CHIEF COMPLAINT: Mental status changes
Hypoglycemia

PRESENT ILLNESS: 56yo RH M h/o alcoholic cirrhosis, diabetes, chronic renal
insufficiency p/w hypoglycemia and AMS. Pt was in USOH till last
night. His wife heard him moaning at 2 am. EMS was called. His
FSG was 30. He recived D50 and FSG went up to 130. He was
confused and delirious and was taken to the ED.
.
In the ED he was founbd to have fever to 101 and was delirious
and agitated. His head CT was neg for acute IC process. He
underwent LP under conscious sedation. Neuro was consulted. He
received CTX 2g x 1 and acyclovir 750 mg x 1. UA was neg and CXR
showed LLL opacity concerning for PNA.
.
His wife reports that he had a episode of hypoglycemia at the
time of [**Holiday **] when he also had a seizure-like activity
with it. However at that time his MS [**Name13 (STitle) 34984**] to baseline
quickly. Also she notes that he has [**Last Name (un) **] coughing on and off for
past few days, sometimes bringing up mucus.
.
ROS (per his wife): No night sweats or recent weight loss or
gain. Denied shortness of breath. Denied chest pain or
tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.
Denied rash.

MEDICAL HISTORY: DM with unspecified complication type 2 - Type w many
complications
Retinopathy, Neuropathy
Diabetes Type: 2
Years w/ DM: 4 Age of Diag: 52 Year Diag: [**2137**]
How Diag: classic symptoms
Patient treats diabetes with: - Insulin. Patient is on the
sliding level insulin plan.
Alcoholic Cirrhosis of Liver
Hyperparathyroidism, secondary, of renal origin
Joint pain, shoulder
GI Bleeding
Alcohol Abuse
Psych Factors Associated with DM
Anemia of End Stage Renal Disease awaits renal-liver transplant
Impotence, organic origin
Hypofunction, testicular NEC
Chronic kidney disease, stage 3
Microalbuminuria
Hypertension, benign essential

MEDICATION ON ADMISSION: Multivitamin once a day
Humalog sliding scale
nadolol 40 mg once a day
nortriptyline 25 mg once a day
lisinopril 20 mg once a day
Lantus insulin 10 units once a day
folic acid 1 mg daily
calcitriol 0.5 mg daily
Amoxicillin before dental work

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.6 138/70 89 16 100%/RA
Gen Awake, NAD
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in

FAMILY HISTORY: mother/father had diabetes

SOCIAL HISTORY: on disability. Quit etoh 4yrs ago. Wife does not know of any
illicit drug use.
Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Injury to bladder and urethra, without mention of open wound into cavity,End stage renal disease,Anemia in chronic kidney disease,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Thrombocytopenia, unspecified,Unspecified accident,Accidents occurring in residential institution,Reaction to spinal or lumbar puncture,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere
DMII oth uncntrld,Hyp kid NOS w cr kid V,Acidosis,Bladder/urethra inj-clos,End stage renal disease,Anemia in chr kidney dis,Alcohol cirrhosis liver,Alcoh dep NEC/NOS-remiss,Thrombocytopenia NOS,Accident NOS,Accid in resident instit,Lumbar puncture reaction,Abn react-procedure NEC,Nephritis NOS in oth dis
Admission Date:  [**2142-11-20**]              Discharge Date:   [**2142-11-22**]

Date of Birth:  [**2086-2-26**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 2160**]
Chief Complaint:
Mental status changes
Hypoglycemia

