CHIEF COMPLAINT: Hyperglycemia

PRESENT ILLNESS: Ms [**Known lastname **] is a 72 year old female with a history of insulin
dependent DM2, and left breast cancer s/p lumpectomy and XRT in
[**2168**] who presents with poorly controlled blood sugars. She was
first started on insulin in [**Month (only) **] when she was admitted to
[**Hospital **] Hospital with a urinary tract infection. She was treated
with antibiotics and discharged home after several days. She
again presented with a UTI in [**Month (only) 547**] to [**Hospital **] hospital. During
her most recent hospitalization at [**Location (un) **] she developed
urosepsis and pyelonephritis and was treated in the ICU. During
both admissions she was hyperglycemic and there was significant
difficulty controlling her sugars. She was discharged one week
ago from [**Hospital **] Hospital on a novolog sliding scale and
glargine 70 units QHS. After discharge she reports that her
fingersticks have been between 300 and 500. She has been feeling
increasingly fatigued and is not satisfied with her current
regiment. She decided to come into [**Hospital1 18**] for further management,
and for "better doctors." She reports good compliance with her
medications, and has been on a diabetic diet. She has lost her
appetite and has not eaten very much during the last week. Other
than her fatigue and loss of appetite, she denies any other
symptoms including fevers/chills, nausea, vomiting, chest pain
or SOB.

MEDICAL HISTORY: MEDICAL & SURGICAL HISTORY:
- Insulin Dependent DM (started on insulin [**1-/2174**])
- L breast Ca s/p lumpectomy and XRT in [**2168**], no chemotherapy
- s/p R knee replacement
- PVD s/p L fem-[**Doctor Last Name **] bypass, occasional edema of L lower
extremity
- HTN
- HLD

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from Patient.
1. Enalapril Maleate 20 mg PO DAILY
2. Levothyroxine Sodium 100 mcg PO DAILY
3. Lipitor 40 mg PO DAILY
4. Atenolol 25 mg PO DAILY
5. Aspirin 81 mg PO DAILY
6. Glargine 70 Units Bedtime
7. Furosemide 40 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Exam on Admission
VS: 98.6 142/78 86 18 96%RA FS 419 on admission, 392 this
morning 72kg
GENERAL: NAD, alert, orientated, comfortable
HEENT: PERRL, EOMI, MMM
NECK: Supple, no JVD, no cervical LAD
HEART: RRR, no murmurs, rubs or gallops, normal S1-S2.
LUNGS: CTA bilat, no ronchi/rales/wheezes, good air movement
ABDOMEN: Soft/NT/ND, no rebound/guarding, no hepatosplenomegaly

FAMILY HISTORY: She has a cousin with DM

SOCIAL HISTORY: Lives in [**Location **] w Husband. Retired. Independent of ADLs, walks
w use of cane. Former tobacco smoker, 30pkyrs but quit 23 years
ago, Social EtOH, denies illicits.
Cyst and pseudocyst of pancreas,Septicemia due to escherichia coli [E. coli],Septic shock,Severe sepsis,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Chronic systolic heart failure,Other diseases of spleen,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Personal history of malignant neoplasm of breast,Peripheral vascular disease, unspecified,Benign essential hypertension,Personal history of tobacco use,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other nonspecific abnormal serum enzyme levels
Pancreat cyst/pseudocyst,E coli septicemia,Septic shock,Severe sepsis,Urin tract infection NOS,Hyposmolality,Chr systolic hrt failure,Spleen disease NEC,DMII wo cmp uncntrld,Long-term use of insulin,Hx of breast malignancy,Periph vascular dis NOS,Benign hypertension,History of tobacco use,Hyperlipidemia NEC/NOS,Hypothyroidism NOS,Abn serum enzy level NEC
Admission Date:  [**2174-4-28**]              Discharge Date:   [**2174-5-10**]

Date of Birth:  [**2101-10-20**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 5606**]
Chief Complaint:
Hyperglycemia

