CHIEF COMPLAINT: Hyperkalemia

PRESENT ILLNESS: Mr. [**Known lastname 61289**] is a 25M with DM, ESRD on HD, recent PE at [**Hospital1 112**] [**3-8**] mo
ago, who was sent in after routine labs showed hyperkalemia.

MEDICAL HISTORY: Diabetes mellitus, type I. Diagnosed in [**2162**]. Poorly controlled
with past DKA. Complicated with retinopathy, nephropathy.
Hypertension, poorly controlled
ESRD on HD  MWF - nephrologist is [**Doctor Last Name 4090**]
Pericarditis and pericardial effusion ?minoxidil related per
renal note
PE  dx at [**Hospital1 112**] ~1mo ago per patient
Chronic constipation
Chronic anemia
Oppositional defiant disorder

MEDICATION ON ADMISSION: patient says he gets refills at [**Company 4916**] pharmacy [**Hospital1 8**] St
in [**Location (un) 577**]. **many medications on hold as has not picked up for

ALLERGIES: Codeine

PHYSICAL EXAM: Vitals 97 80 [**Telephone/Fax (2) 61292**]% on RA
General Young man, scratching at body, no acute distress
HEENT Anicteric, conjunctiva pale, MMM. PEARL, EOMI. +Bruxism
Neck no JVD appreciated
Pulm lungs clear bilaterally, no rales or wheezing
CV regular S1 S2 no m/r/g +S4
Abd soft bowel sounds present nontender no bruit
Extrem warm no edema palpable distal pulses. legs symmetric,
nontender
Neuro eyes closed but following commands, CN 2-12 intact aside
light-only vision, full strength in bilateral upper and lower
extremities, sensation intact to light touch, no pronator drift,
able to sit up when asked to do so.
Skin Multiple tattoos, nodules at sites of itching
R tunneled catheter without tenderness or purulence.

FAMILY HISTORY: Father, grandmother with diabetes mellitus. No relatives
currently on dialysis. Mother with [**Last Name **] problem, details
unknown to him. No history of clot.

SOCIAL HISTORY: Lives with mother. On disability. Smokes since age 16 - he can't
say amount. Denies recent alcohol use. Denies illicit drug use
including meth or cocaine.
Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Hyposmolality and/or hyponatremia,Diabetes with renal manifestations, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Personal history of venous thrombosis and embolism,Personal history of noncompliance with medical treatment, presenting hazards to health,Abnormal coagulation profile,Oppositional defiant disorder,Tobacco use disorder,Lichenification and lichen simplex chronicus,Anxiety state, unspecified,Profound impairment, both eyes, impairment level not further specified,Old retinal detachment, total or subtotal,Background diabetic retinopathy,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Nonspecific abnormal electrocardiogram [ECG] [EKG],Polyneuropathy in diabetes,Anemia in chronic kidney disease,Chest pain, unspecified,Renal dialysis status
Mal hyp kid w cr kid V,End stage renal disease,Hyposmolality,DMI renal uncntrld,Long-term use of insulin,Hx-ven thrombosis/embols,Hx of past noncompliance,Abnrml coagultion prfile,Opposition defiant disor,Tobacco use disorder,Lichenification,Anxiety state NOS,Both eyes blind-who def,Old detachment, total,Diabetic retinopathy NOS,Meth resis Staph carrier,Abnorm electrocardiogram,Neuropathy in diabetes,Anemia in chr kidney dis,Chest pain NOS,Renal dialysis status
Admission Date:  [**2186-5-10**]              Discharge Date:   [**2186-5-18**]

Date of Birth:  [**2160-11-6**]             Sex:   M

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 2186**]
Chief Complaint:
Hyperkalemia

Major Surgical or Invasive Procedure:
Hemodialysis

History of Present Illness:
Mr. [**Known lastname 61289**] is a 25M with DM, ESRD on HD, recent PE at [**Hospital1 112**] [**3-8**] mo
ago, who was sent in after routine labs showed hyperkalemia.

