CHIEF COMPLAINT: Diabetic Ketoacidosis

PRESENT ILLNESS: 39 year old male with DM1, h/o depression and polysubstance
abuse, Hep C who presents with lethargy and polydipsia after not
taking his insulin for 2 days. He reports that his lost his
glucometer and insulin. Over the past 2 days he developed nausea
and lethargy and polydipsia. He felt warm to the touch per his
girlfriend, but [**Name2 (NI) 15598**]'t take his temperature. He also was more
confused the evening prior to admission. He additionally
complined of [**5-21**] chest pressure, non-radiating which lasted [**2-11**]
hours. No associated SOB, cough, or urinary symptoms.
.
In the ED, T 97.6 HR 110 , BP 137/64 R 16 O2 sats 96 % on RA. K
7.0 with AG of 25, and pH 7.22 pCO2 27 pO2 103 and glucose above
the dectable range on fingerstick with a serum glucose of 753
and peaked T waves,  on ECG he receieved calcium gluconate 1 amp
x1, 3 L NS, insulin 10 unit IVx1 and insulin drip at 10 units
per hour, ASA 325 mg po x1. On arrival to the ICU he reported
feeling better. Denies CP or SOB.

MEDICAL HISTORY: Past Psych History:
-Patient's Psychiatrist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 78730**] at [**Hospital1 **], whom the
patient has been seeing for the past 2 years for
psychopharmacology.
-Therapist: No present therapist. Pt had been seeing [**First Name4 (NamePattern1) 1060**]
[**Last Name (NamePattern1) **] for 2 years but stopped seeing her.
-inpatient hospitalizations including [**Hospital1 **], [**Hospital1 18**],
FH. Last hospitalization [**9-15**] at [**Hospital1 18**].  Second to last
hospitalization was at Bayridge last
year- around [**9-13**]. He reports that his presentation has been
similar with each presentation with depression, SI and PSA.
-Although patient denies history of [**Last Name (LF) **], [**First Name3 (LF) **] [**First Name3 (LF) **], he has history
of multiple suicide attempts. During a past admission, he
reported cutting his wrists at 18yo, and h/o multiple o/d
attempts with most recent [**3-15**] requiring ICU stay at FH. He
reports h/o attempted asphyxiation.
-Per [**Name (NI) **], pt reports a prior diagnosis of BPAD- he denies manic
sxs, stating that he predominantly presents with "depression and
anger".
-Per [**Name (NI) **], h/o assaultive behaviors with h/o jail time for
assault and battery. He reports that his last jail sentence was
3 years ago. He denied present legal issues, stating that his
parole ended [**12-14**].

MEDICATION ON ADMISSION: Bupropion SR 150 mg 1 tab po daily
Insulin lantus 30 units SQ QHS
Insulin lispro at sliding scale dose

ALLERGIES: Penicillins

PHYSICAL EXAM: General Appearance: Well nourished

FAMILY HISTORY: Mother, Father, one brother with ETOH dependence

SOCIAL HISTORY: Currently lives with his daughter and is a plumber. Has been
sober from EtOH and substances for the last 3 years until
relapsing a few days ago with EtOH and cocaine. Former heroine
user. Quit smoking 3 yrs ago.
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Dehydration,Unspecified viral hepatitis C without hepatic coma,Coronary atherosclerosis of unspecified type of vessel, native or graft,Depressive disorder, not elsewhere classified,Other, mixed, or unspecified drug abuse, unspecified
DMI ketoacd uncontrold,Acute kidney failure NOS,Dehydration,Hpt C w/o hepat coma NOS,Cor ath unsp vsl ntv/gft,Depressive disorder NEC,Drug abuse NEC-unspec
Admission Date:  [**2189-8-3**]              Discharge Date:   [**2189-8-5**]

Date of Birth:  [**2149-8-30**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 398**]
Chief Complaint:
Diabetic Ketoacidosis

Major Surgical or Invasive Procedure:
None


History of Present Illness:
39 year old male with DM1, h/o depression and polysubstance
abuse, Hep C who presents with lethargy and polydipsia after not
taking his insulin for 2 days. He reports that his lost his
glucometer and insulin. Over the past 2 days he developed nausea
and lethargy and polydipsia. He felt warm to the touch per his
girlfriend, but [**Name2 (NI) 15598**]'t take his temperature. He also was more
confused the evening prior to admission. He additionally
complined of [**5-21**] chest pressure, non-radiating which lasted [**2-11**]
hours. No associated SOB, cough, or urinary symptoms.
.
In the ED, T 97.6 HR 110 , BP 137/64 R 16 O2 sats 96 % on RA. K
7.0 with AG of 25, and pH 7.22 pCO2 27 pO2 103 and glucose above
the dectable range on fingerstick with a serum glucose of 753
and peaked T waves,  on ECG he receieved calcium gluconate 1 amp
x1, 3 L NS, insulin 10 unit IVx1 and insulin drip at 10 units
per hour, ASA 325 mg po x1. On arrival to the ICU he reported
feeling better. Denies CP or SOB.

