CHIEF COMPLAINT: DKA

PRESENT ILLNESS: This is a 24 y/o woman with no known medical history who
presented to her PCPs office today with critically high glucose
level. Leading up to this presentation, the patient reports that
for the past 2 weeks she has been experiencing abdominal
bloating, nausea, vomiting, increased thirst, frequency of
urination and generalized body aches. She does report one
episode of diarrhea within this time frame. However she denies
any recent sinus infections, dental procedures, urinary tract
infections, sores or wounds.
In the ED the patient's vitals were as follows: T100, HR130, BP
164/49, RR26, O2sat 98. Her labs were noteworthy for the
following: AG 19, ABG 7.39/28/84/18, and urinary ketones. She
received bolus of insulin 13U and was started on insulin gtt of
6U/hr. Her glucose decreased to 473. Her anion gap increased to
26. The patient was transferred to the ICU for further mgmt.

MEDICAL HISTORY: Obesity
Hypertension--not started on meds.

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T HR110 BP136/90 RR O2 sat
Gen: obese AAF in NAD, speaking in full sentences, very pleasant

FAMILY HISTORY: mother HTN
father HTN, ? hx of diabetes

SOCIAL HISTORY: Patient is in college, she is sexually active with her boyfriend
and they are currently trying to conceive. She was diagnosed
with Chlamydia 2 years ago.  Denies tobacco.
Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Morbid obesity,Unspecified essential hypertension
DMII ketoacd uncontrold,Urin tract infection NOS,Morbid obesity,Hypertension NOS
Admission Date:  [**2133-11-16**]              Discharge Date:   [**2133-11-21**]

Date of Birth:  [**2109-8-19**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1974**]
Chief Complaint:
DKA

Major Surgical or Invasive Procedure:
None.


History of Present Illness:
This is a 24 y/o woman with no known medical history who
presented to her PCPs office today with critically high glucose
level. Leading up to this presentation, the patient reports that
for the past 2 weeks she has been experiencing abdominal
bloating, nausea, vomiting, increased thirst, frequency of
urination and generalized body aches. She does report one
episode of diarrhea within this time frame. However she denies
any recent sinus infections, dental procedures, urinary tract
infections, sores or wounds.
In the ED the patient's vitals were as follows: T100, HR130, BP
164/49, RR26, O2sat 98. Her labs were noteworthy for the
following: AG 19, ABG 7.39/28/84/18, and urinary ketones. She
received bolus of insulin 13U and was started on insulin gtt of
6U/hr. Her glucose decreased to 473. Her anion gap increased to
26. The patient was transferred to the ICU for further mgmt.

Past Medical History:
Obesity
Hypertension--not started on meds.

Social History:
Patient is in college, she is sexually active with her boyfriend
and they are currently trying to conceive. She was diagnosed
with Chlamydia 2 years ago.  Denies tobacco.

Family History:
mother HTN
father HTN, ? hx of diabetes

Physical Exam:
T HR110 BP136/90 RR O2 sat
Gen: obese AAF in NAD, speaking in full sentences, very pleasant

HEENT: PERRLA, mucous membranes and lips extremely dry
HEART: tachy, S1S2, no gmr
LUNGS: CTA b/l
ABD: soft, round protuberant, non-tender, non-distended,
negative guarding, negative rebound tenderness, hypoactive bowel
sounds
EXT:no cce, warm, 2+DP bilaterally

Pertinent Results:
[**2133-11-16**] 04:30PM   WBC-16.8*# RBC-5.79*# HGB-15.2# HCT-45.9#
MCV-79* MCH-26.2* MCHC-33.0 RDW-14.6
[**2133-11-16**] 04:30PM   NEUTS-81.9* LYMPHS-14.1* MONOS-2.3 EOS-0.5
BASOS-1.1
[**2133-11-16**] 04:30PM   PLT COUNT-473*

[**2133-11-16**] 04:30PM   GLUCOSE-876* UREA N-20 CREAT-1.4* SODIUM-125*
POTASSIUM-6.6* CHLORIDE-90* TOTAL CO2-16*

[**2133-11-16**] 04:30PM   CALCIUM-10.9* PHOSPHATE-3.2 MAGNESIUM-3.2*
[**2133-11-16**] 04:30PM   ALT(SGPT)-15 AST(SGOT)-10 ALK PHOS-139*
AMYLASE-34 TOT BILI-0.4
[**2133-11-16**] 04:30PM   LIPASE-30

[**2133-11-16**] 05:45PM   ABG  PO2-84* PCO2-28* PH-7.39 TOTAL CO2-18*

CXR:  No convincing radiographic evidence of acute
cardiopulmonary disease.