Major Surgical or Invasive Procedure:
Splenic abscess drainage


History of Present Illness:
Ms [**Known lastname **] is a 72 year old female with a history of insulin
dependent DM2, and left breast cancer s/p lumpectomy and XRT in
[**2168**] who presents with poorly controlled blood sugars. She was
first started on insulin in [**Month (only) **] when she was admitted to
[**Hospital **] Hospital with a urinary tract infection. She was treated
with antibiotics and discharged home after several days. She
again presented with a UTI in [**Month (only) 547**] to [**Hospital **] hospital. During
her most recent hospitalization at [**Location (un) **] she developed
urosepsis and pyelonephritis and was treated in the ICU. During
both admissions she was hyperglycemic and there was significant
difficulty controlling her sugars. She was discharged one week
ago from [**Hospital **] Hospital on a novolog sliding scale and
glargine 70 units QHS. After discharge she reports that her
fingersticks have been between 300 and 500. She has been feeling
increasingly fatigued and is not satisfied with her current
regiment. She decided to come into [**Hospital1 18**] for further management,
and for "better doctors." She reports good compliance with her
medications, and has been on a diabetic diet. She has lost her
appetite and has not eaten very much during the last week. Other
than her fatigue and loss of appetite, she denies any other
symptoms including fevers/chills, nausea, vomiting, chest pain
or SOB.

At [**Hospital1 18**] ED, initial vital signs were 98.8 82 122/61 18 100%RA.
Exam was unremarkable. Labs were notable for WBC 16 (N80), Hct
37.6, Na 125, Cl 86, Cr 0.9, glucose 518, lactate 2.1, AP 266,
UA w 8WBC, no bacteria. CXR was unremarkable. EKG was
unremarkable. Patient was given 1g CTX IV for presumed UTI, 2L
normal saline. Repeat FS was 398. Vital signs prior to transfer
were 98.8 78 125/58 18 100%RA. Access was 18g PIVx1.

Overnight, patient was hemodynamically stable without any issues
on the floor. She denies any chest pain, SOB, dysuria,
hematuria. She reports some loose stool but this is consistent
with her baseline and denies any melena. Denies any fevers,
chills, night sweats, headache, abdominal pain, nausea or
vomiting.


Past Medical History:
MEDICAL & SURGICAL HISTORY:
- Insulin Dependent DM (started on insulin [**1-/2174**])
- L breast Ca s/p lumpectomy and XRT in [**2168**], no chemotherapy
- s/p R knee replacement
- PVD s/p L fem-[**Doctor Last Name **] bypass, occasional edema of L lower
extremity
- HTN
- HLD

Social History:
Lives in [**Location **] w Husband. Retired. Independent of ADLs, walks
w use of cane. Former tobacco smoker, 30pkyrs but quit 23 years
ago, Social EtOH, denies illicits.


Family History:
She has a cousin with DM


Physical Exam:
Exam on Admission
VS: 98.6 142/78 86 18 96%RA FS 419 on admission, 392 this
morning 72kg
GENERAL: NAD, alert, orientated, comfortable
HEENT: PERRL, EOMI, MMM
NECK: Supple, no JVD, no cervical LAD
HEART: RRR, no murmurs, rubs or gallops, normal S1-S2.
LUNGS: CTA bilat, no ronchi/rales/wheezes, good air movement
ABDOMEN: Soft/NT/ND, no rebound/guarding, no hepatosplenomegaly

EXTREMITIES: WWP, 1+ DP/PT pulses equal bilaterally, no cyanosis
clubbing or edema
SKIN: No rashes/lesions
NEURO: A&Ox3, moving all extremities

Exam on Discharge
VS: 98.3 124/76 75 20 97% Ra
JP drained 50cc yeasterday, today drained 40cc, bulb had just
been changed so unable to assess fluid color/turbidity
GENERAL: NAD, alert, orientated, comfortable
HEENT: PERRL, EOMI, MMM
NECK: Supple, no JVD, no cervical LAD
HEART: RRR, no murmurs, rubs or gallops, normal S1-S2.
LUNGS: CTA bilat, no ronchi/rales/wheezes, good air movement
ABDOMEN: Soft/NT/ND, no rebound/guarding, no hepatosplenomegaly

EXTREMITIES: WWP, 1+ DP/PT pulses equal bilaterally, no cyanosis
clubbing or edema
SKIN: No rashes/lesions
NEURO: A&Ox3, moving all extremities
TUBES/LINES/DRAIN: Drainage site appears clean, dry and intact