Past Medical History:
Past Psych History:
-Patient's Psychiatrist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 78730**] at [**Hospital1 **], whom the
patient has been seeing for the past 2 years for
psychopharmacology.
-Therapist: No present therapist. Pt had been seeing [**First Name4 (NamePattern1) 1060**]
[**Last Name (NamePattern1) **] for 2 years but stopped seeing her.
-inpatient hospitalizations including [**Hospital1 **], [**Hospital1 18**],
FH. Last hospitalization [**9-15**] at [**Hospital1 18**].  Second to last
hospitalization was at Bayridge last
year- around [**9-13**]. He reports that his presentation has been
similar with each presentation with depression, SI and PSA.
-Although patient denies history of [**Last Name (LF) **], [**First Name3 (LF) **] [**First Name3 (LF) **], he has history
of multiple suicide attempts. During a past admission, he
reported cutting his wrists at 18yo, and h/o multiple o/d
attempts with most recent [**3-15**] requiring ICU stay at FH. He
reports h/o attempted asphyxiation.
-Per [**Name (NI) **], pt reports a prior diagnosis of BPAD- he denies manic
sxs, stating that he predominantly presents with "depression and
anger".
-Per [**Name (NI) **], h/o assaultive behaviors with h/o jail time for
assault and battery. He reports that his last jail sentence was
3 years ago. He denied present legal issues, stating that his
parole ended [**12-14**].

Past Medical History:
DM type 1 (poorly controlled)
Hepatitis C
Polysubstance abuse


Social History:
Currently lives with his daughter and is a plumber. Has been
sober from EtOH and substances for the last 3 years until
relapsing a few days ago with EtOH and cocaine. Former heroine
user. Quit smoking 3 yrs ago.


Family History:
Mother, Father, one brother with ETOH dependence


Physical Exam:
General Appearance: Well nourished

Eyes / Conjunctiva: PERRL

Head, Ears, Nose, Throat: Normocephalic

Cardiovascular: (S1: Normal), (S2: Normal)

Peripheral Vascular: (Right radial pulse: Not assessed), (Left
radial pulse: Not assessed), (Right DP pulse: Present), (Left DP
pulse: Present)

Respiratory / Chest: (Expansion: Symmetric), (Breath Sounds:
Clear : )

Abdominal: Soft, Non-tender, Bowel sounds present, No(t)
Distended, No(t) Tender:

Extremities: Right: Absent, Left: Absent

Skin:  Not assessed

Neurologic: Responds to: Not assessed, Movement: Not assessed,
Tone: Not assessed

Pertinent Results:
[**2189-8-5**] 04:28AM BLOOD WBC-4.9# RBC-4.11* Hgb-12.0* Hct-35.8*
MCV-87 MCH-29.3 MCHC-33.7 RDW-13.6 Plt Ct-163

[**2189-8-5**] 04:28AM BLOOD Glucose-187* UreaN-12 Creat-1.0 Na-137
K-4.3 Cl-112* HCO3-17* AnGap-12
[**2189-8-5**] 04:28AM BLOOD Calcium-7.3* Phos-1.8* Mg-1.5*
[**2189-8-3**] 08:33PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG


Brief Hospital Course:
DKA - Upon admission to the [**Hospital Unit Name 153**], the patient's diabetic
ketoacidosis was treated with IV fluids and an insulin drip.
During the course of his first 12 hours of admission, his
hyperglycemia decreased from 436 to a goal of between 100-200
with 25 units/hours insulin drip.  The patient had an anion gap
of 21 in the ICU, which closed by the morning of admission.  He
also received 8 liters NS IVF.  After his serum glucose was
stabilized and his anion gap closed, he was converted back to
his home lantus, but at a reduced dose of 20 units SQ QHS, which
was increased to 30 units SQ QHS the morning of discharge.  He
was also placed on a insulin glargine sliding scale, as
recommended by endocrinology.

Hyperkalemia - The patient had an elevated potassium up to 6.8
with ECG changes, specifically peaked T waves.  He was given 1
gram of calcium gluconate and his potassium stabilized and on
the morning of discharge was 4.3.

Chest discomfort - The patient reported chest discomfort
described as pressure for 1 hour the day of admission.  The pain
resolved prior to admission, and during the length of his
hospital stay he reported no similar symptoms or chest pain.
His ECG did not demonstrate any changes and his cardiac enzymes
were negative x2.

CAD - Received 81 mg ASA PO daily.

Polysubstance abuse - Urine tox screen was negative.

Depression - Received home dose of wellbutrin SR.

Hepatitis C - Stable during admission.

