CHIEF COMPLAINT: hyperglycemia, CP, SI

PRESENT ILLNESS: Mr. [**Known lastname **] is a 41yo gentleman with h/o type 1 DM, hepatitis C
and polysubstance abuse who presented with chest pain and
passive SI, and was found to have hyperglycemia to 985. The
history is somewhat limited by patient sleepiness, but per him,
he was doing well until about three days ago, when home stress
caused him to start drinking again and doing cocaine. He said he
drank about 3 gallons of hard liquor over the past 3 days and
was doing cocaine daily. He reports his last drink was just
before going to the ED and his last cocaine was 7pm the night
before admission. During this time, he lost track of his insulin
and was not taking it. On the morning of admission, he developed
substernal chest heaviness radiating to his shoulder and worse
with exertion. For this as well as passive SI, he presented to
the ED.
.
In the emergency department initial vitals. He was given aspirin
and ativan. EKG did not show evidence of ischemia. Labs were
notable for glucose of 985, k of 5.0, anion gap of 19 (ABG not
done), positive urine ketones, positive urine cocaine, negative
in serum (other tox screen negative). His sodium was 122, which
corrected to 136.2. Calculated osmolality was 316 and 344 with
corrected sodium). WBC was 6.2 and CEs were normal x 1. CXR was
felt to be normal. He was given 10mg IV regular insulin and
started on an insulin gtt at 8U/hr. By the time of signout, he
was finishing his 2ng liter of NS with a 3rd to be hanged upon
leaving the ED. He remained hemodynamically in the ED.
.
vitals before transfer. 81 113/57 13 97%RA AF
.
REVIEW OF SYSTEMS:
(+)ve: as per HPI
(-)ve: fever, chills, night sweats, loss of appetite, fatigue,
palpitations, rhinorrhea, nasal congestion, cough, sputum
production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia,
melena, dysuria, urinary frequency, urinary urgency, focal
numbness, focal weakness, myalgias, arthralgias

MEDICAL HISTORY: Type 1 DM followed at [**Last Name (un) **]
Chronic Hepatitis C - has been referred to Liver Center
Polysubstance abuse - heroin overdose in 96 and 00, has been on
suboxone from Dr. [**Last Name (STitle) 93335**]
Alcohol abuse - reports gets shaky but no known h/o seizures or
DTs
Bipolar disorder h/o suicide attempts (by cutting himself, by
overdose)
s/p appendectomy
Cardiac cath in [**2189**] with non-obstructive coronary disease
Dyslipidemia

MEDICATION ON ADMISSION: Meds [**First Name8 (NamePattern2) **] [**Last Name (un) 387**] notes:
Lantus 100/ml as directed
Simvastatin 5mg take 1 tablet (5MG) by ORAL route every day in
the evening
Suboxone 8mg-2mg place 1 tablet (8MG) by Sublingual route every
day allow to dissolve slowly in mouth without chewing or
swallowing
Humalog 100/ml as directed
Accu-chek Aviva test 4-5X/day
Insulin Syringe Ultra-fine Ii 31gx5/16"
Abilify 30mg once at bedtime
Aspirin 81mg once a day
Wellbutrin Sr 150mg once a day
Accu-chek Comfort Curve as directed
Glucagon Emergency Kit 1mg as needed
Viagra 100mg take [**2-12**] -1 tablet as directed
Ketostix Reagent as directed

ALLERGIES: Penicillins

PHYSICAL EXAM: GENERAL: sleepy, but cooperative and in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. No JVD.
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses. No stigmata of chronic
liver disease.
NEURO: A&Ox3. Appropriate but sleepy, frequently falls asleep.
Wakes right back up with prompting and is cooperative. CN 2-12
intact. Preserved sensation throughout. 5/5 strength throughout.
Normal coordination. Gait assessment deferred
PSYCH: endorses passive SI

FAMILY HISTORY: Both parents were alcoholics.

SOCIAL HISTORY: Works as roofer. Longest period of sobriety was 17 months with
help of NA/AA. Has had frequent lapses. Mr. [**Known lastname **] only smokes
tobacco when he is on a drinking binge. He has a 9yo daughter
with whom he is close. Lives with his girlfriend, who does not
use drugs or drink.
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Cocaine dependence, continuous,Hyposmolality and/or hyponatremia,Suicidal ideation,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Acute alcoholic intoxication in alcoholism, continuous,Precordial pain,Chronic hepatitis C without mention of hepatic coma,Bipolar disorder, unspecified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder
DMI ketoacd uncontrold,Acute kidney failure NOS,Cocaine depend-contin,Hyposmolality,Suicidal ideation,Long-term use of insulin,Hx of past noncompliance,Ac alcohol intox-contin,Precordial pain,Chrnc hpt C wo hpat coma,Bipolar disorder NOS,Crnry athrscl natve vssl,Anemia NOS,Hyperlipidemia NEC/NOS,Tobacco use disorder
Admission Date:  [**2191-2-24**]              Discharge Date:   [**2191-3-1**]

