CHIEF COMPLAINT: Nausea, vomiting

PRESENT ILLNESS: 55 yo M with history of DM, HTN, high cholesterol presented to
the ED with sevedral days of nausea and vomiting. The patient
reports being in his USOH until Monday, 5 days prior to admssion
when he developed malaise, rigors, and myalgias. He did not
check his temperature. He then developed nausea, vomiting,
non-bilious, non-bloody. He reports not being able to tolerate
any po's since Monday. He reports 5-6 episodes of emesis daily.
He said he stopped taking all of his usual medications,
including insulin on Monday because he was not sure what was
going on. He had been taking Advil with relief in symptoms. He
denies diarrhea, abdominal pain, cough, chest pain before coming
to the ED (developed non-productive cough in the ED). No sick
contacts.
.
ED course: VS on admission T 100.7; HR 119; BP 184/77; RR 30; O2
98% RA. Labs were significant for WBC of 17, Cr 2.5, K 3.2,
serum glucose 474, presence of urine glucose 1000; urine ketones
15. AG =19 initially. Lactate 1.6. Trop 0.12; CK [**2049**]; MB 9 on
presentation (with Cr 2.5. Trop went up to 0.38. EKG sinus rate
104; new ST depression in aVL on this am's EKG.
.
Patient resuscitated with 2L NS. In the ED the paitent was also
given:
Acetaminophen 1000 mg x 2, Insulin Human Regular 6 units IV and
8 units SC; Ondansetron 4 mg IV x 2; Levofloxacin 750mg; Aspirin
325mg.
.
By the time the patient arrived to the floor, he felt improved.
Continues to have nausea. Denies CP or any other symptpoms. He
has nver had DKA before.

MEDICAL HISTORY: 1. HTN
2. DM type 2
3. Hypercholesterolemia
4. Hepatitis C
5. PUD
6. R cranial nerve palsy
7. Erectile dysfunction
8. Prostatitis
9. BPH
10. L renal cell carcinoma
11. LLL radiculopathy
12. Microalbuminuria

MEDICATION ON ADMISSION: Aspirin 81mg daily
Neurontin 300mg [**Hospital1 **]
Vytorin 10-40mg daily
Glipizide 10mg [**Hospital1 **]
Metoprolol 50mg [**Hospital1 **]
Prilosec daily
Glucophage 1000mg [**Hospital1 **]
Levirmir Pen 10mL at bedtime
Norvasc 5mg daily
Doxazosin 2mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 100.9   95   156/94    27   97% RA
General: resting in bed; pleasant; alert and oriented x 3; NAD;
breathing comfortably
HEENT: OP clear; no scleral icterus; MM sl dry
Neck: no JVD, no bruits
Heart: regular, nl S1S2, no m/rubs/gallops
Lungs: soft crackles at left base
Abd: + BS, soft, NT, ND
Ext: no edema, palp pulses throughout

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Lives with wife. [**Name (NI) **] children. Quit smoking 20 y ago. No alcohol
Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Alkalosis,Chronic hepatitis C without mention of hepatic coma,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of kidney,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease
Subendo infarct, initial,Acute kidney failure NOS,Pneumonia, organism NOS,DMII ketoacd uncontrold,Alkalosis,Chrnc hpt C wo hpat coma,Chronic kidney dis NOS,Hx of kidney malignancy,BPH w/o urinary obs/LUTS,Pure hypercholesterolem,Hy kid NOS w cr kid I-IV,Anemia in chr kidney dis
Admission Date:  [**2110-5-9**]              Discharge Date:   [**2110-5-13**]

Date of Birth:  [**2054-5-22**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 10370**]
Chief Complaint:
Nausea, vomiting