Major Surgical or Invasive Procedure:
lumbar puncture


History of Present Illness:
56yo RH M h/o alcoholic cirrhosis, diabetes, chronic renal
insufficiency p/w hypoglycemia and AMS. Pt was in USOH till last
night. His wife heard him moaning at 2 am. EMS was called. His
FSG was 30. He recived D50 and FSG went up to 130. He was
confused and delirious and was taken to the ED.
.
In the ED he was founbd to have fever to 101 and was delirious
and agitated. His head CT was neg for acute IC process. He
underwent LP under conscious sedation. Neuro was consulted. He
received CTX 2g x 1 and acyclovir 750 mg x 1. UA was neg and CXR
showed LLL opacity concerning for PNA.
.
His wife reports that he had a episode of hypoglycemia at the
time of [**Holiday **] when he also had a seizure-like activity
with it. However at that time his MS [**Name13 (STitle) 34984**] to baseline
quickly. Also she notes that he has [**Last Name (un) **] coughing on and off for
past few days, sometimes bringing up mucus.
.
ROS (per his wife): No night sweats or recent weight loss or
gain. Denied shortness of breath. Denied chest pain or
tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.
Denied rash.


Past Medical History:
DM with unspecified complication type 2 - Type w many
complications
Retinopathy, Neuropathy
Diabetes Type: 2
Years w/ DM: 4 Age of Diag: 52 Year Diag: [**2137**]
How Diag: classic symptoms
Patient treats diabetes with: - Insulin. Patient is on the
sliding level insulin plan.
Alcoholic Cirrhosis of Liver
Hyperparathyroidism, secondary, of renal origin
Joint pain, shoulder
GI Bleeding
Alcohol Abuse
Psych Factors Associated with DM
Anemia of End Stage Renal Disease awaits renal-liver transplant
Impotence, organic origin
Hypofunction, testicular NEC
Chronic kidney disease, stage 3
Microalbuminuria
Hypertension, benign essential

Social History:
on disability. Quit etoh 4yrs ago. Wife does not know of any
illicit drug use.


Family History:
mother/father had diabetes


Physical Exam:
VS: 97.6 138/70 89 16 100%/RA
Gen Awake, NAD
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in

oropharynx
Neck Supple, no carotid bruits appreciated. No nuchal rigidity
Lungs CTA bilaterally
CV RRR, nl S1S2, no M/R/G noted
Abd soft, NT/ND, normoactive bowel sounds, no masses or
organomegaly noted. Tympanic
Ext No C/C/E b/l
Skin no rashes or lesions noted


Pertinent Results:
[**2142-11-22**] 06:45AM BLOOD WBC-5.5 RBC-3.06* Hgb-8.8* Hct-27.1*
MCV-89 MCH-28.8 MCHC-32.5 RDW-13.5 Plt Ct-133*
[**2142-11-21**] 03:31AM BLOOD WBC-5.5 RBC-2.95* Hgb-8.6* Hct-26.1*
MCV-88 MCH-29.2 MCHC-33.1 RDW-13.6 Plt Ct-119*
[**2142-11-20**] 04:27AM BLOOD WBC-6.3# RBC-3.86* Hgb-11.0* Hct-33.9*
MCV-88 MCH-28.5 MCHC-32.5 RDW-14.0 Plt Ct-187
[**2142-11-20**] 10:20AM BLOOD Neuts-81.2* Bands-0 Lymphs-12.7*
Monos-5.4 Eos-0.6 Baso-0.1
[**2142-11-21**] 12:16PM BLOOD PT-14.7* PTT-37.2* INR(PT)-1.3*
[**2142-11-22**] 06:45AM BLOOD Glucose-111* UreaN-13 Creat-1.9* Na-138
K-4.1 Cl-105 HCO3-27 AnGap-10
[**2142-11-20**] 04:27AM BLOOD Glucose-110* UreaN-19 Creat-2.2* Na-137
K-4.3 Cl-101 HCO3-26 AnGap-14
[**2142-11-21**] 12:16PM BLOOD ALT-16 AST-33 LD(LDH)-152 AlkPhos-82
Amylase-124* TotBili-0.3
[**2142-11-20**] 04:27AM BLOOD ALT-23 AST-39 AlkPhos-118* Amylase-189*
TotBili-0.7
[**2142-11-22**] 06:45AM BLOOD Calcium-8.6 Phos-2.9 Mg-2.1
[**2142-11-21**] 12:16PM BLOOD Albumin-3.4 Calcium-7.8* Phos-2.5*
Mg-3.6* Iron-66
[**2142-11-21**] 12:16PM BLOOD calTIBC-241* VitB12-354 Folate-GREATER TH
Ferritn-157 TRF-185*
[**2142-11-21**] 03:31AM BLOOD %HbA1c-5.8
[**2142-11-20**] 04:29AM BLOOD Ammonia-40
[**2142-11-20**] 04:27AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2142-11-20**] 06:14PM BLOOD Lactate-1.6
[**2142-11-20**] 10:24AM BLOOD Lactate-2.3*
[**2142-11-21**] 06:17PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.002
[**2142-11-21**] 06:17PM URINE Blood-SM  Nitrite-NEG Protein-NEG
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2142-11-20**] 10:18PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.011
[**2142-11-20**] 10:18PM URINE Blood-MOD Nitrite-NEG Protein-TR
Glucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2142-11-20**] 10:18PM URINE RBC-88* WBC-1 Bacteri-NONE Yeast-NONE
Epi-<1 /HPF
[**2142-11-20**] 10:18PM URINE Mucous-RARE
[**2142-11-20**] 05:50AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.005
[**2142-11-20**] 05:50AM URINE RBC-0 WBC-0 Bacteri-NONE Yeast-NONE Epi-0
[**2142-11-20**] 05:50AM URINE
[**2142-11-20**] 05:50AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-NEG mthdone-NEG
[**2142-11-20**] 10:00AM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-0 Polys-76
Lymphs-8 Monos-16
[**2142-11-20**] 10:00AM CEREBROSPINAL FLUID (CSF) TotProt-30 Glucose-70
[**2142-11-20**] 10:00AM CEREBROSPINAL FLUID (CSF) HERPES SIMPLEX VIRUS
PCR-PND