Date of Birth:  [**2149-8-30**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 1115**]
Chief Complaint:
hyperglycemia, CP, SI

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Mr. [**Known lastname **] is a 41yo gentleman with h/o type 1 DM, hepatitis C
and polysubstance abuse who presented with chest pain and
passive SI, and was found to have hyperglycemia to 985. The
history is somewhat limited by patient sleepiness, but per him,
he was doing well until about three days ago, when home stress
caused him to start drinking again and doing cocaine. He said he
drank about 3 gallons of hard liquor over the past 3 days and
was doing cocaine daily. He reports his last drink was just
before going to the ED and his last cocaine was 7pm the night
before admission. During this time, he lost track of his insulin
and was not taking it. On the morning of admission, he developed
substernal chest heaviness radiating to his shoulder and worse
with exertion. For this as well as passive SI, he presented to
the ED.
.
In the emergency department initial vitals. He was given aspirin
and ativan. EKG did not show evidence of ischemia. Labs were
notable for glucose of 985, k of 5.0, anion gap of 19 (ABG not
done), positive urine ketones, positive urine cocaine, negative
in serum (other tox screen negative). His sodium was 122, which
corrected to 136.2. Calculated osmolality was 316 and 344 with
corrected sodium). WBC was 6.2 and CEs were normal x 1. CXR was
felt to be normal. He was given 10mg IV regular insulin and
started on an insulin gtt at 8U/hr. By the time of signout, he
was finishing his 2ng liter of NS with a 3rd to be hanged upon
leaving the ED. He remained hemodynamically in the ED.
.
vitals before transfer. 81 113/57 13 97%RA AF
.
REVIEW OF SYSTEMS:
(+)ve: as per HPI
(-)ve: fever, chills, night sweats, loss of appetite, fatigue,
palpitations, rhinorrhea, nasal congestion, cough, sputum
production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia,
melena, dysuria, urinary frequency, urinary urgency, focal
numbness, focal weakness, myalgias, arthralgias


Past Medical History:
Type 1 DM followed at [**Last Name (un) **]
Chronic Hepatitis C - has been referred to Liver Center
Polysubstance abuse - heroin overdose in 96 and 00, has been on
suboxone from Dr. [**Last Name (STitle) 93335**]
Alcohol abuse - reports gets shaky but no known h/o seizures or
DTs
Bipolar disorder h/o suicide attempts (by cutting himself, by
overdose)
s/p appendectomy
Cardiac cath in [**2189**] with non-obstructive coronary disease
Dyslipidemia


Social History:
Works as roofer. Longest period of sobriety was 17 months with
help of NA/AA. Has had frequent lapses. Mr. [**Known lastname **] only smokes
tobacco when he is on a drinking binge. He has a 9yo daughter
with whom he is close. Lives with his girlfriend, who does not
use drugs or drink.

Family History:
Both parents were alcoholics.


Physical Exam:
GENERAL: sleepy, but cooperative and in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. No JVD.
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses. No stigmata of chronic
liver disease.
NEURO: A&Ox3. Appropriate but sleepy, frequently falls asleep.
Wakes right back up with prompting and is cooperative. CN 2-12
intact. Preserved sensation throughout. 5/5 strength throughout.
Normal coordination. Gait assessment deferred
PSYCH: endorses passive SI

Discharge exam:
97.0 120/56 57 18 95RA
awake, alert, cooporative. Mood improved.
physical exam unchanged.


Pertinent Results:
[**2191-2-24**] 06:50AM   GLUCOSE-985* UREA N-20 CREAT-1.3* SODIUM-122*
POTASSIUM-5.0 CHLORIDE-82* TOTAL CO2-21* ANION GAP-24*
[**2191-2-24**] 09:15AM   ACETONE-TRACE OSMOLAL-308

