CHIEF COMPLAINT: n/v and weakness

PRESENT ILLNESS: Pt is a 43 yo woman who presented to [**Hospital **] clinic to return
equipment associated with her capsule endoscopy. She c/o n/v and
weakness. FSBS checked there revealed BS>400. She was referred
to ED for evaluation. She had been given golytely bowel prep
several days before for cleaning the bowel in prep for capsul
endoscopy as eval for anemia

MEDICAL HISTORY: 1. Type 1 diabetes
-- 2 failed pancreatic transplants, most recent in [**2195-5-18**], at
[**Hospital1 **]
2. GERD, now s/p nissen in [**2188**].
3. Constipation.
4. History adenomatous polyps, negative colonoscopy in [**2189**].
5. OCD
6. Status post wrist and knee surgeries for tendon repairs.
7. Possible seizure disorder, primary neurologist, Dr.
[**Last Name (STitle) **],at [**State 1558**]. The patient has never
been seen in the hospital to have true seizure disorder;
however, she has described seizures consistent with tonic clonic
seizures at home and, therefore, is on Depakote for seizure
prophylaxis. She is also noted to have psychogenic seizures, per
Dr. [**Last Name (STitle) **], which are characteristically episodes of
unresponsiveness or shaking that is not consistent with organic
brain seizures. She has had several psychogenic seizures and has
been admitted at other hospitals for these episodes, usually
they pass over a number of hours and the only thing that has
been shown to help is constant reassurance from the staff that
the patient is doing well.
8. Hypercholesterolemia.
9. History of schizo-affective disorder.
10. History of catatonic depression.
11. question of bipolar disorder.
12. ADHD
13. Hypothyroid
14. allergic to tegretol, codeine (rash)

MEDICATION ON ADMISSION: MEDICATIONS - Confirmed with pt all doses in ED at [**2196-6-28**]:
1. Insulin pump with Humalog.
2. Protonix 40 mg p.o. b.i.d.
3. Neurontin 900 mg q.a.m., 900 mg q. lunch, 1,200 mg q.h.s.
4. Depakote ER 1,500 mg q.d.
5. Lipitor 10 mg q.d.
6. Levoxyl 75 mg p.o. q.d.
7. HCTZ 12.5 mg po qd
8. Lisinopril 40 mg po qd
9. Adderal 20 mg po qd
10. Luvox 250 mg po qd
11. ASA 81 mg po qd

ALLERGIES: Compazine / Codeine / Benzodiazepines

PHYSICAL EXAM: PHYSICAL EXAMINATION ON ADMISSION:
Vital signs: Temperature 97.8, blood pressure 104/68, heart rate
70 , respiratory rate 16/min, saturating 97% in room air.
General: NAD
HEENT: perlla, oropharynx clear
Neck: supple, no jvd
Heart: rrr, nl s1+s2, no m/r/g
Lungs: ctab, nl effort
Abdomen: soft, non tender, nl bs
Extremities:  no o/c/c
Neurologic:  a&o x 3

FAMILY HISTORY: NC

SOCIAL HISTORY: - TOB, - ETOH, - Drugs
Diabetes with neurological manifestations, type I [juvenile type], uncontrolled,Other vascular complications of medical care, not elsewhere classified,Dehydration,Schizoaffective disorder, unspecified,Polyneuropathy in diabetes,Poisoning by insulins and antidiabetic agents,Accidental poisoning by hormones and synthetic substitutes,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Anemia, unspecified,Other constipation,Esophageal reflux,Unspecified acquired hypothyroidism,Epilepsy, unspecified, without mention of intractable epilepsy,Attention deficit disorder with hyperactivity,Obsessive-compulsive disorders
DMI neuro uncntrld,Vasc comp med care NEC,Dehydration,Schizoaffective dis NOS,Neuropathy in diabetes,Poison-insulin/antidiab,Acc poison-hormones,Phlbts sprfc vn up extrm,Anemia NOS,Constipation NEC,Esophageal reflux,Hypothyroidism NOS,Epilep NOS w/o intr epil,Attn deficit w hyperact,Obsessive-compulsive dis
Admission Date:  [**2196-6-28**]              Discharge Date:   [**2196-7-2**]

Date of Birth:  [**2152-7-6**]             Sex:   F

Service: MEDICINE

Allergies:
Compazine / Codeine / Benzodiazepines

Attending:[**First Name3 (LF) 1973**]
Chief Complaint:
n/v and weakness

Major Surgical or Invasive Procedure:
L femoral CVL placement


History of Present Illness:
Pt is a 43 yo woman who presented to [**Hospital **] clinic to return
equipment associated with her capsule endoscopy. She c/o n/v and
weakness. FSBS checked there revealed BS>400. She was referred
to ED for evaluation. She had been given golytely bowel prep
several days before for cleaning the bowel in prep for capsul
endoscopy as eval for anemia