Blood and urine culture neg to date. CSF cultures neg to date.

US FINDINGS: Limited survey of the four quadrants of the abdomen
demonstrates no intra-abdominal ascites. Incidental note is made
of an echogenic liver echotexture and cholelithiasis, which was
also present on previous study.

IMPRESSION: No intra-abdominal ascites.

CXR: FINDINGS: A single portable radiograph is available for
review. Lung volumes are slightly decreased when compared to
previous. Fullness within the hilar regions bilaterally is
believed secondary to low lung volumes and vascular crowding.
There is a subtle opacity within the left lung base. No effusion
or pneumothorax is identified.

IMPRESSION: Suble opacity in the left lung base which may
represent focal atelectasis however correlation with PA and
lateral radiographs recommended. Otherwise, no acute
cardiopulmonary process is detected.

NONCONTRAST HEAD CT: Multiple attempts were made, however, the
patient was not able lie still and various parts of scan are
limited by motion. Within the limitations, there is no evidence
of acute intracranial hemorrhage or major vascular territorial
infarct. The ventricles are normal in size and configuration.
There are no extra-axial fluid collections. No calvarial
fractures identified. There is complete opacification of the
right maxillary sinus with mild thickening of the underlying
bone, suggesting chronic sinusitis.

IMPRESSION:
1. Limited study due to motion. No evidence of acute
intracranial hemorrhage or major vascular territorial infarct.

2. Chronic right maxillary sinusitis.

CXR: FINDINGS: In comparison to the previous examination of
[**2142-11-20**], there is no relevant change. The pre-existing very
subtle parenchymal opacity at the left lateral lung base is
slightly smaller than on the previous examination. The lack of
contour loss of the left hemidiaphragm, not the left heart
border, makes an inflammatory opacity unlikely. No pleural
effusion. No signs of fluid overload, no other suspicious
pulmonary opacities. The size of the cardiac silhouette is
within the upper range of normal, with an accentuated left heart
border.

IMPRESSION: In comparison to [**2140-11-20**], there is slight
decrease in subtle left- sided opacity. Configuration and
morphology of this opacity, however, make an inflammatory
etiology unlikely. Accentuated left heart border.