Major Surgical or Invasive Procedure:
None

History of Present Illness:
55 yo M with history of DM, HTN, high cholesterol presented to
the ED with sevedral days of nausea and vomiting. The patient
reports being in his USOH until Monday, 5 days prior to admssion
when he developed malaise, rigors, and myalgias. He did not
check his temperature. He then developed nausea, vomiting,
non-bilious, non-bloody. He reports not being able to tolerate
any po's since Monday. He reports 5-6 episodes of emesis daily.
He said he stopped taking all of his usual medications,
including insulin on Monday because he was not sure what was
going on. He had been taking Advil with relief in symptoms. He
denies diarrhea, abdominal pain, cough, chest pain before coming
to the ED (developed non-productive cough in the ED). No sick
contacts.
.
ED course: VS on admission T 100.7; HR 119; BP 184/77; RR 30; O2
98% RA. Labs were significant for WBC of 17, Cr 2.5, K 3.2,
serum glucose 474, presence of urine glucose 1000; urine ketones
15. AG =19 initially. Lactate 1.6. Trop 0.12; CK [**2049**]; MB 9 on
presentation (with Cr 2.5. Trop went up to 0.38. EKG sinus rate
104; new ST depression in aVL on this am's EKG.
.
Patient resuscitated with 2L NS. In the ED the paitent was also
given:
Acetaminophen 1000 mg x 2, Insulin Human Regular 6 units IV and
8 units SC; Ondansetron 4 mg IV x 2; Levofloxacin 750mg; Aspirin
325mg.
.
By the time the patient arrived to the floor, he felt improved.
Continues to have nausea. Denies CP or any other symptpoms. He
has nver had DKA before.

Past Medical History:
1. HTN
2. DM type 2
3. Hypercholesterolemia
4. Hepatitis C
5. PUD
6. R cranial nerve palsy
7. Erectile dysfunction
8. Prostatitis
9. BPH
10. L renal cell carcinoma
11. LLL radiculopathy
12. Microalbuminuria

Social History:
Lives with wife. [**Name (NI) **] children. Quit smoking 20 y ago. No alcohol

Family History:
Noncontributory

Physical Exam:
VS: 100.9   95   156/94    27   97% RA
General: resting in bed; pleasant; alert and oriented x 3; NAD;
breathing comfortably
HEENT: OP clear; no scleral icterus; MM sl dry
Neck: no JVD, no bruits
Heart: regular, nl S1S2, no m/rubs/gallops
Lungs: soft crackles at left base
Abd: + BS, soft, NT, ND
Ext: no edema, palp pulses throughout