Past Medical History:
1. Type 1 diabetes
-- 2 failed pancreatic transplants, most recent in [**2195-5-18**], at
[**Hospital1 **]
2. GERD, now s/p nissen in [**2188**].
3. Constipation.
4. History adenomatous polyps, negative colonoscopy in [**2189**].
5. OCD
6. Status post wrist and knee surgeries for tendon repairs.
7. Possible seizure disorder, primary neurologist, Dr.
[**Last Name (STitle) **],at [**State 1558**]. The patient has never
been seen in the hospital to have true seizure disorder;
however, she has described seizures consistent with tonic clonic
seizures at home and, therefore, is on Depakote for seizure
prophylaxis. She is also noted to have psychogenic seizures, per
Dr. [**Last Name (STitle) **], which are characteristically episodes of
unresponsiveness or shaking that is not consistent with organic
brain seizures. She has had several psychogenic seizures and has
been admitted at other hospitals for these episodes, usually
they pass over a number of hours and the only thing that has
been shown to help is constant reassurance from the staff that
the patient is doing well.
8. Hypercholesterolemia.
9. History of schizo-affective disorder.
10. History of catatonic depression.
11. question of bipolar disorder.
12. ADHD
13. Hypothyroid
14. allergic to tegretol, codeine (rash)


Social History:
- TOB, - ETOH, - Drugs

Family History:
NC

Physical Exam:
PHYSICAL EXAMINATION ON ADMISSION:
Vital signs: Temperature 97.8, blood pressure 104/68, heart rate
70 , respiratory rate 16/min, saturating 97% in room air.
General: NAD
HEENT: perlla, oropharynx clear
Neck: supple, no jvd
Heart: rrr, nl s1+s2, no m/r/g
Lungs: ctab, nl effort
Abdomen: soft, non tender, nl bs
Extremities:  no o/c/c
Neurologic:  a&o x 3


Pertinent Results:
[**2196-7-2**] 10:10AM BLOOD WBC-3.0* RBC-3.40* Hgb-10.9* Hct-31.8*
MCV-93 MCH-32.1* MCHC-34.4 RDW-15.6* Plt Ct-189
[**2196-7-2**] 10:10AM BLOOD Glucose-112* UreaN-13 Creat-0.8 Na-142
K-3.6 Cl-105 HCO3-30 AnGap-11
[**2196-6-30**] 10:54AM BLOOD ALT-8 AST-21 LD(LDH)-169 CK(CPK)-109
AlkPhos-51 Amylase-45 TotBili-0.1
[**2196-6-30**] 10:54AM BLOOD Lipase-11
[**2196-6-30**] 10:54AM BLOOD CK-MB-4 cTropnT-<0.01
[**2196-7-1**] 05:10AM BLOOD Calcium-8.8 Phos-4.3 Mg-2.5
[**2196-6-30**] 10:54AM BLOOD Hapto-44
[**2196-6-30**] 10:54AM BLOOD Ammonia-15
[**2196-6-30**] 12:22PM BLOOD Valproa-96
[**2196-6-30**] 11:18AM BLOOD Type-ART pO2-247* pCO2-49* pH-7.42
calTCO2-33* Base XS-6 Intubat-NOT INTUBA
[**2196-6-28**] 05:47PM BLOOD Glucose-217* Lactate-2.7* Na-140 K-4.5
Cl-101 calHCO3-29
[**2196-6-30**] 11:06AM BLOOD freeCa-1.18

LUE ULTRASOUND: FINDINGS: [**Doctor Last Name **]-scale, color, and pulse wave
Doppler son[**Name (NI) 1417**] were performed of the left internal jugular,
subclavian, axillary, brachial, basilic, and cephalic veins.
Normal flow, compressibility, waveforms, and augmentation is
demonstrated. No intraluminal thrombus is identified. No
discrete fluid collection is identified to suggest abscess.

IMPRESSION: No evidence of DVT or abscess in the left upper
extremity.

Portable AP chest radiograph compared to [**2193-4-22**].

The heart size is normal. Mediastinal contours, position, and
width are unremarkable. The lung volumes are generally low.
Crowdedness of the lung vessels in both bases is demonstrated
accompanied by small patchy areas of consolidation, especially
in the left retrocardiac space which may represent atypical
bacterial or viral infection. The possibility of the upper lung
redisrtribution of the blood flow cannot be excluded, and might
reflect minimal volume overload. No pleural effusions or
pneumothorax are demonstrated.

