CHIEF COMPLAINT: DKA - glucose 1200

PRESENT ILLNESS: Mr. [**Known lastname 62528**] is a 25 yo man with no significant PMH who presents
with three weeks of throat pain and odynophagia. Pt reports pain
on swallowing solids but not with liquids, and has been drinking
a lot of fluids, especially juice and soda.  Pt went to his
school health clinic for sore throat, where a culture was taken
and he was given medication to swish and swallow (likely
nystatin but pt unsure of name). The pain did not resolve and
the pt reports decreased desire to eat [**1-27**] pain. As a result he
has been eating little, mainly yogurt, ice cream and other
"junk."  He returned to his school clinic, where his blood was
drawn and he was told to come to the ER due to high blood sugar.
    He reports a 35 pound weight loss in the last 2 months since
his school physical. He notes thirst, increased urination, no
nausea but 2 episodes of vomiting.  He has had some blurry
vision, but says he thinks this is because he needed a new
prescription for eye glasses, which he recently filled. He just
moved to [**Location (un) **] about one month ago from [**Location (un) 18317**] to start law
school at [**University/College **]. His father has diabetes and uses insulin
for it.  No other family history.  Pt notes occasional
palpitations when he is running around only, denies SOB,
lightheadedness, numbness or tingling, dysuria, hematuria, had
been constipated but now having regular BMs.
    In the ER the pt was found to have a serum glucose of 1200
and an anion gap of 30. He was admitted to the unit, where he
was aggressively hydrated and started on an insulin drip.

MEDICAL HISTORY: Pt states that he had pneumnia 2 years ago. He has never been
hospitalized.  He has been told that he has "borderline high"
blood pressure.

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:98.9, 159/90, 69, 100% RA
GEN:Well appearing AA mail in NAD. Tearful but very pleasant and
talkative.
HEENT:Pupils equal, MM dry with white plaquing, neck is supple
with no LAD.
CV: RRR, hyperdynamic, no murmurs
RESP: CTAB
ABD: NDNT, normoactive BS, soft
EXT: NO pedal edema, warm and well perfused.
NEURO:non-focal.

FAMILY HISTORY: father with diabetes diagnosed at age 40, on insulin. otherwise
noncontributory.

SOCIAL HISTORY: Pt is a law student at [**University/College 5130**]. He is from [**Location (un) 18317**]. Denies
tobacco, occasional alcohol but when he does usually binge
drinking, no history of blackouts, denies other drug use.
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Candidiasis of mouth,Unspecified essential hypertension,Family history of diabetes mellitus
DMI ketoacd uncontrold,Thrush,Hypertension NOS,Fam hx-diabetes mellitus
Admission Date:  [**2162-9-10**]              Discharge Date:   [**2162-9-15**]

Date of Birth:  [**2137-5-9**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1055**]
Chief Complaint:
DKA - glucose 1200

Major Surgical or Invasive Procedure:
none


History of Present Illness:
Mr. [**Known lastname 62528**] is a 25 yo man with no significant PMH who presents
with three weeks of throat pain and odynophagia. Pt reports pain
on swallowing solids but not with liquids, and has been drinking
a lot of fluids, especially juice and soda.  Pt went to his
school health clinic for sore throat, where a culture was taken
and he was given medication to swish and swallow (likely
nystatin but pt unsure of name). The pain did not resolve and
the pt reports decreased desire to eat [**1-27**] pain. As a result he
has been eating little, mainly yogurt, ice cream and other
"junk."  He returned to his school clinic, where his blood was
drawn and he was told to come to the ER due to high blood sugar.
    He reports a 35 pound weight loss in the last 2 months since
his school physical. He notes thirst, increased urination, no
nausea but 2 episodes of vomiting.  He has had some blurry
vision, but says he thinks this is because he needed a new
prescription for eye glasses, which he recently filled. He just
moved to [**Location (un) **] about one month ago from [**Location (un) 18317**] to start law
school at [**University/College **]. His father has diabetes and uses insulin
for it.  No other family history.  Pt notes occasional
palpitations when he is running around only, denies SOB,
lightheadedness, numbness or tingling, dysuria, hematuria, had
been constipated but now having regular BMs.
    In the ER the pt was found to have a serum glucose of 1200
and an anion gap of 30. He was admitted to the unit, where he
was aggressively hydrated and started on an insulin drip.

Past Medical History:
Pt states that he had pneumnia 2 years ago. He has never been
hospitalized.  He has been told that he has "borderline high"
blood pressure.

Social History:
Pt is a law student at [**University/College 5130**]. He is from [**Location (un) 18317**]. Denies
tobacco, occasional alcohol but when he does usually binge
drinking, no history of blackouts, denies other drug use.