Brief Hospital Course:
# H/o DM type 2 / Hypoglycemia: from poor po intake from missing
dentures. Now resolved as her started eating. [**Last Name (un) **] follow up
arranged/ Diabetic education provided by nutrition. Continue
lantus at 6 units at bedtime with humalog coverage only if
sugars>200. Discussed at length with patient about appropriate
meals and [**Last Name (un) **] education. VNA arranged for at home for continual
diabetic education.

# Delirium: resolved. Likely related to prolonged hypoglyemia.
No signs of infection on LP. Did well off antibiotics. Per wife,
patient's mentation is at baseline. Neuro folloed as well.

#Fever in ER: no recurrence. Negative culture data to date.
Antibiotics stopped.

# CKD stage : On list for kidney transplant. On renal
supplements - calcitriol and lisinopril.

# Alcoholic cirrhosis: on nadolol. On list for liver transplant.
D/w liver team - no indication of acute encephalopathy.

# Anemia: has a history of varices (banded) in past. Guiac neg
per ICU team.
Hematocrit stable in hospital. Plan hct check with PCP next
appt. Patient reports he stopped taking oral iron a few weeks
back which could be the reason he is now anemic.

# Post LP headache - resolved with conservative measures.
.
# Thrombocytopenia: dilutional vs hypersplenism. Has had low
platelets in past. Plan to check plts with PCP at next appt.
.
# Hematuria: repeat UA with PCP. [**Name10 (NameIs) **] from foley trauma. U
culture pending.

# Abnormal CXR: Opacity since [**2139**] - as above. Defer further
evaluation to PCP.

Medications on Admission:
Multivitamin once a day
Humalog sliding scale
nadolol 40 mg once a day
nortriptyline 25 mg once a day
lisinopril 20 mg once a day
Lantus insulin 10 units once a day
folic acid 1 mg daily
calcitriol 0.5 mg daily
Amoxicillin before dental work

Discharge Medications:
1. Nadolol 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).
2. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1)
Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*0*
3. Calcitriol 0.5 mcg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
4. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
7. Insulin Glargine 100 unit/mL Solution Sig: 6 (six) Units
Subcutaneous at bedtime.
8. Multivitamin     Tablet Sig: One (1) Tablet PO once a day.
9. Amoxicillin 500 mg Capsule Sig: Four (4) Capsule PO once: one
hour before dental work as recommended by  the dentist.
10. Nortriptyline 25 mg Capsule Sig: One (1) Capsule PO once a
day.
11. Humalog 100 unit/mL Solution Sig: as per attached sliding
scale  Subcutaneous four times a day.


Discharge Disposition:
Home With Service

Facility:
[**Hospital 119**] Homecare

Discharge Diagnosis:
Hypoglycemia, resolved
Diabetes mellitus type 1, uncontrolled with complications
Delirium, resolved
Alcoholic cirrhosis
Chronic kidney disease stage 3


Discharge Condition:
stable.


Discharge Instructions:
Your were admitted for confulsion likely related to very low
sugar levels. The low sugar was from missing a meal or eating
poorly (while being on insulin). It is very important that you
closely monitor your sugars and take regular meals especially
since you are on insulin.

Keep your appointments. You also are advised to follo wup with
[**Hospital **] clinic.

Nursing services have been set up for you at home (visiting
nurses) mainly for diabetic education.

Return to the hospital if you notice any bleeding, confusion,
sweating or other symptoms of concern to you. Your platelets and
hematocrit counts were low and so please discuss with your
primary doctor [**First Name8 (NamePattern2) **] [**Last Name (Titles) **] about getting a blood work done at your
visit with him. Also discuss with your primary doctor about
getting another urine test to look for blood.

Followup Instructions:
Primary care Provider: [**First Name8 (NamePattern2) **] [**Name11 (NameIs) 815**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2142-12-6**] 2:30. Discuss with your primary doctor about
checking a bloot test for CBC at that time.