Pertinent Results:
[**2174-5-10**] 04:42AM BLOOD WBC-11.8* RBC-3.68* Hgb-10.3* Hct-33.2*
MCV-90 MCH-28.0 MCHC-31.1 RDW-14.8 Plt Ct-494*
[**2174-5-9**] 04:31AM BLOOD WBC-12.0* RBC-3.53* Hgb-10.1* Hct-32.0*
MCV-91 MCH-28.5 MCHC-31.4 RDW-14.7 Plt Ct-461*
[**2174-5-8**] 06:30AM BLOOD WBC-12.1* RBC-3.74* Hgb-10.6* Hct-34.2*
MCV-91 MCH-28.4 MCHC-31.1 RDW-14.8 Plt Ct-431
[**2174-5-7**] 05:43AM BLOOD WBC-12.5* RBC-3.67* Hgb-10.4* Hct-33.1*
MCV-90 MCH-28.4 MCHC-31.4 RDW-14.4 Plt Ct-410
[**2174-5-3**] 06:25AM BLOOD WBC-27.9*# RBC-3.36* Hgb-9.7* Hct-30.3*
MCV-90 MCH-28.9 MCHC-32.0 RDW-14.0 Plt Ct-293
[**2174-4-29**] 06:40AM BLOOD WBC-14.2* RBC-4.01* Hgb-11.7* Hct-36.6
MCV-92 MCH-29.3 MCHC-32.0 RDW-14.0 Plt Ct-410
[**2174-4-28**] 06:25PM BLOOD WBC-16.0* RBC-4.19* Hgb-12.2 Hct-37.6
MCV-90 MCH-29.1 MCHC-32.5 RDW-13.6 Plt Ct-453*
[**2174-4-28**] 06:25PM BLOOD Neuts-80* Bands-2 Lymphs-10* Monos-6
Eos-1 Baso-0 Atyps-0 Metas-0 Myelos-1*
[**2174-5-10**] 04:42AM BLOOD Plt Ct-494*
[**2174-5-9**] 04:31AM BLOOD Plt Ct-461*
[**2174-5-8**] 06:30AM BLOOD Plt Ct-431
[**2174-5-3**] 08:35AM BLOOD PT-14.6* PTT-27.8 INR(PT)-1.4*
[**2174-4-29**] 06:40AM BLOOD Plt Ct-410
[**2174-4-28**] 06:25PM BLOOD Plt Ct-453*
[**2174-5-10**] 04:42AM BLOOD Glucose-158* UreaN-14 Creat-0.6 Na-135
K-4.5 Cl-100 HCO3-25 AnGap-15
[**2174-5-9**] 04:31AM BLOOD Glucose-112* UreaN-15 Creat-0.6 Na-135
K-4.2 Cl-101 HCO3-24 AnGap-14
[**2174-5-8**] 06:30AM BLOOD Glucose-117* UreaN-10 Creat-0.7 Na-136
K-4.4 Cl-102 HCO3-25 AnGap-13
[**2174-4-29**] 06:40AM BLOOD Glucose-403* UreaN-13 Creat-0.7 Na-130*
K-4.0 Cl-96 HCO3-23 AnGap-15
[**2174-4-29**] 12:36AM BLOOD Glucose-367* UreaN-12 Creat-0.7 Na-128*
K-4.0 Cl-95* HCO3-21* AnGap-16
[**2174-4-28**] 06:25PM BLOOD Glucose-518* UreaN-13 Creat-0.9 Na-125*
K-4.0 Cl-86* HCO3-25 AnGap-18
[**2174-5-10**] 04:42AM BLOOD ALT-24 AST-13 AlkPhos-289* TotBili-0.3
[**2174-5-9**] 04:31AM BLOOD ALT-34 AST-18 AlkPhos-328* TotBili-0.3
[**2174-5-8**] 06:30AM BLOOD ALT-40 AST-20 AlkPhos-348* TotBili-0.3
[**2174-5-5**] 06:18AM BLOOD ALT-103* AST-54* AlkPhos-477* TotBili-0.2
[**2174-5-3**] 06:25AM BLOOD ALT-149* AST-293* AlkPhos-555*
TotBili-0.5
[**2174-4-28**] 06:25PM BLOOD ALT-32 AST-23 CK(CPK)-14* AlkPhos-266*
TotBili-0.6
[**2174-5-2**] 06:30AM BLOOD Lipase-13
[**2174-4-29**] 12:36AM BLOOD GGT-83*
[**2174-5-10**] 04:42AM BLOOD Calcium-8.9 Phos-3.1 Mg-1.7
[**2174-5-9**] 04:31AM BLOOD Calcium-8.6 Phos-3.5 Mg-1.7
[**2174-5-8**] 06:30AM BLOOD Calcium-8.5 Phos-3.3 Mg-1.7
[**2174-4-29**] 12:36AM BLOOD Calcium-8.7 Phos-2.1* Mg-1.5*
[**2174-4-29**] 12:50PM BLOOD %HbA1c-11.6* eAG-286*
[**2174-5-1**] 07:35AM BLOOD TSH-2.9
[**2174-5-8**] 06:30AM BLOOD Cortsol-24.0*