Brief Hospital Course:
41 yo with history of DMI, multiple admissions for DKA, HCV,
polysubstance abuse, and bipolar disorder who presents with
hyperglycemia, elevated gap, and positive ketones in the setting
of insulin noncompliance.
.
Primary Diagnosis: 250.13 DIABETES TYPE I, KETOACIDOSIS
Elevated BG, gap, and positive serum ketones in setting of
noncompliance of insulin and cocaine binge consistant with DKA
vs hyperglycemia with starvation/ketotic state. Noncompliance is
likely precipitant, other causes could be infection but no focal
signs of infection, UA negative for infection, and CXR clear.
Corrected sodium 136.2. GAP closed to 12 upon arrival to ICU
with normalization of Bicarb. His insulin gtt was continued
until his BG normalized and his gap closed.  He was transitioned
to lantus per [**First Name8 (NamePattern2) **] [**Last Name (un) 387**] DKA protocol with q 1 hr finger sticks,
goal 100-200.  On the floor his glucoses were managed with
lantus 30, humalog 4 with meals(higher if carb load, patient
carb counts).
.
ACUTE RENAL FAILURE: likely volume depletion in setting of
hyperglycemia and etoh binge.  Cr returned to baseline with IVF.
.
Secondary Diagnosis: 303.90 DRUG USE/DEPENDENCE, ALCOHOL
Secondary Diagnosis: 304.20 DRUG USE/DEPENDENCE, COCAINE
 significant EtOH in last three days. cocaine as above.  CIWA
started, but not required.  Psych and social work consulted.
Discharged to partial hospital program.
.
Secondary Diagnosis: 296.80 BIPOLAR DISORDER, UNSPECIFIED
Passive SI in ED.  Psychiatry saw the patient and recommended
inpatient psych admission initially; therefore a section 12 was
placed and a 1:1 sitter was employed.  However, as the [**Hospital 228**]
medical condition stabilized and home psych medications were
restarted his mood improved and SI resolved.  He denied further
suicidality.  After discussion by the psych team with the
patient, his girlfriend and his outpatient treaters, he was
found stable for discharge home with close psych follow up and
enrollment in a partial hospital treatment program.
.
#. HCV, chronic: stable. f/u as o/p.
.
CODE STATUS: Full
.
EMERGENCY CONTACT: [**First Name8 (NamePattern2) 1060**] [**Last Name (NamePattern1) 93337**] [**Telephone/Fax (1) 93336**]

Medications on Admission:
Meds [**First Name8 (NamePattern2) **] [**Last Name (un) 387**] notes:
Lantus 100/ml as directed
Simvastatin 5mg take 1 tablet (5MG) by ORAL route every day in
the evening
Suboxone 8mg-2mg place 1 tablet (8MG) by Sublingual route every
day allow to dissolve slowly in mouth without chewing or
swallowing
Humalog 100/ml as directed
Accu-chek Aviva test 4-5X/day
Insulin Syringe Ultra-fine Ii 31gx5/16"
Abilify 30mg once at bedtime
Aspirin 81mg once a day
Wellbutrin Sr 150mg once a day
Accu-chek Comfort Curve as directed
Glucagon Emergency Kit 1mg as needed
Viagra 100mg take [**2-12**] -1 tablet as directed
Ketostix Reagent as directed


Discharge Medications:
1. Lantus 100 unit/mL Cartridge Sig: Thirty (30) units
Subcutaneous at bedtime.
2. Humalog 100 unit/mL Cartridge Sig: Four (4) units
Subcutaneous with meals and snack: with sliding scale. Please
also take with carbohydrate counting as instructed.
3. Simvastatin 5 mg Tablet Sig: One (1) Tablet PO once a day.
4. Buprenorphine-Naloxone 8-2 mg Tablet, Sublingual Sig: One (1)
Tablet Sublingual TID (3 times a day).
5. Aripiprazole 15 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
6. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.
7. Bupropion HCl 150 mg Tablet Sustained Release Sig: One (1)
Tablet Sustained Release PO QAM (once a day (in the morning)).
8. Quetiapine 50 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnosis: 250.13 DIABETES TYPE I, KETOACIDOSIS
Secondary Diagnosis: 311 DEPRESSION, NOS
Secondary Diagnosis: 303.90 DRUG USE/DEPENDENCE, ALCOHOL
Secondary Diagnosis: 070.54 HEPATITIS, C CHRONIC
Secondary Diagnosis: 285.9 ANEMIA, UNSPECIFIED


Discharge Condition:
Mental Status:Clear and coherent
Level of Consciousness:Alert and interactive
Activity Status:Ambulatory - Independent

Discharge Instructions:
As we discussed, you were admitted for high glucoses related to
not taking your insulin. Please continue to take your insulin as
prescribed. We also strongly recommend that you refrain from
using any alcohol or other drugs.
You are being discharged to a partial hospital program for
further management of your depression.

Followup Instructions:
Therapy appointment today at 4pm with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] and a
4:30 Suboxone group appointment today.

Intake appointment at [**Hospital **] Hospital [**Telephone/Fax (1) 35932**] in JP
tomorrow, Wednesday, [**3-2**] at 9 am.