Family History:
father with diabetes diagnosed at age 40, on insulin. otherwise
noncontributory.

Physical Exam:
VS:98.9, 159/90, 69, 100% RA
GEN:Well appearing AA mail in NAD. Tearful but very pleasant and
talkative.
HEENT:Pupils equal, MM dry with white plaquing, neck is supple
with no LAD.
CV: RRR, hyperdynamic, no murmurs
RESP: CTAB
ABD: NDNT, normoactive BS, soft
EXT: NO pedal edema, warm and well perfused.
NEURO:non-focal.


Pertinent Results:
[**2162-9-10**] 11:19AM   PO2-99 PCO2-39 PH-7.32* TOTAL CO2-21 BASE
XS--5
[**2162-9-10**] 11:19AM   GLUCOSE-1046* LACTATE-2.2* NA+-130* K+-6.3*
[**2162-9-10**] 10:50AM URINE  COLOR-Straw APPEAR-Clear SP [**Last Name (un) 155**]-1.028
[**2162-9-10**] 10:50AM URINE  BLOOD-SM NITRITE-NEG PROTEIN-TR
GLUCOSE-1000 KETONE-150 BILIRUBIN-NEG UROBILNGN-NEG PH-5.0
LEUK-NEG
[**2162-9-10**] 10:50AM URINE  RBC-0-2 WBC-0 BACTERIA-NONE YEAST-NONE
EPI-0
[**2162-9-10**] 10:47AM   GLUCOSE-1200* K+-5.6*
[**2162-9-10**] 10:30AM   GLUCOSE-1200* UREA N-31* CREAT-2.4*
SODIUM-130* POTASSIUM-5.7* CHLORIDE-80* TOTAL CO2-19* ANION
GAP-37*
[**2162-9-10**] 10:30AM   AMYLASE-80
[**2162-9-10**] 10:30AM   LIPASE-56
[**2162-9-10**] 10:30AM   MAGNESIUM-2.7*
[**2162-9-10**] 10:30AM   WBC-10.8 RBC-5.56 HGB-15.4 HCT-47.9 MCV-86
MCH-27.8 MCHC-32.3 RDW-12.3
[**2162-9-10**] 10:30AM   NEUTS-89.2* LYMPHS-8.2* MONOS-2.1 EOS-0.1
BASOS-0.4
[**2162-9-10**] 10:30AM   HYPOCHROM-1+
[**2162-9-10**] 10:30AM   PLT COUNT-301

CXR: mild cardiomegaly, no acute pathology
.
Urine cx: c/w contamination

Brief Hospital Course:
Mr. [**Known lastname 62528**] is a 25 yo man with new DM who presented in DKA.

1. Diabetes Mellitus w/ DKA: Pt presented initially with glucose
1200, anion gap 30 and ketones.  Clinical picture a bit clouded
- unclear if this is [**Name (NI) 11398**] or DM2. DKA and young age would argue
for DM1, however, pt is overweight with some acanthosis in
armpits, has FH of DM2, and very high glucose not c/w typical
DKA presentation. (However, pt was drinking soda and juice as
well as eating ice cream before presentation so may have driven
glucose up higher than typical presentation.) After discharge,
his Cpeptide level came back as normal, which suggests DM2.
Anti-islet antibodies and GAD antibodies are pending at this
time and will help to clarify the picture.
     Patient recently presented with esophageal candidiasis
infection, which is consistent with immunosuppression,
especially that seen in diabetics.  On admission, CXR was
negative for any infiltrate, UA was negative for infection, and
EKG showed no ischemic changes with cardiac enzymes negative x2.

     The pt was treated with aggressive fluid hydration and
insulin drip in the ICU with improvement of his glucose levels
and closure of his anion gap.  The pt was
initially having a great deal of denial and difficulty accepting
his new diagnosis of diabetes, refusing insulin and challenging
the team's decision-making around his isulin doses. He was also
eating sugar-filled foods and drinking regular soda despite
being told repeatedly that he needs to follow a diabetic diet.
After his third hospital day, with stabilization and transfer to
the floor, the pt felt more in control of his diagnosis, wroked
along with the team on his diet and insulin doses and asked many
pertinent and appropriate questions. He was seen by [**Last Name (un) **] and
will follow up as an outpt with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17033**] at [**Last Name (un) **], as well
as by signing up for the "Diabetes Today" series of classes at
[**Last Name (un) **].  He was seen by a nutritionist several times throughout
his stay and was working on adjusting his diet to be more
appropriate for a diabetic.  He reported that he was feeling
stress from his new diagnosis and was thinking about the social
implications this disease will have on his life.  By the last
hospital day, the pt was able to check his own fingersticks and
to draw up and administer his own insulin. He repeatedly
required >80 units of insulin per day and was discharged on
Lantus 50units qAM with a pre-meal humalog slide scale to begin
administering insulin at FS 151 (14 units) and increase by 2
units for each 50 increase.  At bedtime he only administers
insulin for FS >250 and starts with 2 units to increase by one
for every increase of 50 in  FS.  He will email [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17033**] with
his fingersticks in the coming days and call to make an
appointment with her ASAP as an outpt. The pt was discharged
with all diabetes materials, including lancets, glucometer, test
strips, syringes, insulin, and ketostix.  The pt has not yet
been educated about a glucagon emergency kit, which should be
done as an outpt. Pt should also be reminded to get a medic
alert bracelet.

