlipidemia NEC/NOS,Hypertension NOS,Dysthymic disorder,Hypopotassemia,Candidal vulvovaginitis,Eating disorder NOS
Admission Date:  [**2164-12-29**]              Discharge Date:   [**2165-1-2**]

Date of Birth:  [**2128-7-21**]             Sex:   F

Service: MEDICINE

Allergies:
Phenergan / Reglan

Attending:[**First Name3 (LF) 783**]
Chief Complaint:
nausea/vomiting

Major Surgical or Invasive Procedure:
none


History of Present Illness:
36yo F with IDDM and gastroparesis s/p gastric pacemaker in
[**6-22**], p/w N/V X 1 day, unable to tolerate POs. She was in her
USOH (on tube feeds with daily vomiting and self-administered
IVF boluses - per PCP note in [**2164-8-19**]). One day pta she had
increased po intake "binged". Since that time, she has been
unable to tolerate po's. In the ED, found to be hypertensive
203/107 with blood glucose of 427 by fingerstick, 363 on chem &.
At that timeshe was treated with 10 u insulin IV, blood glucose
decreased to 251, however it remained labile throughout her ED
stay (427 [rec'd 10 u reg]-->251-->327 [rec'd 10 u
reg]-->339-->280). In the ED she developed an anion gap and DKA
treatment was started with insulin gtt at 2 u/hr. Nausea was
also difficult to control s/p 12.5 anzemetX2, serial doses of
ativan. She also required MSO4 for abdominal pain. Her blood
pressure was controlled with 5 mg lopressor X3 iv, then 10 mg
hydral IV x2 (for bp's 170's at that time). She also recieved
approx 5 L NS total in the ED. She currently has ongoing nausea
but denied any fevers, hills, diarrhea, dysuria, but does think
her port-a-cath may be infected, and was recently seen for this
(BCx drawn by VN per report but not in computer). Admitted for
further monitoring.

Past Medical History:
Diabetes, diagnosed in [**2145**], type 1, Dx at age 17, followed at
[**Last Name (un) **]
 Severe gastroparesis treated previously with a GJ tube, which
 was then removed due to patient intolerance.  The patient has
 been through multiple medical therapies and has failed all of
 these. Now s/p gastric pacer and J tube placement in [**6-22**].
Mild retinopathy
Bilateral cataracts
Hypertension
Anxiety/Depression
Panic attacks
Anemia
Hypercholesterolemia
Dilaudid addiction


Social History:
The patient is a nonsmoker and nondrinker. She has never used IV
drugs.  She lives with her parents but was previously living in
[**State 108**] and moved up here in order to obtain care for
gastroparesis.

Family History:
Brother with diabetes, sister with Crohn disease, father with
type 2 diabetes, uncle on mother's side who died from myocardial
infarction at age 50, maternal grandmother who died from
myocardial infarction at age 50.

Physical Exam:
VS: T 99.1, BP 114/43, HR 67, RR 29, Sat 99%
Gen: sleepy but arousable, actively wretching after arousal
Skin: w/d/i, hyperpigmented macules scattered over back
HEENT: PERRL, eomi, mmm, o/p clear, portacath in place
Heart: RRR, no m/r/g, nl S1 and S2
Lungs: good air movement, CTA B
Abd: scar from prev J tube, s, diffusely tender, nd, active bs
Extrem: no c/c/e
Neuro/Psych: AAO x 3, appears anxious, further testing deferred
2.2 active emesis

Pertinent Results:
[**2164-12-29**] 8:25p
144  111  20      AGap=15
---|----|---< 147
3.1  21  0.7

[**2164-12-29**] 12:42p
UCG: Negative
Comments: For Quantitation Of Positives, Send Serum For Hcg

Color Straw, Appear Clear, SpecGr 1.014, pH 7.0, Urobil Neg,
Bili Neg
Leuk Neg,  Bld Tr,  Nitr Neg,  Prot Neg,  Glu 1000,  Ket 15,
RBC 0,  WBC 0,
Bact None,  Yeast None,  Epi 0

[**2164-12-29**] 11:30a
137  101  22      AGap=17
----|----|---<363
3.8   23  0.8

ALT: 15 AP: 71 Tbili: 0.6 Alb:
AST: 18 [**Doctor First Name **]: 74

     12.2
10.1>----<382     MCV: 91
     36.1

 N:91.7 L:6.1 M:1.6 E:0.6 Bas:0

[**2164-12-29**]  06:50p
141   105  21      AGap=23
----|----|---< 339
3.8   17   0.7