Provider: [**Initials (NamePattern4) **] [**Last Name (NamePattern4) 5004**] [**Last Name (NamePattern1) **], M.D. Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2191-3-21**] 4:00
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Cocaine dependence, continuous,Hyposmolality and/or hyponatremia,Suicidal ideation,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Acute alcoholic intoxication in alcoholism, continuous,Precordial pain,Chronic hepatitis C without mention of hepatic coma,Bipolar disorder, unspecified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder'}


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, CP, SI

PRESENT ILLNESS: Mr. [**Known lastname **] is a 41yo gentleman with h/o type 1 DM, hepatitis C
and polysubstance abuse who presented with chest pain and
passive SI, and was found to have hyperglycemia to 985. The
history is somewhat limited by patient sleepiness, but per him,
he was doing well until about three days ago, when home stress
caused him to start drinking again and doing cocaine. He said he
drank about 3 gallons of hard liquor over the past 3 days and
was doing cocaine daily. He reports his last drink was just
before going to the ED and his last cocaine was 7pm the night
before admission. During this time, he lost track of his insulin
and was not taking it. On the morning of admission, he developed
substernal chest heaviness radiating to his shoulder and worse
with exertion. For this as well as passive SI, he presented to
the ED.
.
In the emergency department initial vitals. He was given aspirin
and ativan. EKG did not show evidence of ischemia. Labs were
notable for glucose of 985, k of 5.0, anion gap of 19 (ABG not
done), positive urine ketones, positive urine cocaine, negative
in serum (other tox screen negative). His sodium was 122, which
corrected to 136.2. Calculated osmolality was 316 and 344 with
corrected sodium). WBC was 6.2 and CEs were normal x 1. CXR was
felt to be normal. He was given 10mg IV regular insulin and
started on an insulin gtt at 8U/hr. By the time of signout, he
was finishing his 2ng liter of NS with a 3rd to be hanged upon
leaving the ED. He remained hemodynamically in the ED.
.
vitals before transfer. 81 113/57 13 97%RA AF
.
REVIEW OF SYSTEMS:
(+)ve: as per HPI
(-)ve: fever, chills, night sweats, loss of appetite, fatigue,
palpitations, rhinorrhea, nasal congestion, cough, sputum
production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia,
melena, dysuria, urinary frequency, urinary urgency, focal
numbness, focal weakness, myalgias, arthralgias

MEDICAL HISTORY: Type 1 DM followed at [**Last Name (un) **]
Chronic Hepatitis C - has been referred to Liver Center
Polysubstance abuse - heroin overdose in 96 and 00, has been on
suboxone from Dr. [**Last Name (STitle) 93335**]
Alcohol abuse - reports gets shaky but no known h/o seizures or
DTs
Bipolar disorder h/o suicide attempts (by cutting himself, by
overdose)
s/p appendectomy
Cardiac cath in [**2189**] with non-obstructive coronary disease
Dyslipidemia

MEDICATION ON ADMISSION: Meds [**First Name8 (NamePattern2) **] [**Last Name (un) 387**] notes:
Lantus 100/ml as directed
Simvastatin 5mg take 1 tablet (5MG) by ORAL route every day in
the evening
Suboxone 8mg-2mg place 1 tablet (8MG) by Sublingual route every
day allow to dissolve slowly in mouth without chewing or
swallowing
Humalog 100/ml as directed
Accu-chek Aviva test 4-5X/day
Insulin Syringe Ultra-fine Ii 31gx5/16"
Abilify 30mg once at bedtime
Aspirin 81mg once a day
Wellbutrin Sr 150mg once a day
Accu-chek Comfort Curve as directed
Glucagon Emergency Kit 1mg as needed
Viagra 100mg take [**2-12**] -1 tablet as directed
Ketostix Reagent as directed

ALLERGIES: Penicillins

PHYSICAL EXAM: GENERAL: sleepy, but cooperative and in NAD
HEENT: Normocephalic, atraumatic. No conjunctival pallor. No
scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck Supple, No
LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**]. No JVD.
LUNGS: CTAB, good air movement biaterally.
ABDOMEN: NABS. Soft, NT, ND. No HSM
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis/ posterior
tibial pulses.
SKIN: No rashes/lesions, ecchymoses. No stigmata of chronic
liver disease.
NEURO: A&Ox3. Appropriate but sleepy, frequently falls asleep.
Wakes right back up with prompting and is cooperative. CN 2-12
intact. Preserved sensation throughout. 5/5 strength throughout.
Normal coordination. Gait assessment deferred
PSYCH: endorses passive SI

FAMILY HISTORY: Both parents were alcoholics.

SOCIAL HISTORY: Works as roofer. Longest period of sobriety was 17 months with
help of NA/AA. Has had frequent lapses. Mr. [**Known lastname **] only smokes
tobacco when he is on a drinking binge. He has a 9yo daughter
with whom he is close. Lives with his girlfriend, who does not
use drugs or drink. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Cocaine dependence, continuous,Hyposmolality and/or hyponatremia,Suicidal ideation,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Acute alcoholic intoxication in alcoholism, continuous,Precordial pain,Chronic hepatitis C without mention of hepatic coma,Bipolar disorder, unspecified,Coronary atherosclerosis of native coronary artery,Anemia, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder'}