Brief Hospital Course:
72yo F PMHx DM2 w recent initiation of insulin 2 mo ago, recent
hospitalization for pyelonephritis presenting w poorly
controlled fingersticks, hyperglycemia found to have UTI,
bacteremia and splenic abscess.
.
#E. Coli bacteremi/Sepsis/splenic abscess ?????? Patient was
transferred to the MICU for hemodynamic instability. She was
found to be septic with positive blood cultures for E. Coli and
found to have large 13 cm splenic abscess on imaging.  Patient
underwent CT guided drainage of the abscess and a JP drain was
placed. Her antibiotics were broadened to meropenem given
mutli-drug resistant E. coli. Final culture data showed E coli.
Her sepsis resolved given improvement in SBPs with IVF. Last
blood culture was positive on [**2174-5-2**].  ID was consulted to help
with management of antibiotic choice and course of meropenem
while in the hospital with transition to ertapenem 1gm Q24H to
end on [**2174-6-3**]. She was transferred back to the medical
floor and remained hemodynamically stable. She underwent a TTE
which was within normal limits and showed no evidence of
endocarditis. JP drain site was clean, dry and intact. IR
recommended the drain be flushed with 5-10cc saline Q8H and
remain in place until the daily net drainage is less than 15cc
per day (subtracting the flushes), at which time she will need a
repeat CT. If there is no fluid collection, the drain may be
removed by the primary care physician with no further need for
follow up.
.
# Hyperglycemia - Patient has a history of poorly controlled DM
with prior non-compliance with her oral regimen. She was
recently started on insulin and presented with one week of
elevated blood sugars likely in the setting of her splenic
abscess. She was seen by [**Last Name (un) **] diabetes consult who recommended
her sliding scale insulin regimen be increased and her evening
glargine decreased. She was started on metformin once her anion
gap completly normalized. She will be discharged on metformin
and a new insulin scale. She was also given a nutrition consult
to help with her outpatient DM management.
.
# UTI - Patient was found to have multi resistent E. coli in her
urine likely secondary to her splenic abscess. We treated her
with meropenem as above which was changed to Ertepenem for ease
of admninistration (once daily dosing) to treat her bacteremia
and abscess.
.
# Hyponatremia - Patient was found to have a sodium of 125 on
admission which corrected to 135 and therefore was thought to
have been from pseudohyponatremia. We continued to monitor her
sodium which returned to [**Location 213**] at discharge.
.
# Elevated Alk Phos - Patient had an elevated alk phos to 266 on
admission that trended to 411, with ALT and AST of 86. RUQ exam
was unremarkable. She has a remote history of breast cancer so
we were initialy concerned about relapse with [**Last Name (un) 2043**] metastasis.
GGT was obtained which was also elevated suggesting that alk
phos was hepatic in origin. AP downtrended during her
hospitalization. CT did not show any liver pathology.
.
# HTN: Well controlled on home medications. We held atenolol due
to her hypotension in the setting of sepsis. We recommend
restarting on discharge.
.
# HLD: Statin held given elevated LFTs. She may consider
restarting this in the future.
.
# Hypothyroidism: Continued her home dose of levothyroxine
.
# PVD: Continued on home ASA
.
# Enlarged endometrial stripe: Found on imaging as incidental
finding.  At this time we recommend outpatient evaluation with a
vaginal ultrasound. The patient is aware and will make a
gynecological appointment through her PCP.
.
# Pancreatic cyst: Found on imaging as incidental finding.  At
this time we recommend outpatien evaluation with a MRCP. The
patient is aware of the pancreatic cyst and will schedule MRCP
through her PCP.
.
# Transition: Please arrange MRCP and transvaginal ultrasound as
an outpatient. In regards to the JP drain, monitor daily output
until the net output is less than 10-15cc per day. At that point
please reimage with a CT and insure there is no fluid remaining.
If CT shows complete resolution of the abscess, the drain may be
removed with no further follow up. Continue IV antibiotics until
[**6-3**] with ertapenem 1gm Q24H. Check CBC with diff, BMP, LFTs
each week after discharge and fax the results to the [**Hospital **] clinic
at [**Telephone/Fax (1) 1419**]. A follow up appointment with ID is arranged for
[**5-27**].