Brief Hospital Course:
36yo F with IDDM and gastroparesis s/p gastric pacemaker in
[**6-22**], p/w N/V, unable to tolerate POs who presents with DKA.
During hospitalization the following problems were addressed:
1.  DKA:  thought to be due to increased po intake and
subsequent nausea and vomiting complicated by anxiety state.
She had noted tenderness at her port-a-cath site, but blood
cultures drawn through that port were negative.  Other causes of
infection were ruled out by UA, Blood culture, CXR.  She was
started on an insulin gtt with aggressive fluid hydration.  Her
anion gap was closed by hte second day of admission and urine
ketones decreased.  Once tolerating  a po diet, the insulin gtt
was discontinued and she was started on a standing insulin
regimen of Lantus and Humalog, with a humalog sliding scale.
[**Last Name (un) **] was consulted.  HgbA1c [**10-22**] was 7.5%.
2. Nausea/Vomiting:  was likely related to patient's known
gastroparesis.  She had a gastric pacemaker placed in [**6-22**], and
her J-tube was subsequently removed.  Nausea is nonresponsive to
typical regimens.  She was treated initially with standing
Anzemet, ativan and morphine.  By the time of discharge nausea
was controlled on standing Anzamet (she had been on standing
Zofran at home) and prn ativan.
3.  HTN:  she was hypertensive on admission, treated with iv
hydralizine and lopressor in the ED.  She was normotensive on
day two.  After blood pressures began to rise her home regimen
of lisinopril, atenolol and clonidine was resumed.  BP remained
stable throughout the remainder of her hospitalization.
4.  Nutrition:  The patient was started on a diabetic diet by
the second day of admission.  Her hypokalemia and
hyperphosphatemia secondary to DKA treatment were supplemented.
She has a history of eating disorders secondary to her
gastroparesis and complicated by anxiety and eating disorders.
She is scheduled to follow-up with a psychiatrist in [**2-23**], but
would likely benefit from earlier evaluation by an eating
disorder clinic.
Dispo:  communication is with the patient.  She is a full code.
She will follow up with Dr. [**Last Name (STitle) 10689**] in GI, [**Hospital **] clinic, and her
primary care physician.  [**Name10 (NameIs) **] if by the R subclavian port.


Medications on Admission:
Meds @ Home:
Ambien 10 mg qhs
ASPIRIN 81MG qd
ATENOLOL 75MG qd
CLONAZEPAM 0.75MG TID:PRN
CLONAZEPAM 1.5MG TID
CLONIDINE 0.1MG [**Hospital1 **]
DEXTROAMPHETAMINE 7.5MG qd
LANTUS 20??? units qhs
Humalog sliding scale
LISINOPRIL 40MG qd
MORPHINE 15MG qd:prn
MOTRIN Elixir 600 mg TID:PRN via Jtube
PRILOSEC 20MG [**Hospital1 **]
ZELNORM 6MG [**Hospital1 **]
ZOFRAN 8MG TID
XANAX PRN
VALIUM PRN

Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
3. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO TID (3 times a
day).
4. Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
5. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

6. Clonidine HCl 0.1 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
7. Tegaserod Hydrogen Maleate 6 mg Tablet Sig: One (1) Tablet PO
bid ().
8. Lorazepam 1 mg Tablet Sig: 0.5-2 Tablets PO Q4-6H (every 4 to
6 hours) as needed.
9. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2
times a day).
10. Insulin Glargine 100 unit/mL Solution Sig: Thirteen (13)
units Subcutaneous at bedtime.
Disp:*500 units* Refills:*2*
11. Insulin Lispro (Human) 100 unit/mL Solution Sig: as
prescribed  Subcutaneous as prescribed: if FS = 101-150, then 3
units
if FS = 151-200, then 4 units
if FS = 201-250, then 5 units
if FS = 251-300
then 6 units
if FS = 301-350 then 7 units.
Disp:*250 units* Refills:*2*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 5065**] Healthcare

Discharge Diagnosis:
PRIMARY:
diabetic ketoacidosis
SECONDARY:
gastroparesis
diabetes mellitus
hypertension
Hyperlipidemia
anemia
anxiety
binge eating

Discharge Condition:
stable, tolerating PO, no DKA

Discharge Instructions:
1) Please seek immediate medical attention if experiencing
changes in bowel habits, nausea, vomiting, abdominal pain,
fever, chills.
2) Take all medications as prescribed
3) Follow-up on all appointments

Followup Instructions:
Provider: [**Name10 (NameIs) **] PSYCH PAIN PSYCHOLOGY Where: PAIN PSYCHOLOGY
Date/Time:[**2165-1-23**] 11:00

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD Where: [**Hospital6 29**] [**Hospital **] Phone:[**Telephone/Fax (1) 250**] Date/Time:[**2165-1-25**] 1:30