In the ED, initial vitals were: 97.8 87 172/111 18 100.
Complained of CP similar to prior PE. Exam without neuro
deficits per ER. EKG done showed peaked Ts but felt similar to
prior. Admit labs notable for hypoglycemia to 30, K 6.5, flat
CK, tropn at his baseline. Bedside echo showed no pericardial
effusion. Given kayexalate, calcium, insulin/glucose for his
hyperK. Also given zofran, benadryl, dilaudid 1.25mg IV, and
labetalol 100mg bolus and now on labetalol drip. Started on
heparin drip given INR of 1 here. Last HD Monday, was due for HD
today. Vitals prior to transfer 89 [**Telephone/Fax (2) 61291**]%RA. Access PIV
x2, HD cath.

On evaluation in the MICU, he is most concerned about pruritis.
He says he wouldn't have come into the hospital had he not been
told to do so because of his labs. He is not willing to give a
detailed history but on specific questioning endorses midsternal
chest discomfort that began in the cab, currently resolved. He
says he felt dizzy with it, no SOB, no leg pains. He endorses a
mild headache, no back pains. No vision changes - he is blind.
He says he took pills the morning of admission, but can't recall
the names of his medications. His mother helps him with his
meds. He denies depression or substance use.

Review of systems is otherwise negative for fevers, chills,
sweats, recent illness.

Past Medical History:
Diabetes mellitus, type I. Diagnosed in [**2162**]. Poorly controlled
with past DKA. Complicated with retinopathy, nephropathy.
Hypertension, poorly controlled
ESRD on HD  MWF - nephrologist is [**Doctor Last Name 4090**]
Pericarditis and pericardial effusion ?minoxidil related per
renal note
PE  dx at [**Hospital1 112**] ~1mo ago per patient
Chronic constipation
Chronic anemia
Oppositional defiant disorder

Social History:
Lives with mother. On disability. Smokes since age 16 - he can't
say amount. Denies recent alcohol use. Denies illicit drug use
including meth or cocaine.

Family History:
Father, grandmother with diabetes mellitus. No relatives
currently on dialysis. Mother with [**Last Name **] problem, details
unknown to him. No history of clot.

Physical Exam:
Vitals 97 80 [**Telephone/Fax (2) 61292**]% on RA
General Young man, scratching at body, no acute distress
HEENT Anicteric, conjunctiva pale, MMM. PEARL, EOMI. +Bruxism
Neck no JVD appreciated
Pulm lungs clear bilaterally, no rales or wheezing
CV regular S1 S2 no m/r/g +S4
Abd soft bowel sounds present nontender no bruit
Extrem warm no edema palpable distal pulses. legs symmetric,
nontender
Neuro eyes closed but following commands, CN 2-12 intact aside
light-only vision, full strength in bilateral upper and lower
extremities, sensation intact to light touch, no pronator drift,
able to sit up when asked to do so.
Skin Multiple tattoos, nodules at sites of itching
R tunneled catheter without tenderness or purulence.

Pertinent Results:
Admission Labs:
[**2186-5-10**] 02:35PM   WBC-7.7 RBC-2.75* HGB-8.2* HCT-25.8* MCV-94
MCH-30.0 MCHC-31.9 RDW-16.5*
[**2186-5-10**] 02:35PM   NEUTS-66.1 LYMPHS-22.4 MONOS-7.5 EOS-3.4
BASOS-0.5
[**2186-5-10**] 02:35PM   PLT COUNT-541*#
[**2186-5-10**] 02:35PM   CK-MB-3 cTropnT-0.35*
[**2186-5-10**] 02:35PM   CK(CPK)-117
[**2186-5-10**] 02:35PM   GLUCOSE-32* UREA N-47* CREAT-8.7* SODIUM-133
POTASSIUM-6.5* CHLORIDE-93* TOTAL CO2-28 ANION GAP-19
[**2186-5-10**] 11:00PM   CK-MB-3 cTropnT-0.32*

STUDIES:
EKG SR @84, borderline L axis, normal intervals, TWI in I and
vL. No pathologic q's. Nonspecific STD, likely [**3-7**] LV strain.
T's do appear peaked. +LVH by voltage. In comparison to [**2185-10-16**]
EKG, TWI in I is new and axis is more leftward

Repeat EKG 1am: notable for TWI in V5-V6 in setting of HTN
220/110's.