Pertinent Results:
[**2110-5-8**] 11:00PM URINE  GRANULAR-0-2
[**2110-5-8**] 11:00PM URINE  RBC-[**1-27**]* WBC-[**5-4**]* BACTERIA-OCC
YEAST-NONE EPI-0-2
[**2110-5-8**] 11:00PM URINE  BLOOD-LG NITRITE-NEG PROTEIN-500
GLUCOSE-1000 KETONE-15 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2110-5-8**] 11:00PM URINE  COLOR-Yellow APPEAR-Clear SP [**Last Name (un) 155**]-1.021
[**2110-5-8**] 11:30PM   PT-11.1 PTT-27.2 INR(PT)-0.9
[**2110-5-8**] 11:30PM   PLT SMR-NORMAL PLT COUNT-337
[**2110-5-8**] 11:30PM   HYPOCHROM-NORMAL ANISOCYT-NORMAL
POIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL
POLYCHROM-NORMAL
[**2110-5-8**] 11:30PM   NEUTS-94.9* BANDS-0 LYMPHS-3.2* MONOS-1.9*
EOS-0.1 BASOS-0
[**2110-5-8**] 11:30PM   WBC-17.3*# RBC-3.50* HGB-10.7* HCT-29.6*
MCV-85 MCH-30.5 MCHC-36.0* RDW-14.4
[**2110-5-8**] 11:30PM   CK-MB-9 cTropnT-0.12*
[**2110-5-8**] 11:30PM   CK(CPK)-[**2049**]*
[**2110-5-8**] 11:30PM   estGFR-Using this
[**2110-5-8**] 11:30PM   GLUCOSE-474* UREA N-41* CREAT-2.8* SODIUM-134
POTASSIUM-3.6 CHLORIDE-93* TOTAL CO2-22 ANION GAP-23
[**2110-5-8**] 11:48PM   GLUCOSE-446* LACTATE-2.0 K+-3.6
[**2110-5-9**] 01:44AM   LACTATE-1.6 K+-3.2*
[**2110-5-9**] 01:44AM   COMMENTS-GREEN TOP
[**2110-5-9**] 04:00AM   CK-MB-11* MB INDX-0.6 cTropnT-0.33*
[**2110-5-9**] 04:00AM   LIPASE-41
[**2110-5-9**] 04:00AM   ALT(SGPT)-37 AST(SGOT)-73* CK(CPK)-1705* ALK
PHOS-64 TOT BILI-0.4
[**2110-5-9**] 04:00AM   GLUCOSE-298* UREA N-39* CREAT-2.5* SODIUM-133
POTASSIUM-3.2* CHLORIDE-98 TOTAL CO2-24 ANION GAP-14
[**2110-5-9**] 05:45AM   CK-MB-10 MB INDX-0.5 cTropnT-0.38*
[**2110-5-9**] 05:45AM   CK(CPK)-1828*
[**2110-5-9**] 10:29AM   PLT COUNT-291
[**2110-5-9**] 10:29AM   WBC-14.1* RBC-3.01* HGB-9.0* HCT-26.1* MCV-87
MCH-29.8 MCHC-34.3 RDW-14.4
[**2110-5-9**] 10:29AM   CALCIUM-8.0* PHOSPHATE-2.6*
[**2110-5-9**] 10:29AM   CK-MB-12* MB INDX-0.7 cTropnT-0.58*
[**2110-5-9**] 10:29AM   ALT(SGPT)-39 AST(SGOT)-87* CK(CPK)-1776* ALK
PHOS-64 TOT BILI-0.5
[**2110-5-9**] 10:29AM   GLUCOSE-303* UREA N-35* CREAT-2.3* SODIUM-135
POTASSIUM-3.7 CHLORIDE-103 TOTAL CO2-23 ANION GAP-13
[**2110-5-9**] 11:15AM URINE  OSMOLAL-430
[**2110-5-9**] 11:15AM URINE  HOURS-RANDOM CREAT-63 SODIUM-23
[**2110-5-9**] 06:30PM   PLT COUNT-321
[**2110-5-9**] 06:30PM   WBC-14.5* RBC-2.36* HGB-7.1* HCT-19.5*#
MCV-83 MCH-30.0 MCHC-36.3* RDW-14.5
[**2110-5-9**] 06:30PM   CALCIUM-7.8* PHOSPHATE-1.5* MAGNESIUM-1.8
[**2110-5-9**] 06:30PM   CK-MB-9 cTropnT-1.14*
[**2110-5-9**] 06:30PM   GLUCOSE-113* UREA N-32* CREAT-2.2*
SODIUM-131* POTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-21* ANION
GAP-12
[**2110-5-9**] 10:00PM   PLT COUNT-269
[**2110-5-9**] 10:00PM   WBC-11.4* RBC-2.67* HGB-7.9* HCT-22.4* MCV-84
MCH-29.6 MCHC-35.2* RDW-14.7
[**2110-5-9**] 10:00PM   CALCIUM-7.7* PHOSPHATE-2.3* MAGNESIUM-1.8
[**2110-5-9**] 10:00PM   GLUCOSE-113* UREA N-32* CREAT-2.2* SODIUM-133
POTASSIUM-4.0 CHLORIDE-104 TOTAL CO2-22 ANION GAP-11
.
[**2110-5-9**]: Sinus tachycardia. There is a late transition with tiny
R waves in the anterior leads consistent with possible prior
anterior wall myocardial infarction. Minimal ST segment
elevation in the inferior leads consistent with possible
ischemia or infarction. Clinical correlation is suggested.
Compared to the previous tracing left ventricular hypertrophy is
no longer apparent and ST segment elevation is new.
.
[**2110-5-9**] AXR: Fidnings suggestive of mild partial or early small
bowel obstruction. If clinically indicated, continued monitoring
is advised.
.
[**2110-5-9**] CXR: Left lower lobe pneumonia.
.
[**2110-5-10**] Echo: Mild left ventricular cavity enlargement with
moderate global hypokinesis suggestive of a diffuse process
(toxin, metabolic, etc. - though cannot fully exclude
multivessel CAD).
.
[**2110-5-9**] EKG: Sinus tachycardia. Left axis deviation. Late
transition with tiny R waves in the anterior leads consistent
with possible prior anterior wall myocardial infarction. Minimal
ST segment elevation in the inferior leads with diffuse ST-T
wave changes consistent with possible ischemia or infarction.
Clinical correlation is suggested.
.
[**2110-5-9**] EKG: Sinus tachycardia. Probable left ventricular
hypertrophy. Non-specific ST-T wave changes. Compared to the
previous tracing of [**2110-5-9**] no change.
.
[**2110-5-10**] EKG: Sinus rhythm. Compared to the previous tracing the
rate is slower.
.
[**2110-5-11**] CXR: Sinus rhythm. Compared to the previous tracing the
rate is slower.
.
[**2110-5-11**] EKG: Sinus rhythm. Occasional atrial premature beats.
Leftward axis. Intraventricular conduction delay. Non-specific
ST-T wave changes. Compared to the previous tracing of [**2110-5-10**]
atrial ectopy is new. The QRS duration is similar.
.
[**2110-5-12**] CXR: Consolidation in the left lower lobe, not
significantly changed since the prior radiographs.