IMPRESSION: Focal areas of small patchy opacities, most likely
due to atypical bacterial infection or viral pneumonia. Volume
overload cannot be excluded.


Brief Hospital Course:
Pt was given fluids in ED and admitted to 11 [**Hospital **] medical
floor. Her fingerstick blood sugars were followed and she was
given insulin. Dr. [**Last Name (STitle) 3617**] of [**Last Name (un) **] consult team was consulted to
evaluate the cause of her hyperglycemia. On the morning of [**6-30**],
she was found rapidly unresponsive with a fingerstick of 60. her
insulin pump was removed and a code blue was called, and the
patient had no central or peripheral access. Oral glucose was
given and a small peripheral IV was placed during attempt at R
femoral CVL.

Femoral CVL wire could not be advanced in the vessle. The
patient had notable skin bleeding. Direct pressure for 5 minutes
held. Through the left arm PVL 1xamp D50 was pushed with return
to consciousness of the patient. While waiting for transfer to
the MICU, several minutes later the patient was noted to be
twitching, and the LUE PVL dislodged. At this time a second FS
was 60, and she again was unresponsive, so a second code-blue
was called. A Left femoral CVL was placed, with some resistance
to advancement of the wire, but the catheter was placed
succesfully. 2 amps of D50 were given. She then was placed on a
D5 drip and transferred to the MICU. After line placement she
was noted with petechia over her body, and it was not known if
they were there before. Hemolysis labs, coagulation profile and
platelets were checked which were normal.

In the MICU she was given additional dextrose, with close
followup by [**Last Name (un) **], was stabilized on a new regimen. It is
unclear what caused the hypoglycemia, but it is through to be
dose stacking with the pump. She was observed for 48h with
stable blood sugars.

1. Type 1 DM uncontrolled
- [**Last Name (un) **] consultation, with close f/u with Dr. [**Last Name (STitle) 174**] this week
- Continue pump

2. LUE THROMBOPHLEBITIS
- D50 infiltration during code
- No DVT on US
- warm packs

3. Hypothyroidism
- Synthroid

4. Hyperlipidemia
- Lipitor

5. ADHD
- Adderal

6. Epilepsy
- Depakote

Medications on Admission:
MEDICATIONS - Confirmed with pt all doses in ED at [**2196-6-28**]:
1. Insulin pump with Humalog.
2. Protonix 40 mg p.o. b.i.d.
3. Neurontin 900 mg q.a.m., 900 mg q. lunch, 1,200 mg q.h.s.
4. Depakote ER 1,500 mg q.d.
5. Lipitor 10 mg q.d.
6. Levoxyl 75 mg p.o. q.d.
7. HCTZ 12.5 mg po qd
8. Lisinopril 40 mg po qd
9. Adderal 20 mg po qd
10. Luvox 250 mg po qd
11. ASA 81 mg po qd


Discharge Medications:
1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
2. Gabapentin 300 mg Capsule Sig: Three (3) Capsule PO Q8H
(every 8 hours).
3. Divalproex 500 mg Tablet Sustained Release 24 hr Sig: Three
(3) Tablet Sustained Release 24 hr PO DAILY (Daily).
4. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
6. Hydrochlorothiazide 25 mg Tablet Sig: 0.5 Tablet PO DAILY
(Daily).
7. Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

8. Dextrose (Diabetic Use) 300 mg Tablet Sig: One (1) Tablet PO
PRN (as needed).
9. Adderall 10 mg Tablet Sig: One (1) Tablet PO once a day.
10. Insulin
Take your insulin as previously directed by [**Hospital **] Clinic


Discharge Disposition:
Home

Discharge Diagnosis:
Type 1 DM uncontrolled with complications
LUE Thrombophlebitis
Hypothyroidism
Hyperlipidemia
ADHD
Epilepsy


Discharge Condition:
Good


Discharge Instructions:
Closely monitor your blood sugars, and if they become lower than
80, immediately consume sugar containing foods. Closely monitor
your insulin pump as instructed by your diabetes doctors [**First Name8 (NamePattern2) **] [**Name5 (PTitle) 4372**]

