CHIEF COMPLAINT: DKA

PRESENT ILLNESS: 23y/o F diagnosed with DM in [**2171**], initially told it was type 2.
 Started insulin after episode of hyperglycemia summer of [**2172**].
Pt had increased nausea and vomiting one day prior to admission.
 Did not eat 4 days PTA, more po intake 2d PTA but not back to
baseline.  Took her 25 units of lantus at noon on [**1-2**] (day PTA),
but has not been taking her humalog sliding scale due to
decreased po intake.  Pt has had 1-2 episodes of hypoglycemia,
otherwise few problems with insulin.  Unclear whether episode of
hyperglycemia last summer was true DKA.  Pt denies diarrhea,
abdominal pain, fever, cough, or dysuria.
.
Pt was recently seen in ED with frontal headache, for which she
got an LP (negative) and CT head (no bleed, mass effect, or
hydrocephalus).  Was discharged with Percocet, which she stopped
taking due to nausea.  Describes headache as frontal, sharp,
worse with sitting up.  Headache is the same in character as
prior to LP.  Associated nausea, no vomiting, paresthesias,
aura, or photophobia.
.
In the ED, bicarb was 6, anion gap 34, glucose was 345.  Pt was
placed on insulin gtt at 4 units/hour and given 10 units
humalog.  Was given 4L of NS.  Also given anzemet 12.5mg IV x2,
toradol 30mg, and morphine 2mg.

MEDICAL HISTORY: 1.  diabetes type 1 - currently does not have endocrinologist -
set to see one at [**University/College 5130**]
2.  asthma - mild intermittent - never hospitalized or
intubated, takes prn albuterol, triggers include environmental
allergies
3.  h/o L knee surgery x4 involving cartilage repair and
transplant, also with tear of ACL

MEDICATION ON ADMISSION: glargine 25U lunch
albuterol prn
ibuprofen prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  98.6   108/39   113   14   100% RA
Gen: A&Ox3, cooperative
HEENT:  PERRL, EOMI, MM dry
Neck: no JVD, no LAD
CV: tachycardic, regular, nl S1/S2, no m/r/g
Pulm: CTAB
Abd: soft, mild LLQ tenderness to palpation, no rebound or
guarding, +BS, no masses
Ext: warm, 2+ PT pulses, no edema

FAMILY HISTORY: FH:  DM - mother's cousins
asthma - father
M died of liver disease [**12-30**] EtOH

SOCIAL HISTORY: Student at [**University/College 5130**], studying industrial engineering.  Lives
with sister.  Denies tobacco, stopped drinking EtOH after the
death of her mother from alcohol-related liver disease, denies
IVDU.
Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Volume depletion, unspecified,Long-term (current) use of insulin,Headache,Asthma, unspecified type, unspecified
DMI keto nt st uncntrld,Volume depletion NOS,Long-term use of insulin,Headache,Asthma NOS
Admission Date:  [**2174-1-3**]              Discharge Date:   [**2174-1-5**]

Date of Birth:  [**2150-12-27**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8487**]
Chief Complaint:
DKA


Major Surgical or Invasive Procedure:
None

History of Present Illness:
23y/o F diagnosed with DM in [**2171**], initially told it was type 2.
 Started insulin after episode of hyperglycemia summer of [**2172**].
Pt had increased nausea and vomiting one day prior to admission.
 Did not eat 4 days PTA, more po intake 2d PTA but not back to
baseline.  Took her 25 units of lantus at noon on [**1-2**] (day PTA),
but has not been taking her humalog sliding scale due to
decreased po intake.  Pt has had 1-2 episodes of hypoglycemia,
otherwise few problems with insulin.  Unclear whether episode of
hyperglycemia last summer was true DKA.  Pt denies diarrhea,
abdominal pain, fever, cough, or dysuria.
.
Pt was recently seen in ED with frontal headache, for which she
got an LP (negative) and CT head (no bleed, mass effect, or
hydrocephalus).  Was discharged with Percocet, which she stopped
taking due to nausea.  Describes headache as frontal, sharp,
worse with sitting up.  Headache is the same in character as
prior to LP.  Associated nausea, no vomiting, paresthesias,
aura, or photophobia.
.
In the ED, bicarb was 6, anion gap 34, glucose was 345.  Pt was
placed on insulin gtt at 4 units/hour and given 10 units
humalog.  Was given 4L of NS.  Also given anzemet 12.5mg IV x2,
toradol 30mg, and morphine 2mg.


Past Medical History:
1.  diabetes type 1 - currently does not have endocrinologist -
set to see one at [**University/College 5130**]
2.  asthma - mild intermittent - never hospitalized or
intubated, takes prn albuterol, triggers include environmental
allergies
3.  h/o L knee surgery x4 involving cartilage repair and
transplant, also with tear of ACL

Social History:
Student at [**University/College 5130**], studying industrial engineering.  Lives
with sister.  Denies tobacco, stopped drinking EtOH after the
death of her mother from alcohol-related liver disease, denies
IVDU.