Brief Hospital Course:
Mr. [**Known lastname **] is a 55 year old man with diabetes, hypertension,
and hyperlipidemia, who presented with fever, nausea, and
vomiting, and who was found to be in DKA with infiltrate on CXR,
now positive for Legionella. His brief hospital course, by
problem:
.
#) Pneumonia. Urinary Legionella antigen positive, treated
empirically for CAP for 3 days with levofloxacin. Afebrile,
leukocytosis resolved, satting well on room air. CXR showed that
pneumonia unchanged. He was given a total 14-day course of
levofloxacin.
.
#) NSTEMI. Subendocardial ischemia in the setting of acute
demand from difficult-to-control hypertension/fever/pneumonia.
Non-specific EKG changes. Enzymes trending down.  He will get a
P-MIBI once pneumonia has resolved and blood pressure is better
controlled; it was scheduled for [**6-4**]. Continued aspirin,
statin, beta blocker, [**Last Name (un) **]. Blood pressure was aggressively
controlled, and the patient was discharged on many blood
pressure medications (see med list).
.
#) Anemia. Received 2 units of pRBC's in MICU. Hematocrit
remained stable.
.
#) Hypertension. Has been difficult to control, requiring
esmolol and nitro drip for control. Blood pressure on floor has
been 142-180 systolic. Titrated medications to max dose; the
patient has follow up appointment with his PCP next week for
further titration of blood pressure medications.
.
#) Elevated blood glucose. Likely high in the setting of
infection. Initial anion gap closed quickly. Blood sugars have
been well controlled since transfer. He was continued on Lantus
while inpatient, and his outpatient oral hypoglycemic
medications were restarted at the time of discharge.
.
#) Nausea. Resolved.
.
#) Metabolic acidosis/resp alkalosis. Anion gap is 12. [**Month (only) 116**] have
respiratory alkalosis from pneumonia, with compensatory renal
acidosis. Mildly elevated anion gap (12) was concerning given no
clear source (lactate WNL, blood glucose has been well
controlled, ? renal failure). It resolved by the time of
discharge.
.
#) Renal failure. s/p left nephrectomy with rising creatinine
over the past few months (appears baseline is 1.6-2.0 or so).
MRI in [**12/2109**] showed widely patent R kidney vasculature.
Creatinine was monitored and remained stable.

Medications on Admission:
Aspirin 81mg daily
Neurontin 300mg [**Hospital1 **]
Vytorin 10-40mg daily
Glipizide 10mg [**Hospital1 **]
Metoprolol 50mg [**Hospital1 **]
Prilosec daily
Glucophage 1000mg [**Hospital1 **]
Levirmir Pen 10mL at bedtime
Norvasc 5mg daily
Doxazosin 2mg daily


Discharge Medications:
1. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
Disp:*30 Tablet(s)* Refills:*2*
3. Hydralazine 50 mg Tablet Sig: 1.5 Tablets PO Q6H (every 6
hours).
Disp:*180 Tablet(s)* Refills:*2*
4. Valsartan 160 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
5. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
Disp:*60 Tablet(s)* Refills:*2*
6. Metoprolol Tartrate 50 mg Tablet Sig: Two (2) Tablet PO TID
(3 times a day).
Disp:*180 Tablet(s)* Refills:*2*
7. Doxazosin 2 mg Tablet Sig: One (1) Tablet PO once a day.
8. Vytorin 10-40 10-40 mg Tablet Sig: One (1) Tablet PO once a
day.
9. Neurontin 300 mg Capsule Sig: One (1) Capsule PO twice a day.

10. Glipizide 10 mg Tablet Sig: One (1) Tablet PO twice a day.
11. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
12. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a
day.
13. Levemir Flexpen 100 unit/mL Insulin Pen Subcutaneous
14. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H
(every 24 hours) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Diabetic ketoacidosis
Type 2 diabetes
Hypertension
Demand ischemia


Discharge Condition:
Stable, blood pressures improved,


Discharge Instructions:
You were admitted with high blood pressure, high blood sugars,
and pneumonia. You are being treated with many new blood
pressure medications and antibiotics for the pneumonia. Please
take all of the new medications as prescribed, and complete the
entire course of the antibiotics.
.
If you develop nausea, vomiting, dizziness, chest pain,
shortness of breath, high fevers, or other concerning symptoms,
please seek medical attention immediately.