2. Thrush: The pt had complaints of sore throat for 3w prior to
admission, and was , given Nystatin swish and swallow as an
outpt for oral thrush. The pt claimed he was partially compliant
with this regimen. On admission, he had oral thrush on
examination. He was treated with continued swish and swallow as
well as Fluconazole. Control of his sugars as well as treatment
with antifungals should provide adequate treatment. The pt was
treated with fluconazole for 5 days, and thrush cleared by
hospital day 3.
.
3. Hypertension: The pt was persistently hypertensive throughout
his hospital stay, ranging from 140-160 SBP.  The pt states that
he was told that he was "borderline hypertensive" in the past.
Given his new diagnosis of diabetes, we started the pt on
lisinopril 5mg PO qday.  This should be readdressed in the
future and treatment adjusted accordingly. The pt has no PCP, [**Name10 (NameIs) 3**]
he is new to the area, but would like to see [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] in [**Company 191**]
if his insurance allows.
.
4. Psychosocial: The pt is new to [**Location (un) 86**], here from [**Location (un) 18317**], and
is a first year law student at [**University/College 5130**] [**Location (un) **]. His
mother was here with him from [**Name (NI) 18317**] throughout his stay and
was very attentive to his needs. The two were initially
resistent and did not accept the diagnosis of diabetes (at times
becoming quite angry with staff, cursing and yelling at them),
but after a few days both played an active role in learning
about the illness.  The pt was given letters to take to his [**Male First Name (un) **]
and professors regarding his absence from school and his
possible need to have snacks or leave lectures unannounced to
check his FS. He was also given a letter to bring with him
during air travel to bring his diabetes supplies with him on
planes.  As an outpt, it will be well worth continually checking
in with th e pt on his adjustment to his new diabetes, as well
as his stress level given first year law student now with
another major life change. This should be followed as an outpt.
.
5. Dispo: The pt was discharged to home with all diabetes
supplies as listed above and with the phone numbers to call
[**Last Name (un) **] for an appointment with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17033**] and [**Hospital 191**] clinic to
call for an appt with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. He will also call [**Last Name (un) **] for
the "Diabetes Today" classes.  He should have tight follow up of
his diabetes and hypertension.

Medications on Admission:
None

Discharge Medications:
1. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
2. Insulin Glargine 100 unit/mL Solution Sig: 0.5 mL
Subcutaneous once a day: please give yourself 50 units of
insuline Glargine every morning.
Disp:*100 mL* Refills:*6*
3. One Touch Ultra Lancets
One Touch Ultra Lancets
sig: please use with One Touch Ultra glucometer to check blood
suger

disp: #200
4. One Touch Ultra test strips
One Touch Ultra glucometer test strips
sig: please use with One Touch Ultra glucometer to test your
blood sugar

disp: #200
5. urine ketostix
Urine Ketostix

sig: use ketostix to test urine for ketones when your finger
stick is greater than 250 or when you feel nauseated or
vomiting. If positive ketones, call [**Last Name (un) **] for the doctor
on-call or come to the ER.

disp: #100
6. BD 1cc syringes with 29G needle
BD 1cc syringes with 29G short needles

sig: use to dispense insulin

disp: #200
7. Insulin Lispro (Human) 100 unit/mL Solution Sig: according to
slide scale  Subcutaneous before breakfast, lunch, dinner, and
bedtime as needed for high fingersticks: Please give insulin
Lispro (Humalog) as needed according to your slide scale when
you check finger sticks before meals and before bedtime.
Disp:*100 mL* Refills:*6*


Discharge Disposition:
Home

Discharge Diagnosis:
diabetes


Discharge Condition:
good


Discharge Instructions:
1. Please follow your new diabetic diet.  Avoid easy sugars - do
not drink juice, or [**Doctor Last Name **] (diet is ok), do not chew sugar gum or
candy. Keep your carbohydrate eating to a minimum, as described
in your new diabetic diet.