Medications on Admission:
Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from Patient.
1. Enalapril Maleate 20 mg PO DAILY
2. Levothyroxine Sodium 100 mcg PO DAILY
3. Lipitor 40 mg PO DAILY
4. Atenolol 25 mg PO DAILY
5. Aspirin 81 mg PO DAILY
6. Glargine 70 Units Bedtime
7. Furosemide 40 mg PO DAILY


Discharge Medications:
1. Aspirin 81 mg PO DAILY
2. Atenolol 25 mg PO DAILY
3. Enalapril Maleate 20 mg PO DAILY
4. Levothyroxine Sodium 100 mcg PO DAILY
5. Furosemide 40 mg PO DAILY
6. MetFORMIN (Glucophage) 1000 mg PO BID
7. Senna 1 TAB PO BID:PRN constipation
8. Polyethylene Glycol 17 g PO DAILY:PRN constpiation
hold for loose stools
9. ertapenem *NF* 1 gram Injection daily Reason for Ordering:
Transitioning from Meropenam
Start [**2174-5-9**]
10. Glargine 14 Units Bedtime
Insulin SC Sliding Scale using HUM Insulin


Discharge Disposition:
Extended Care

Facility:
[**Location (un) 931**] House Nursing & Rehabilitation Center - [**Location (un) 932**]

Discharge Diagnosis:
Splenic Abscess
Hyperglycemia


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 blood sugars and
were found to have a splenic abscess. We had trouble controlling
your blood pressure since the infection had spread to your blood
and transfered you to the intensive care unit for close
monitoring. Radiology drained the abscess and placed a JP drain
which will continue to drain fluids. Once stable, we transfered
you back to the floor. You were started on an antibiotic called
Miropenem while at the hospital. We will send you to your rehab
center on a similar antibiotic called ertapenem and will need
this antibiotic until [**6-3**]. Please have your rehab center or
your primary care physician check CBC with differential, BMP,
LFTs each week and fax the results to the [**Hospital **] clinic at
[**Telephone/Fax (1) 1419**]. You will need to have the nursing home monitor the
JP output. Once the output is less than 10-15ml per day,
schedule an appointment with your primary care physician. [**Name10 (NameIs) 357**]
get a CT exam the morning prior to the visit to verify complete
resolution. Your PCP can remove the JP drain at that time.

We also recommend stopping your atorvastatin since this can
contribute to abnormal liver function tests. Please have your
liver tests checked by your primary care physician at your next
appointment.

You had high blood sugar levels. This is likely due to your
infection. We monitored your blood sugar and other electrolytes
frequently throughout the day. We consulted the [**Last Name (un) **] Diabetes
service and they recommended a new insulin plan which you will
go home on. We will review your new insulin regiment in detail
before you leave. [**Last Name (un) **] also recommended starting Metformin, an
oral medication you should take twice a day that can help with
the management of diabetes. You will need to follow up with your
primary care physician for further management of your diabetes.

We also consulted the nutrition service and hope that they
provided some education about diet that will help with your
future sugar control.

Your CT exam had two findings that you will need to follow up as
an outpatient. The CT showed a thickened endometrial stripe and
you will need to get a transvaginal ultrasound. Please have your
PCP arrange an appointment with your gynecologist. The CT also
showed a pancreatic cyst and you will require a MRCP for further
evaluation.

Medicaion Changes
START Metformin
START Ertapenem
STOP Atorvastatin

It was a pleasure taking care of you during your hospital stay.

Followup Instructions:
Name: [**Last Name (LF) **],[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
Date: Thursday [**2174-5-12**] at 1:30pm
Address: [**State 8536**] [**Apartment Address(1) 8537**], [**Location (un) **],[**Numeric Identifier 8538**]
Phone: [**Telephone/Fax (1) 58624**]
Fax: [**Telephone/Fax (1) 83917**]

[**Last Name (un) **] Diabetes Center
Wednesday [**2174-5-11**] at 8:30am
Phone: [**Telephone/Fax (1) 25521**]

Infectious Disease Clinic at [**Hospital1 18**]
Dr. [**Last Name (STitle) 7443**] on [**2174-5-27**] at 10:00am
Phone: [**Telephone/Fax (1) 457**]

Provider: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 13125**] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 457**]
Date/Time:[**2174-6-17**] 10:30





Name:  [**Known lastname 18105**],[**Known firstname 1013**]              Unit No:   [**Numeric Identifier 18106**]

Admission Date:  [**2174-4-28**]              Discharge Date:   [**2174-5-10**]

Date of Birth:  [**2101-10-20**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 12576**]
Addendum:
To clarify - this patient had hypotension due to septic shock
during this hospitalization.