[**Hospital **] clinic:
1. With [**Doctor First Name **] ([**Telephone/Fax (1) 2378**]) on [**2142-11-29**] at 1430 hours
2. Dr [**Last Name (STitle) 10516**] on [**2142-12-24**] at 11AM

Provider:  [**Name10 (NameIs) **] Phone:[**Telephone/Fax (1) 327**] Date/Time:[**2143-1-7**]
10:00
Provider: [**Name10 (NameIs) **] [**Name8 (MD) **], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2143-1-23**] 10:00
Provider: [**First Name4 (NamePattern1) 971**] [**Last Name (NamePattern1) 970**], MD Phone:[**Telephone/Fax (1) 673**]
Date/Time:[**2143-1-25**] 10:30
{'Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Injury to bladder and urethra, without mention of open wound into cavity,End stage renal disease,Anemia in chronic kidney disease,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Thrombocytopenia, unspecified,Unspecified accident,Accidents occurring in residential institution,Reaction to spinal or lumbar puncture,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}


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: Mental status changes
Hypoglycemia

PRESENT ILLNESS: 56yo RH M h/o alcoholic cirrhosis, diabetes, chronic renal
insufficiency p/w hypoglycemia and AMS. Pt was in USOH till last
night. His wife heard him moaning at 2 am. EMS was called. His
FSG was 30. He recived D50 and FSG went up to 130. He was
confused and delirious and was taken to the ED.
.
In the ED he was founbd to have fever to 101 and was delirious
and agitated. His head CT was neg for acute IC process. He
underwent LP under conscious sedation. Neuro was consulted. He
received CTX 2g x 1 and acyclovir 750 mg x 1. UA was neg and CXR
showed LLL opacity concerning for PNA.
.
His wife reports that he had a episode of hypoglycemia at the
time of [**Holiday **] when he also had a seizure-like activity
with it. However at that time his MS [**Name13 (STitle) 34984**] to baseline
quickly. Also she notes that he has [**Last Name (un) **] coughing on and off for
past few days, sometimes bringing up mucus.
.
ROS (per his wife): No night sweats or recent weight loss or
gain. Denied shortness of breath. Denied chest pain or
tightness, palpitations. Denied nausea, vomiting, diarrhea,
constipation or abdominal pain. No recent change in bowel or
bladder habits. No dysuria. Denied arthralgias or myalgias.
Denied rash.

MEDICAL HISTORY: DM with unspecified complication type 2 - Type w many
complications
Retinopathy, Neuropathy
Diabetes Type: 2
Years w/ DM: 4 Age of Diag: 52 Year Diag: [**2137**]
How Diag: classic symptoms
Patient treats diabetes with: - Insulin. Patient is on the
sliding level insulin plan.
Alcoholic Cirrhosis of Liver
Hyperparathyroidism, secondary, of renal origin
Joint pain, shoulder
GI Bleeding
Alcohol Abuse
Psych Factors Associated with DM
Anemia of End Stage Renal Disease awaits renal-liver transplant
Impotence, organic origin
Hypofunction, testicular NEC
Chronic kidney disease, stage 3
Microalbuminuria
Hypertension, benign essential

MEDICATION ON ADMISSION: Multivitamin once a day
Humalog sliding scale
nadolol 40 mg once a day
nortriptyline 25 mg once a day
lisinopril 20 mg once a day
Lantus insulin 10 units once a day
folic acid 1 mg daily
calcitriol 0.5 mg daily
Amoxicillin before dental work

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 97.6 138/70 89 16 100%/RA
Gen Awake, NAD
HEENT NC/AT, no scleral icterus noted, MMM, no lesions noted in

FAMILY HISTORY: mother/father had diabetes

SOCIAL HISTORY: on disability. Quit etoh 4yrs ago. Wife does not know of any
illicit drug use. 

### Response:
{'Diabetes with other specified manifestations, type II or unspecified type, uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Injury to bladder and urethra, without mention of open wound into cavity,End stage renal disease,Anemia in chronic kidney disease,Alcoholic cirrhosis of liver,Other and unspecified alcohol dependence, in remission,Thrombocytopenia, unspecified,Unspecified accident,Accidents occurring in residential institution,Reaction to spinal or lumbar puncture,Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}