Family History:
FH:  DM - mother's cousins
asthma - father
M died of liver disease [**12-30**] EtOH

Physical Exam:
VS:  98.6   108/39   113   14   100% RA
Gen: A&Ox3, cooperative
HEENT:  PERRL, EOMI, MM dry
Neck: no JVD, no LAD
CV: tachycardic, regular, nl S1/S2, no m/r/g
Pulm: CTAB
Abd: soft, mild LLQ tenderness to palpation, no rebound or
guarding, +BS, no masses
Ext: warm, 2+ PT pulses, no edema

Brief Hospital Course:
1.  DKA - likely precipitated by nausea/vomiting and decreased
po intake.
Started on insulin drip, sugars dropped to 70 and given half amp
of D50, sugars became elevated again, and titrated slowly down
in insulin drip, during the evening she tolerated POs and she
was started on her standing and sliding scale insulin, and there
was an overlap of her glargine and sliding scale by two hours.
[**Last Name (un) **] was consulted for these recommendations. Nutrition was
consulted for diabetic nutrition education.  Her sugars remained
stable and she was discharged on a regiment including standing
lantus during the evening, and with humalog 8U prior to each
meal, and then a sliding scale humalog insulin regiment two
hours after her meals.  She was scheduled to follow up at [**Last Name (un) **]
for diabetes management.

.
2.  headaches: She had a dull frontal headache of unclear origin
during her hospital course which was relieved by ibuprofen. It
was thought to be secondary to sinusitis, tension, or migraines.

.
3.  nausea - Her initial nausea was controlled by anzement and
had resolved by discharge with good tolerance of POs
.

Code - full
.
Communication - sister
.


Medications on Admission:
glargine 25U lunch
albuterol prn
ibuprofen prn

Discharge Medications:
1. Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8
hours) as needed.
Disp:*30 Tablet(s)* Refills:*0*
2. Insulin Glargine 100 unit/mL Solution Sig: One (1)
Subcutaneous once a day: 25 units glargine at night.
Disp:*1 qs* Refills:*2*
3. Humalog 100 unit/mL Solution Sig: Three (3)  Subcutaneous
three times a day: 8 Units prior to meal.
Disp:*1 qs* Refills:*2*
4. Insulin Syringe     Syringe Sig: One (1)  Miscell.  five
times a day.
Disp:*1 qs* Refills:*0*
5. Humalog 100 unit/mL Solution Sig: One (1)  Subcutaneous four
times a day: Please administer insulin per sliding scale, prior
to meals and at bedtime.
Disp:*1 qs* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Diabetic Ketoacidosis


Discharge Condition:
Stable


Discharge Instructions:
If you experience increased headaches, fevers, chills or other
concerning symptoms please call your doctor

Please take your medications as instructed.  Please take your
lantus at night, then administer your humalog (8U) prior to
meals, and then check your blood sugar after meals and
administer humalog according to the sliding scale.

Please follow up with you doctors listed below

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] at [**Telephone/Fax (1) 12648**]. We have
emailed her regarding an appointment, and she should contact you
within one week to verify an appointment date. Otherwise please
call [**Last Name (un) **] for an appointment
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Volume depletion, unspecified,Long-term (current) use of insulin,Headache,Asthma, unspecified type, unspecified'}


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: DKA

PRESENT ILLNESS: 23y/o F diagnosed with DM in [**2171**], initially told it was type 2.
 Started insulin after episode of hyperglycemia summer of [**2172**].
Pt had increased nausea and vomiting one day prior to admission.
 Did not eat 4 days PTA, more po intake 2d PTA but not back to
baseline.  Took her 25 units of lantus at noon on [**1-2**] (day PTA),
but has not been taking her humalog sliding scale due to
decreased po intake.  Pt has had 1-2 episodes of hypoglycemia,
otherwise few problems with insulin.  Unclear whether episode of
hyperglycemia last summer was true DKA.  Pt denies diarrhea,
abdominal pain, fever, cough, or dysuria.
.
Pt was recently seen in ED with frontal headache, for which she
got an LP (negative) and CT head (no bleed, mass effect, or
hydrocephalus).  Was discharged with Percocet, which she stopped
taking due to nausea.  Describes headache as frontal, sharp,
worse with sitting up.  Headache is the same in character as
prior to LP.  Associated nausea, no vomiting, paresthesias,
aura, or photophobia.
.
In the ED, bicarb was 6, anion gap 34, glucose was 345.  Pt was
placed on insulin gtt at 4 units/hour and given 10 units
humalog.  Was given 4L of NS.  Also given anzemet 12.5mg IV x2,
toradol 30mg, and morphine 2mg.

MEDICAL HISTORY: 1.  diabetes type 1 - currently does not have endocrinologist -
set to see one at [**University/College 5130**]
2.  asthma - mild intermittent - never hospitalized or
intubated, takes prn albuterol, triggers include environmental
allergies
3.  h/o L knee surgery x4 involving cartilage repair and
transplant, also with tear of ACL

MEDICATION ON ADMISSION: glargine 25U lunch
albuterol prn
ibuprofen prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:  98.6   108/39   113   14   100% RA
Gen: A&Ox3, cooperative
HEENT:  PERRL, EOMI, MM dry
Neck: no JVD, no LAD
CV: tachycardic, regular, nl S1/S2, no m/r/g
Pulm: CTAB
Abd: soft, mild LLQ tenderness to palpation, no rebound or
guarding, +BS, no masses
Ext: warm, 2+ PT pulses, no edema

FAMILY HISTORY: FH:  DM - mother's cousins
asthma - father
M died of liver disease [**12-30**] EtOH

SOCIAL HISTORY: Student at [**University/College 5130**], studying industrial engineering.  Lives
with sister.  Denies tobacco, stopped drinking EtOH after the
death of her mother from alcohol-related liver disease, denies
IVDU. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Volume depletion, unspecified,Long-term (current) use of insulin,Headache,Asthma, unspecified type, unspecified'}