Discharge Disposition:
Extended Care

Facility:
[**Location (un) 2332**] House Nursing & Rehabilitation Center - [**Location (un) 2333**]

                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern1) 12580**] MD [**MD Number(2) 12581**]

Completed by:[**2174-7-14**]
{'Cyst and pseudocyst of pancreas,Septicemia due to escherichia coli [E. coli],Septic shock,Severe sepsis,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Chronic systolic heart failure,Other diseases of spleen,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Personal history of malignant neoplasm of breast,Peripheral vascular disease, unspecified,Benign essential hypertension,Personal history of tobacco use,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other nonspecific abnormal serum enzyme levels'}


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: Hyperglycemia

PRESENT ILLNESS: Ms [**Known lastname **] is a 72 year old female with a history of insulin
dependent DM2, and left breast cancer s/p lumpectomy and XRT in
[**2168**] who presents with poorly controlled blood sugars. She was
first started on insulin in [**Month (only) **] when she was admitted to
[**Hospital **] Hospital with a urinary tract infection. She was treated
with antibiotics and discharged home after several days. She
again presented with a UTI in [**Month (only) 547**] to [**Hospital **] hospital. During
her most recent hospitalization at [**Location (un) **] she developed
urosepsis and pyelonephritis and was treated in the ICU. During
both admissions she was hyperglycemic and there was significant
difficulty controlling her sugars. She was discharged one week
ago from [**Hospital **] Hospital on a novolog sliding scale and
glargine 70 units QHS. After discharge she reports that her
fingersticks have been between 300 and 500. She has been feeling
increasingly fatigued and is not satisfied with her current
regiment. She decided to come into [**Hospital1 18**] for further management,
and for "better doctors." She reports good compliance with her
medications, and has been on a diabetic diet. She has lost her
appetite and has not eaten very much during the last week. Other
than her fatigue and loss of appetite, she denies any other
symptoms including fevers/chills, nausea, vomiting, chest pain
or SOB.

MEDICAL HISTORY: MEDICAL & SURGICAL HISTORY:
- Insulin Dependent DM (started on insulin [**1-/2174**])
- L breast Ca s/p lumpectomy and XRT in [**2168**], no chemotherapy
- s/p R knee replacement
- PVD s/p L fem-[**Doctor Last Name **] bypass, occasional edema of L lower
extremity
- HTN
- HLD

MEDICATION ON ADMISSION: Preadmissions medications listed are incomplete and require
futher investigation.  Information was obtained from Patient.
1. Enalapril Maleate 20 mg PO DAILY
2. Levothyroxine Sodium 100 mcg PO DAILY
3. Lipitor 40 mg PO DAILY
4. Atenolol 25 mg PO DAILY
5. Aspirin 81 mg PO DAILY
6. Glargine 70 Units Bedtime
7. Furosemide 40 mg PO DAILY

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Exam on Admission
VS: 98.6 142/78 86 18 96%RA FS 419 on admission, 392 this
morning 72kg
GENERAL: NAD, alert, orientated, comfortable
HEENT: PERRL, EOMI, MMM
NECK: Supple, no JVD, no cervical LAD
HEART: RRR, no murmurs, rubs or gallops, normal S1-S2.
LUNGS: CTA bilat, no ronchi/rales/wheezes, good air movement
ABDOMEN: Soft/NT/ND, no rebound/guarding, no hepatosplenomegaly

FAMILY HISTORY: She has a cousin with DM

SOCIAL HISTORY: Lives in [**Location **] w Husband. Retired. Independent of ADLs, walks
w use of cane. Former tobacco smoker, 30pkyrs but quit 23 years
ago, Social EtOH, denies illicits. 

### Response:
{'Cyst and pseudocyst of pancreas,Septicemia due to escherichia coli [E. coli],Septic shock,Severe sepsis,Urinary tract infection, site not specified,Hyposmolality and/or hyponatremia,Chronic systolic heart failure,Other diseases of spleen,Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled,Long-term (current) use of insulin,Personal history of malignant neoplasm of breast,Peripheral vascular disease, unspecified,Benign essential hypertension,Personal history of tobacco use,Other and unspecified hyperlipidemia,Unspecified acquired hypothyroidism,Other nonspecific abnormal serum enzyme levels'}