Medications on Admission:
Bupropion SR 150 mg 1 tab po daily
Insulin lantus 30 units SQ QHS
Insulin lispro at sliding scale dose

OTC
ASA 81 mg po daily
Multivitamin 1 tab daily

Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Bupropion 150 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO DAILY (Daily).
3. Insulin Glargine 100 unit/mL Solution Sig: Thirty (30) units
Subcutaneous at bedtime.
Disp:*900 units* Refills:*2*
4. Insulin Lispro 100 unit/mL Solution Sig: per sliding scale
units Subcutaneous four times a day.
Disp:*1000 units* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary
1. Diabetic ketoacidosis
Secondary
1. Hepatitis C


Discharge Condition:
good


Discharge Instructions:
You were admitted for diabetic ketoacidosis. This was due to not
taking your insulin.  It is very important that you follow your
diabetic regimen including measuring your blood glucose at least
4 times a day and taking appropriate insulin.

Please return to the ED if you develop symptoms including
nausea, vomiting, or abnormally high blood glucose levels.

Please take all of your medications as directed.

Please keep all of your follow up appointments.

Followup Instructions:
You have an appointment today, [**2189-8-5**], at 2pm at the [**Hospital **]
Clinic with [**First Name9 (NamePattern2) 32887**] [**Doctor Last Name 1726**]. At that time, you will get a new
glucometer.

Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 8507**], MD Phone:[**Telephone/Fax (1) 2422**]
Date/Time:[**2189-11-13**] 11:20

Provider: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5004**] [**Last Name (NamePattern1) **], M.D. Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2189-11-2**] 4:20



Completed by:[**2189-8-5**]
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Dehydration,Unspecified viral hepatitis C without hepatic coma,Coronary atherosclerosis of unspecified type of vessel, native or graft,Depressive disorder, not elsewhere classified,Other, mixed, or unspecified drug abuse, 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: Diabetic Ketoacidosis

PRESENT ILLNESS: 39 year old male with DM1, h/o depression and polysubstance
abuse, Hep C who presents with lethargy and polydipsia after not
taking his insulin for 2 days. He reports that his lost his
glucometer and insulin. Over the past 2 days he developed nausea
and lethargy and polydipsia. He felt warm to the touch per his
girlfriend, but [**Name2 (NI) 15598**]'t take his temperature. He also was more
confused the evening prior to admission. He additionally
complined of [**5-21**] chest pressure, non-radiating which lasted [**2-11**]
hours. No associated SOB, cough, or urinary symptoms.
.
In the ED, T 97.6 HR 110 , BP 137/64 R 16 O2 sats 96 % on RA. K
7.0 with AG of 25, and pH 7.22 pCO2 27 pO2 103 and glucose above
the dectable range on fingerstick with a serum glucose of 753
and peaked T waves,  on ECG he receieved calcium gluconate 1 amp
x1, 3 L NS, insulin 10 unit IVx1 and insulin drip at 10 units
per hour, ASA 325 mg po x1. On arrival to the ICU he reported
feeling better. Denies CP or SOB.

MEDICAL HISTORY: Past Psych History:
-Patient's Psychiatrist: Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 78730**] at [**Hospital1 **], whom the
patient has been seeing for the past 2 years for
psychopharmacology.
-Therapist: No present therapist. Pt had been seeing [**First Name4 (NamePattern1) 1060**]
[**Last Name (NamePattern1) **] for 2 years but stopped seeing her.
-inpatient hospitalizations including [**Hospital1 **], [**Hospital1 18**],
FH. Last hospitalization [**9-15**] at [**Hospital1 18**].  Second to last
hospitalization was at Bayridge last
year- around [**9-13**]. He reports that his presentation has been
similar with each presentation with depression, SI and PSA.
-Although patient denies history of [**Last Name (LF) **], [**First Name3 (LF) **] [**First Name3 (LF) **], he has history
of multiple suicide attempts. During a past admission, he
reported cutting his wrists at 18yo, and h/o multiple o/d
attempts with most recent [**3-15**] requiring ICU stay at FH. He
reports h/o attempted asphyxiation.
-Per [**Name (NI) **], pt reports a prior diagnosis of BPAD- he denies manic
sxs, stating that he predominantly presents with "depression and
anger".
-Per [**Name (NI) **], h/o assaultive behaviors with h/o jail time for
assault and battery. He reports that his last jail sentence was
3 years ago. He denied present legal issues, stating that his
parole ended [**12-14**].

MEDICATION ON ADMISSION: Bupropion SR 150 mg 1 tab po daily
Insulin lantus 30 units SQ QHS
Insulin lispro at sliding scale dose

ALLERGIES: Penicillins

PHYSICAL EXAM: General Appearance: Well nourished

FAMILY HISTORY: Mother, Father, one brother with ETOH dependence

SOCIAL HISTORY: Currently lives with his daughter and is a plumber. Has been
sober from EtOH and substances for the last 3 years until
relapsing a few days ago with EtOH and cocaine. Former heroine
user. Quit smoking 3 yrs ago. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Dehydration,Unspecified viral hepatitis C without hepatic coma,Coronary atherosclerosis of unspecified type of vessel, native or graft,Depressive disorder, not elsewhere classified,Other, mixed, or unspecified drug abuse, unspecified'}