[**5-10**] CT CHEST WITH IV CONTRAST: There is no pulmonary embolus or
aortic
dissection. Cardiomegaly is noted with a small amount of
pericardial fluid. There is no pleural effusion or pneumothorax.
There is no lymphadenopathy. A dialysis catheter terminates in
the cavoatrial junction.  There is no worrisome nodule, mass, or
consolidation. Subsegmental atelectasis is noted at the left
lung base.
A hyperenhancing focus is seen in segment [**Doctor First Name 690**] of the liver
measuring
approximately 4 mm, not completely characterized on single phase
study (3:61). A second hyperenhancing focus is seen in segment
II of similar size (3:74).
BONES: Osseous structures appear unremarkable.
IMPRESSION:
1. No pulmonary embolus or aortic dissection.
2. Cardiomegaly with trace pericardial effusion.
3. Two tiny hyperenhancing foci in the liver, may represent
focal nodular
hyperplasia, though incompletely characterized on this exam.

[**5-10**] CXR
SINGLE PORTABLE UPRIGHT VIEW OF THE CHEST: There is moderate to
marked cardiomegaly, with no evidence of congestive heart
failure. There is no focal consolidation to suggest pneumonia.
There is left lung base atelectasis, slightly less severe than
previously seen. A right IJ dialysis catheter terminates near
the cavoatrial junction.
IMPRESSION: Cardiomegaly and left lung base atelectasis.

[**2186-5-11**] TTE: The left atrium is elongated. There is mild
symmetric left ventricular hypertrophy. The left ventricular
cavity size is normal. Overall left ventricular systolic
function is normal (LVEF 70%). There is no ventricular septal
defect. Right ventricular chamber size and free wall motion are
normal. The aortic valve leaflets (3) are mildly thickened but
aortic stenosis is not present. No aortic regurgitation is seen.
The mitral valve leaflets are mildly thickened. There is mild
mitral valve prolapse. An eccentric, posteriorly directed jet of
Mild to moderate ([**2-4**]+) mitral regurgitation is seen. There is
mild pulmonary artery systolic hypertension. There is no
pericardial effusion.

[**2186-5-12**] CT Head: No acute intracranial process.

[**2186-5-14**]: ECG: Sinus rhythm. Possible left atrial abnormality.
Left ventricular hypertrophy. Lateral ST-T wave changes may be
due to left ventricular hypertrophy or ischemia. Compared to the
previous tracing of [**2186-5-11**] there are more T wave inversions in
leads V5-V6 which may be due to lead placement. However,
clinical correlation is suggested.

Discharge Labs:
WBC 12.6, Hematocrit 32.1, Plts 467, INR 2.6, Na 141, K 4.2, Cl
92, HCO2 27, BUN 28, Crt 6.0, Gluc 186, AST 49, ALT 58, AlkP
696, T Bili 0.4

Pending Labs:
Insulin antibody

Brief Hospital Course:
Mr. [**Known lastname 61289**] is a 25 year old man with ESRD on HD, Type 1 DM,
recent PE who presented with hyperkalemia, chest pain, and
hypertensive urgency.

#. Hypertensive urgency:  It was unclear what medication regimen
he was taking as an outpatient prior to admission.  It was felt
that his hypertension on admission was most likely related to
medication nonadherence, anxiety, and volume overload.  He was
initially managed on a labetalol drip but subsequently weaned
off once his oral/transdermal medications used during his recent
[**Hospital1 112**] hospitalization were initiated.  His blood pressure remained
difficult to control on an oral regimen as well and his oral
labetalol was uptitrated.  His blood pressure goal was
160-180/90-100 during this admission.  He did have episodes of
transient hypertension with SBP>200.  He also had one episode of
hypotension with SBP's in the 80's during hemodialysis.  This
was treated by giving back fluid during dialysis and his blood
pressure normalized.

#. Type 1 Diabetes Mellitus: He had labile blood sugars
throughout this admission with both hypoglycemic and
hyperglycemic episodes.  He was followed closely by the [**Hospital **]
clinic and his lantus dose and humalog sliding scale were
adjusted.

#. Anxiety: He was very agitated on admission and did not always
show insight and judgement about his medical conditions.  He was
initially treated with lorazepam and haloperidol as needed for
anxiety.  In the ICU, he was initially felt to not have capacity
to leave against medical advice given his inconsistent ability
to communicate his wishes and express understanding of the
medical consequences of his decisions to refuse treatment.  He
became more agreeable during the rest of his hospitalization
upon transfer to the floor, although commonly refused blood
pressures and blood sugar monitoring.