Followup Instructions:
Dr. [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 174**] at [**Hospital **] Clinic (please contact Dr. [**Last Name (STitle) 174**] for an
appointment next week)
Dr. [**Last Name (STitle) **] [**Name (STitle) 19706**] in [**Location (un) 19707**], MA
Dr. [**First Name4 (NamePattern1) 3613**] [**Last Name (NamePattern1) **] at [**Hospital 18**] [**Hospital **] clinic
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 6952**], MD Phone:[**Telephone/Fax (1) 3241**]
Date/Time:[**2196-11-30**] 11:00
{'Diabetes with neurological manifestations, type I [juvenile type], uncontrolled,Other vascular complications of medical care, not elsewhere classified,Dehydration,Schizoaffective disorder, unspecified,Polyneuropathy in diabetes,Poisoning by insulins and antidiabetic agents,Accidental poisoning by hormones and synthetic substitutes,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Anemia, unspecified,Other constipation,Esophageal reflux,Unspecified acquired hypothyroidism,Epilepsy, unspecified, without mention of intractable epilepsy,Attention deficit disorder with hyperactivity,Obsessive-compulsive disorders'}


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: n/v and weakness

PRESENT ILLNESS: Pt is a 43 yo woman who presented to [**Hospital **] clinic to return
equipment associated with her capsule endoscopy. She c/o n/v and
weakness. FSBS checked there revealed BS>400. She was referred
to ED for evaluation. She had been given golytely bowel prep
several days before for cleaning the bowel in prep for capsul
endoscopy as eval for anemia

MEDICAL HISTORY: 1. Type 1 diabetes
-- 2 failed pancreatic transplants, most recent in [**2195-5-18**], at
[**Hospital1 **]
2. GERD, now s/p nissen in [**2188**].
3. Constipation.
4. History adenomatous polyps, negative colonoscopy in [**2189**].
5. OCD
6. Status post wrist and knee surgeries for tendon repairs.
7. Possible seizure disorder, primary neurologist, Dr.
[**Last Name (STitle) **],at [**State 1558**]. The patient has never
been seen in the hospital to have true seizure disorder;
however, she has described seizures consistent with tonic clonic
seizures at home and, therefore, is on Depakote for seizure
prophylaxis. She is also noted to have psychogenic seizures, per
Dr. [**Last Name (STitle) **], which are characteristically episodes of
unresponsiveness or shaking that is not consistent with organic
brain seizures. She has had several psychogenic seizures and has
been admitted at other hospitals for these episodes, usually
they pass over a number of hours and the only thing that has
been shown to help is constant reassurance from the staff that
the patient is doing well.
8. Hypercholesterolemia.
9. History of schizo-affective disorder.
10. History of catatonic depression.
11. question of bipolar disorder.
12. ADHD
13. Hypothyroid
14. allergic to tegretol, codeine (rash)

MEDICATION ON ADMISSION: MEDICATIONS - Confirmed with pt all doses in ED at [**2196-6-28**]:
1. Insulin pump with Humalog.
2. Protonix 40 mg p.o. b.i.d.
3. Neurontin 900 mg q.a.m., 900 mg q. lunch, 1,200 mg q.h.s.
4. Depakote ER 1,500 mg q.d.
5. Lipitor 10 mg q.d.
6. Levoxyl 75 mg p.o. q.d.
7. HCTZ 12.5 mg po qd
8. Lisinopril 40 mg po qd
9. Adderal 20 mg po qd
10. Luvox 250 mg po qd
11. ASA 81 mg po qd

ALLERGIES: Compazine / Codeine / Benzodiazepines

PHYSICAL EXAM: PHYSICAL EXAMINATION ON ADMISSION:
Vital signs: Temperature 97.8, blood pressure 104/68, heart rate
70 , respiratory rate 16/min, saturating 97% in room air.
General: NAD
HEENT: perlla, oropharynx clear
Neck: supple, no jvd
Heart: rrr, nl s1+s2, no m/r/g
Lungs: ctab, nl effort
Abdomen: soft, non tender, nl bs
Extremities:  no o/c/c
Neurologic:  a&o x 3

FAMILY HISTORY: NC

SOCIAL HISTORY: - TOB, - ETOH, - Drugs 

### Response:
{'Diabetes with neurological manifestations, type I [juvenile type], uncontrolled,Other vascular complications of medical care, not elsewhere classified,Dehydration,Schizoaffective disorder, unspecified,Polyneuropathy in diabetes,Poisoning by insulins and antidiabetic agents,Accidental poisoning by hormones and synthetic substitutes,Phlebitis and thrombophlebitis of superficial veins of upper extremities,Anemia, unspecified,Other constipation,Esophageal reflux,Unspecified acquired hypothyroidism,Epilepsy, unspecified, without mention of intractable epilepsy,Attention deficit disorder with hyperactivity,Obsessive-compulsive disorders'}