Followup Instructions:
You have been
Chest X-ray: To be scheduled by Dr. [**Last Name (STitle) 5717**]
Stress Test: Tuesday, [**2110-5-27**], at 10am. [**Location (un) **] of
[**Hospital Ward Name 23**] Building on [**Hospital Ward Name 516**] of [**Hospital1 18**].
- No smoking or eating for 2 hours prior to the test
- No caffeine or decaffeinated products for 12 hours prior to
the test
- They will send a letter
Please follow up with Dr. [**Last Name (STitle) 5717**] as previously scheduled:
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10477**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2110-5-22**] 9:00
Provider: [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 128**] Date/Time:[**2110-5-23**]
11:00
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 10477**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2110-6-10**] 9:10
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Alkalosis,Chronic hepatitis C without mention of hepatic coma,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of kidney,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease'}


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: 55 yo M with history of DM, HTN, high cholesterol presented to
the ED with sevedral days of nausea and vomiting. The patient
reports being in his USOH until Monday, 5 days prior to admssion
when he developed malaise, rigors, and myalgias. He did not
check his temperature. He then developed nausea, vomiting,
non-bilious, non-bloody. He reports not being able to tolerate
any po's since Monday. He reports 5-6 episodes of emesis daily.
He said he stopped taking all of his usual medications,
including insulin on Monday because he was not sure what was
going on. He had been taking Advil with relief in symptoms. He
denies diarrhea, abdominal pain, cough, chest pain before coming
to the ED (developed non-productive cough in the ED). No sick
contacts.
.
ED course: VS on admission T 100.7; HR 119; BP 184/77; RR 30; O2
98% RA. Labs were significant for WBC of 17, Cr 2.5, K 3.2,
serum glucose 474, presence of urine glucose 1000; urine ketones
15. AG =19 initially. Lactate 1.6. Trop 0.12; CK [**2049**]; MB 9 on
presentation (with Cr 2.5. Trop went up to 0.38. EKG sinus rate
104; new ST depression in aVL on this am's EKG.
.
Patient resuscitated with 2L NS. In the ED the paitent was also
given:
Acetaminophen 1000 mg x 2, Insulin Human Regular 6 units IV and
8 units SC; Ondansetron 4 mg IV x 2; Levofloxacin 750mg; Aspirin
325mg.
.
By the time the patient arrived to the floor, he felt improved.
Continues to have nausea. Denies CP or any other symptpoms. He
has nver had DKA before.

MEDICAL HISTORY: 1. HTN
2. DM type 2
3. Hypercholesterolemia
4. Hepatitis C
5. PUD
6. R cranial nerve palsy
7. Erectile dysfunction
8. Prostatitis
9. BPH
10. L renal cell carcinoma
11. LLL radiculopathy
12. Microalbuminuria

MEDICATION ON ADMISSION: Aspirin 81mg daily
Neurontin 300mg [**Hospital1 **]
Vytorin 10-40mg daily
Glipizide 10mg [**Hospital1 **]
Metoprolol 50mg [**Hospital1 **]
Prilosec daily
Glucophage 1000mg [**Hospital1 **]
Levirmir Pen 10mL at bedtime
Norvasc 5mg daily
Doxazosin 2mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 100.9   95   156/94    27   97% RA
General: resting in bed; pleasant; alert and oriented x 3; NAD;
breathing comfortably
HEENT: OP clear; no scleral icterus; MM sl dry
Neck: no JVD, no bruits
Heart: regular, nl S1S2, no m/rubs/gallops
Lungs: soft crackles at left base
Abd: + BS, soft, NT, ND
Ext: no edema, palp pulses throughout

FAMILY HISTORY: Noncontributory

SOCIAL HISTORY: Lives with wife. [**Name (NI) **] children. Quit smoking 20 y ago. No alcohol 

### Response:
{'Subendocardial infarction, initial episode of care,Acute kidney failure, unspecified,Pneumonia, organism unspecified,Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Alkalosis,Chronic hepatitis C without mention of hepatic coma,Chronic kidney disease, unspecified,Personal history of malignant neoplasm of kidney,Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS),Pure hypercholesterolemia,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Anemia in chronic kidney disease'}