#. Hyperkalemia: He had hyperkalemia on admission with peaked T
waves on ECG.  He was given kayexalate with good effect.  He had
one further episode of hyperkalemia during his stay prior to
dialysis and was given calcium gluconate and kayexalate for
peaked T waves on ECG.  On discharge, he was given a handout of
foods high in potassium to avoid.

#. Chest pain: He had chest pain on presentation to the ED but
had no further CP on admission to the MICU.  He had no evidence
of dissection or PE on CTA chest. His cardiac enzymes were
negative. It was felt that his CP symptoms were likely anxiety-
related.

#. History of PE: He had no evidence of recurrent PE on CTA.  He
had a subtherapeutic INR on admission and was started on a
heparin drip as a bridge to Couamdin therapy.  His INR at
discharge was 2.6 and his heparin drip was stopped.  He will
need close monitoring of his INR after discharge.  He will have
his labs drawn at dialysis and faxed to his primary care
provider.

#. ESRD on HD: He was continued on HD MWF schedule. He was also
continued on sevelemer, neutraphos.  He had a few extra sessions
of ultrafiltration while he was an inpatient.

#. Pruritis: He had generalized pruritis and skin lesions
thought to be consistent with prurigo nodularis.  This was felt
to possibly be related to uremia and he was managed with
hydroxyzine.

#. Elevated LFTs: He had persistently elevated LFTs (most
notably Alk phos to the 600 range with mild elevation in
AST/ALT).  Upon review of his records from [**Hospital1 112**], he was
extensively worked up there with RUQ ultrasound, hepatitis
serologies, ceruloplasmin, automimmune workup, hemochromatosis
labs, as well as other viral serologies.  At that time, his
elevated LFTs were thought to possible be due to right heart
failure in the setting of PE.  However, his lab abnormalities
have persisted.  Medication liver injury was considered a
possibility and his statin was stopped due to this possibility
in addition to some complaints of lower extremity muscle pain.

Medications on Admission:
patient says he gets refills at [**Company 4916**] pharmacy [**Hospital1 8**] St
in [**Location (un) 577**]. **many medications on hold as has not picked up for

per [**10/2185**] DC summary he endorses names (with exceptions noted
below) but can't recall doses.
Lisinopril 40mg daily - on hold, not picked up since [**2186-2-22**]
Clonidine 0.3mg patch qwednesday - on hold, last on [**2186-1-23**]
Labetalol 800mg TID - last filled [**2186-2-23**] and picked up
Hydral 10mg TID - last filled [**2186-2-13**]
ASA 81mg daily - pt denies taking
Sevelmer 667mg TID - on hold
Famotidine 20mg QHS - last filled [**12/2185**]
Simvastatin 20mg daily - last filled [**12/2185**]
Metaclopramide 5mg q6h - not seen in system
Insulin glargine 14 units [**Hospital1 **] and humalog sliding scale - picked
up [**2-/2186**]
Nephrocaps daily - on hold
Colace [**Hospital1 **] prn - on hold
Zofran prn
Coumadin 8mg daily - on hold, not picked up
Neurontin 300mg QHS - on hold, not picked up
Celexa 20mg daily - on hold, last picked up [**2186-1-23**]
Minoxidil 5g daily - on hold, last picked up [**1-/2186**]
Iron - last picked up [**12/2185**]
s/p Nifedipine 90mg XL
.
MEDICATIONS ON DISCHARGE [**Hospital1 112**] [**4-18**]
Labetalol 400mg TID
Lisinopril 40mg daily
Losartan 50mg daily
Coumadin 7.5mg QPM
Tylenol 650mg Q6h
Aspirin 81mg daily
Clonidine 0.3mg/day Qweek patch
Benadryl 25-50mg PO Q6hr
Colace 100mg PO BID
Fluocinonide 0.05% cream topical [**Hospital1 **]
Folic acid 1mg PO daily
Gabapentin 400mg QAM, 400mg PM, 600mg QHS
Dilaudid 1-2mg Q4hr
Hydroxyzine 25mg QID
Ibuprofen 600mg PO TID
Lantus 25units QAM
Aspart [**2188-9-14**]
Reglan 10mg TID with meals
Nephrocaps 1 tab PO daily
Nicotine patch
Omeprazole 20mg daily
Sarna lotion daily prn
Senna [**Hospital1 **]
Sevelamer 1600mg PO TID with meals