Provider: [**Name10 (NameIs) 191**] psychiatry [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **], MD Where: [**Hospital 4054**] [**Hospital3 249**] Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2165-1-30**] 11:30


                             [**First Name11 (Name Pattern1) 734**] [**Last Name (NamePattern1) 735**] MD, [**MD Number(3) 799**]
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Gastroparesis,Background diabetic retinopathy,Anemia of other chronic disease,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Dysthymic disorder,Hypopotassemia,Candidiasis of vulva and vagina,Eating disorder, 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: nausea/vomiting

PRESENT ILLNESS: 36yo F with IDDM and gastroparesis s/p gastric pacemaker in
[**6-22**], p/w N/V X 1 day, unable to tolerate POs. She was in her
USOH (on tube feeds with daily vomiting and self-administered
IVF boluses - per PCP note in [**2164-8-19**]). One day pta she had
increased po intake "binged". Since that time, she has been
unable to tolerate po's. In the ED, found to be hypertensive
203/107 with blood glucose of 427 by fingerstick, 363 on chem &.
At that timeshe was treated with 10 u insulin IV, blood glucose
decreased to 251, however it remained labile throughout her ED
stay (427 [rec'd 10 u reg]-->251-->327 [rec'd 10 u
reg]-->339-->280). In the ED she developed an anion gap and DKA
treatment was started with insulin gtt at 2 u/hr. Nausea was
also difficult to control s/p 12.5 anzemetX2, serial doses of
ativan. She also required MSO4 for abdominal pain. Her blood
pressure was controlled with 5 mg lopressor X3 iv, then 10 mg
hydral IV x2 (for bp's 170's at that time). She also recieved
approx 5 L NS total in the ED. She currently has ongoing nausea
but denied any fevers, hills, diarrhea, dysuria, but does think
her port-a-cath may be infected, and was recently seen for this
(BCx drawn by VN per report but not in computer). Admitted for
further monitoring.

MEDICAL HISTORY: Diabetes, diagnosed in [**2145**], type 1, Dx at age 17, followed at
[**Last Name (un) **]
 Severe gastroparesis treated previously with a GJ tube, which
 was then removed due to patient intolerance.  The patient has
 been through multiple medical therapies and has failed all of
 these. Now s/p gastric pacer and J tube placement in [**6-22**].
Mild retinopathy
Bilateral cataracts
Hypertension
Anxiety/Depression
Panic attacks
Anemia
Hypercholesterolemia
Dilaudid addiction

MEDICATION ON ADMISSION: Meds @ Home:
Ambien 10 mg qhs
ASPIRIN 81MG qd
ATENOLOL 75MG qd
CLONAZEPAM 0.75MG TID:PRN
CLONAZEPAM 1.5MG TID
CLONIDINE 0.1MG [**Hospital1 **]
DEXTROAMPHETAMINE 7.5MG qd
LANTUS 20??? units qhs
Humalog sliding scale
LISINOPRIL 40MG qd
MORPHINE 15MG qd:prn
MOTRIN Elixir 600 mg TID:PRN via Jtube
PRILOSEC 20MG [**Hospital1 **]
ZELNORM 6MG [**Hospital1 **]
ZOFRAN 8MG TID
XANAX PRN
VALIUM PRN

ALLERGIES: Phenergan / Reglan

PHYSICAL EXAM: VS: T 99.1, BP 114/43, HR 67, RR 29, Sat 99%
Gen: sleepy but arousable, actively wretching after arousal
Skin: w/d/i, hyperpigmented macules scattered over back
HEENT: PERRL, eomi, mmm, o/p clear, portacath in place
Heart: RRR, no m/r/g, nl S1 and S2
Lungs: good air movement, CTA B
Abd: scar from prev J tube, s, diffusely tender, nd, active bs
Extrem: no c/c/e
Neuro/Psych: AAO x 3, appears anxious, further testing deferred
2.2 active emesis

FAMILY HISTORY: Brother with diabetes, sister with Crohn disease, father with
type 2 diabetes, uncle on mother's side who died from myocardial
infarction at age 50, maternal grandmother who died from
myocardial infarction at age 50.

SOCIAL HISTORY: The patient is a nonsmoker and nondrinker. She has never used IV
drugs.  She lives with her parents but was previously living in
[**State 108**] and moved up here in order to obtain care for
gastroparesis. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Gastroparesis,Background diabetic retinopathy,Anemia of other chronic disease,Other and unspecified hyperlipidemia,Unspecified essential hypertension,Dysthymic disorder,Hypopotassemia,Candidiasis of vulva and vagina,Eating disorder, unspecified'}