Brief Hospital Course:
1) DIABETES:  New onset diabetes.  Pt was initiated on insulin
gtt until ketoacidosis resolved.  She was then transitioned over
to an insulin regimen.  Seen by [**Last Name (un) **] consult.  Started on
lantus and humalog sliding scale.  This was gradually titrated
up to acheive moderate control though at discharge BG still
remained in 100-200 range.  It was not clear if this was type 1
or type 2 diabetes but more likely type 2 with glucotoxicity of
beta cells resulting in high insulin requirements.  Before
discharge, she was also started on pioglitazone.  Pt will f/u
[**Last Name (un) **] to futher adjust her regimen few days after discharge.
She was instructed on use of glucometer and insulin.
.
2) HTN:  Pt started on labetolol instead of ACE-I as she desires
pregnancy.  This will require further titration as outpt.
.
3) UTI:  Pt had mild dysuria about 2 days into admission.  U/A
showed possible UTI so given 3d of bactrim.

Medications on Admission:
None.

Discharge Medications:
1. Labetalol 100 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*0*
2. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1)
Tablet PO BID (2 times a day) for 2 days.
Disp:*4 Tablet(s)* Refills:*0*
3. Pioglitazone 45 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*0*
4. Insulin Glargine 100 unit/mL Solution Sig: Eighty (80) units
Subcutaneous at bedtime.
Disp:*30 ML* Refills:*2*
5. Insulin Lispro (Human) 100 unit/mL Solution Sig: per sliding
scale units Subcutaneous qACHS.
Disp:*30 ML* Refills:*2*
6. Lancets     Misc Sig: One (1) lancet Miscell.  qACHS.
Disp:*120 lancets* Refills:*2*
7. Insulin Syringe 1 mL 29 x [**2-2**]   Syringe Sig: One (1) syringe
Miscell.  qACHS.
Disp:*150 syringes* Refills:*2*
8. One Touch Test     Strip Sig: One (1) strip Miscell.  qACHS.
Disp:*120 strips* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Diabetes mellitus, type 2
Diabetic ketoacidosis
Hypertension
Urinary tract infection.


Discharge Condition:
Good.


Discharge Instructions:
Take your medications as prescribed.

Check your blood sugar via fingerstick 4 times a day: before
each meal and at bedtime.  Administer insulin based on the
sliding scale.  Also administer fixed dose lantus (glargine) at
bedtime.

Please call Dr. [**Last Name (STitle) **], [**Hospital **] clinic, or return to ER if you
have fever, blood sugars above 360 or less than 50, or any other
symptoms that concern you.  Symptoms of low blood sugar include
sweating, fast heart rate, nervousness, dizziness,
lightheadedness, or weakness.

Followup Instructions:
Please call [**Telephone/Fax (1) 250**] to set up an appointment with your
primary doctor, Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] in 1 -2 weeks.

Call the [**Hospital **] Clinic as soon as possible to set up an
appointment with a nurse educator.
{'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Morbid obesity,Unspecified essential hypertension'}


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: DKA

PRESENT ILLNESS: This is a 24 y/o woman with no known medical history who
presented to her PCPs office today with critically high glucose
level. Leading up to this presentation, the patient reports that
for the past 2 weeks she has been experiencing abdominal
bloating, nausea, vomiting, increased thirst, frequency of
urination and generalized body aches. She does report one
episode of diarrhea within this time frame. However she denies
any recent sinus infections, dental procedures, urinary tract
infections, sores or wounds.
In the ED the patient's vitals were as follows: T100, HR130, BP
164/49, RR26, O2sat 98. Her labs were noteworthy for the
following: AG 19, ABG 7.39/28/84/18, and urinary ketones. She
received bolus of insulin 13U and was started on insulin gtt of
6U/hr. Her glucose decreased to 473. Her anion gap increased to
26. The patient was transferred to the ICU for further mgmt.

MEDICAL HISTORY: Obesity
Hypertension--not started on meds.

MEDICATION ON ADMISSION: None.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: T HR110 BP136/90 RR O2 sat
Gen: obese AAF in NAD, speaking in full sentences, very pleasant

FAMILY HISTORY: mother HTN
father HTN, ? hx of diabetes

SOCIAL HISTORY: Patient is in college, she is sexually active with her boyfriend
and they are currently trying to conceive. She was diagnosed
with Chlamydia 2 years ago.  Denies tobacco. 

### Response:
{'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Urinary tract infection, site not specified,Morbid obesity,Unspecified essential hypertension'}