Discharge Medications:
1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every
6 hours) as needed for pain.
Disp:*100 Tablet(s)* Refills:*0*
2. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
3. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
4. Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly
Transdermal QWED (every Wednesday).
Disp:*5 Patch Weekly(s)* Refills:*2*
5. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
Disp:*60 Capsule(s)* Refills:*2*
6. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO DAILY (Daily).
Disp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*
7. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
Disp:*30 capsules* Refills:*2*
8. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
Disp:*60 Tablet(s)* Refills:*2*
9. Camphor-Menthol 0.5-0.5 % Lotion Sig: One (1) Appl Topical
QID (4 times a day) as needed for itching.
Disp:*1 tube* Refills:*2*
10. Hydroxyzine HCl 25 mg Tablet Sig: One (1) Tablet PO Q6H
(every 6 hours) as needed for itching.
Disp:*90 Tablet(s)* Refills:*2*
11. Sevelamer Carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*180 Tablet(s)* Refills:*2*
12. Lorazepam 1 mg Tablet Sig: 1-2 Tablets PO every six (6)
hours as needed for anxiety.
Disp:*60 Tablet(s)* Refills:*0*
13. Warfarin 2.5 mg Tablet Sig: Two (2) Tablet PO Once Daily at
4 PM.
Disp:*60 Tablet(s)* Refills:*2*
14. Metoclopramide 10 mg Tablet Sig: 0.5 Tablet PO TID (3 times
a day).
Disp:*45 Tablet(s)* Refills:*2*
15. Labetalol 200 mg Tablet Sig: Five (5) Tablet PO twice a day.
Disp:*300 Tablet(s)* Refills:*2*
16. Insulin Glargine 100 unit/mL Solution Sig: Twenty Two (22)
units Subcutaneous at bedtime.
Disp:*qs * Refills:*2*
17. Humalog 100 unit/mL Solution Sig: Insulin sliding scale as
directed  Subcutaneous four times a day.
Disp:*qs * Refills:*2*
18. Outpatient Lab Work
You should have your potassium and INR checked at your dialysis
center on [**2186-5-19**] and [**2186-5-22**].  These results should be faxed to
your primary care doctor Dr. [**Last Name (STitle) 14166**] at [**Telephone/Fax (1) 43090**].
19. Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.
Disp:*30 Tablet(s)* Refills:*2*
20. Prodigy Lancets     Misc Sig: One (1) lancet Miscellaneous
four times a day.
Disp:*120 lancets* Refills:*2*
21. Prodigy     Strip Sig: One (1) strip In [**Last Name (un) 5153**] five times a
day.
Disp:*150 strips* Refills:*2*
22. Alcohol Wipes     Pads, Medicated Sig: One (1) pad Topical
five times a day.
Disp:*1 box* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis:
Hyperkalemia
Hypertensive Urgency

Secondary Diagnosis:
End Stage Renal Disease on Hemodialysis
Type 1 Diabetes Mellitus
History of Pulmonary Embolus


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


Discharge Instructions:
You were admitted to the hospital with high potassium levels and
high blood pressure.  You underwent dialysis while you were here
and your potassium levels returned to [**Location 213**].  Your blood
pressure medications were changed as well.

You had a low Coumadin level (INR) on admission and were placed
on a heparin drip until your INR was in therapeutic range.  It
is important that you take your Coumadin at home and that you
have your INR checked when you are at dialysis.  These results
should be faxed to Dr. [**Last Name (STitle) 14166**] who will help manage your dose of
Coumadin.

Changes to your medications:
Increased labetalol to 1000mg by mouth two times daily
Stopped hydralazine
Started aspirin 325mg by mouth daily
Increased Sevelamer to 1600mg by mouth three times daily with
meals
Stopped famotidine
Added omeprazole 20mg by mouth daily
Added metoclopramide 5mg by mouth three times daily
Added nephrocaps 1 cap by mouth daily
Added docusate 100mg by mouth twice daily
Changed Coumadin to 5mg by mouth daily
Changed insulin dosing: Lantus 22 units at bedtime and humalog
sliding scale as directed
Stopped simvastatin

Followup Instructions:
You have the following appointments scheduled:

Name: [**Last Name (LF) **],[**First Name4 (NamePattern1) 1575**] [**Last Name (NamePattern1) 1105**] MD
Location: [**Hospital3 **] HEALTH CENTER
Address: [**State **], [**Location (un) **],[**Numeric Identifier 60377**]
Phone: [**Telephone/Fax (1) 14167**]
Appointment: [**2186-6-1**] 10:00am