2. Please check your fingerstick to measure blood sugar every
day before meals (breakfast, lunch and dinner), and before you
go to bed at night.  Use your insulin slide scale to finger out
how much Humalog (aka Insulin Lispro) to inject at that time.

3. Regardless of your fingerstick, take your Lantus (Insulin
Glargine) every morning.  Right now your dose is 50 units (0.50
mL). [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17033**] will work with you by email to adjust as
needed.

4. If your fingerstick is higher than 250, or if you feel
nauseated or vomit, check your urine with the urine ketostix. If
you have a positive urine ketone result, call [**Last Name (un) **]
([**Telephone/Fax (1) 62529**] come to the emergency room right away.

5. Please email [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17033**] ([**University/College 62530**]) to give
her your fingerstick measurements. She will tell you how to
adjust your doses of insulin, if necessary.

6. You should call [**Last Name (un) **] ([**Telephone/Fax (1) 2384**]) to arrange for an
appointment with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17033**] as soon as possible and to sign up
for education classes (the series is called "Diabetes Today") as
soon as possible.

7. Please make an appointment with a primary care doctor in the
next 2 weeks.  Depending on what your insurance says, you can
either choose someone at [**University/College 5130**], or call our clinic at
[**Telephone/Fax (1) 250**] and ask for an appointment with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **]. This
person should help to coordinate your care and to check your
blood pressure.

Followup Instructions:
Please email [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17033**] ([**University/College 62530**]) with your
fingersticks every day.



Please call [**Last Name (un) **] ([**Telephone/Fax (1) 2384**]) to schedule an appointment
with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 17033**] as soon as possible.



Please call [**Last Name (un) **] to sign up for diabetes education classes
(the series called "Diabetes Today" as soon as possible.



Please find a primary care doctor (either at [**University/College 5130**] or
here with [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 250**]).




Completed by:[**2162-9-17**]
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Candidiasis of mouth,Unspecified essential hypertension,Family history of diabetes mellitus'}


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 - glucose 1200

PRESENT ILLNESS: Mr. [**Known lastname 62528**] is a 25 yo man with no significant PMH who presents
with three weeks of throat pain and odynophagia. Pt reports pain
on swallowing solids but not with liquids, and has been drinking
a lot of fluids, especially juice and soda.  Pt went to his
school health clinic for sore throat, where a culture was taken
and he was given medication to swish and swallow (likely
nystatin but pt unsure of name). The pain did not resolve and
the pt reports decreased desire to eat [**1-27**] pain. As a result he
has been eating little, mainly yogurt, ice cream and other
"junk."  He returned to his school clinic, where his blood was
drawn and he was told to come to the ER due to high blood sugar.
    He reports a 35 pound weight loss in the last 2 months since
his school physical. He notes thirst, increased urination, no
nausea but 2 episodes of vomiting.  He has had some blurry
vision, but says he thinks this is because he needed a new
prescription for eye glasses, which he recently filled. He just
moved to [**Location (un) **] about one month ago from [**Location (un) 18317**] to start law
school at [**University/College **]. His father has diabetes and uses insulin
for it.  No other family history.  Pt notes occasional
palpitations when he is running around only, denies SOB,
lightheadedness, numbness or tingling, dysuria, hematuria, had
been constipated but now having regular BMs.
    In the ER the pt was found to have a serum glucose of 1200
and an anion gap of 30. He was admitted to the unit, where he
was aggressively hydrated and started on an insulin drip.

MEDICAL HISTORY: Pt states that he had pneumnia 2 years ago. He has never been
hospitalized.  He has been told that he has "borderline high"
blood pressure.

MEDICATION ON ADMISSION: None

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS:98.9, 159/90, 69, 100% RA
GEN:Well appearing AA mail in NAD. Tearful but very pleasant and
talkative.
HEENT:Pupils equal, MM dry with white plaquing, neck is supple
with no LAD.
CV: RRR, hyperdynamic, no murmurs
RESP: CTAB
ABD: NDNT, normoactive BS, soft
EXT: NO pedal edema, warm and well perfused.
NEURO:non-focal.

FAMILY HISTORY: father with diabetes diagnosed at age 40, on insulin. otherwise
noncontributory.

SOCIAL HISTORY: Pt is a law student at [**University/College 5130**]. He is from [**Location (un) 18317**]. Denies
tobacco, occasional alcohol but when he does usually binge
drinking, no history of blackouts, denies other drug use. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Candidiasis of mouth,Unspecified essential hypertension,Family history of diabetes mellitus'}