Name: [**Last Name (LF) 978**], [**First Name7 (NamePattern1) 7208**] [**Initial (NamePattern1) **] [**Last Name (NamePattern4) **]
Location: [**Last Name (un) **] DIABETES CENTER
Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 2378**]
Appointment: [**2186-6-8**] 2:00pm

Name: [**Doctor Last Name **] Zrebiec, LICSW
Location: [**Last Name (un) **] DIABETES CENTER
Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 61293**]
Appt: [**2186-6-8**] at 1:00pm
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Hyposmolality and/or hyponatremia,Diabetes with renal manifestations, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Personal history of venous thrombosis and embolism,Personal history of noncompliance with medical treatment, presenting hazards to health,Abnormal coagulation profile,Oppositional defiant disorder,Tobacco use disorder,Lichenification and lichen simplex chronicus,Anxiety state, unspecified,Profound impairment, both eyes, impairment level not further specified,Old retinal detachment, total or subtotal,Background diabetic retinopathy,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Nonspecific abnormal electrocardiogram [ECG] [EKG],Polyneuropathy in diabetes,Anemia in chronic kidney disease,Chest pain, unspecified,Renal dialysis status'}


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: Hyperkalemia

PRESENT ILLNESS: Mr. [**Known lastname 61289**] is a 25M with DM, ESRD on HD, recent PE at [**Hospital1 112**] [**3-8**] mo
ago, who was sent in after routine labs showed hyperkalemia.

MEDICAL HISTORY: Diabetes mellitus, type I. Diagnosed in [**2162**]. Poorly controlled
with past DKA. Complicated with retinopathy, nephropathy.
Hypertension, poorly controlled
ESRD on HD  MWF - nephrologist is [**Doctor Last Name 4090**]
Pericarditis and pericardial effusion ?minoxidil related per
renal note
PE  dx at [**Hospital1 112**] ~1mo ago per patient
Chronic constipation
Chronic anemia
Oppositional defiant disorder

MEDICATION ON ADMISSION: patient says he gets refills at [**Company 4916**] pharmacy [**Hospital1 8**] St
in [**Location (un) 577**]. **many medications on hold as has not picked up for

ALLERGIES: Codeine

PHYSICAL EXAM: Vitals 97 80 [**Telephone/Fax (2) 61292**]% on RA
General Young man, scratching at body, no acute distress
HEENT Anicteric, conjunctiva pale, MMM. PEARL, EOMI. +Bruxism
Neck no JVD appreciated
Pulm lungs clear bilaterally, no rales or wheezing
CV regular S1 S2 no m/r/g +S4
Abd soft bowel sounds present nontender no bruit
Extrem warm no edema palpable distal pulses. legs symmetric,
nontender
Neuro eyes closed but following commands, CN 2-12 intact aside
light-only vision, full strength in bilateral upper and lower
extremities, sensation intact to light touch, no pronator drift,
able to sit up when asked to do so.
Skin Multiple tattoos, nodules at sites of itching
R tunneled catheter without tenderness or purulence.

FAMILY HISTORY: Father, grandmother with diabetes mellitus. No relatives
currently on dialysis. Mother with [**Last Name **] problem, details
unknown to him. No history of clot.

SOCIAL HISTORY: Lives with mother. On disability. Smokes since age 16 - he can't
say amount. Denies recent alcohol use. Denies illicit drug use
including meth or cocaine. 

### Response:
{'Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease,End stage renal disease,Hyposmolality and/or hyponatremia,Diabetes with renal manifestations, type I [juvenile type], uncontrolled,Long-term (current) use of insulin,Personal history of venous thrombosis and embolism,Personal history of noncompliance with medical treatment, presenting hazards to health,Abnormal coagulation profile,Oppositional defiant disorder,Tobacco use disorder,Lichenification and lichen simplex chronicus,Anxiety state, unspecified,Profound impairment, both eyes, impairment level not further specified,Old retinal detachment, total or subtotal,Background diabetic retinopathy,Carrier or suspected carrier of Methicillin resistant Staphylococcus aureus,Nonspecific abnormal electrocardiogram [ECG] [EKG],Polyneuropathy in diabetes,Anemia in chronic kidney disease,Chest pain, unspecified,Renal dialysis status'}
