CHIEF COMPLAINT: Diabetic ketoacidosis, nausea, vomiting

PRESENT ILLNESS: Mr. [**Known lastname 32713**] is a 40M with a history of HIV (CD4 870, on HAART),
HCV (untreated), type I diabetes who presents with nausea and
vomiting, found to be in DKA.  He states that about 3pm on the
day of presentation he started to feel dehydrated and nauseous.
He vomited non-bilious non-bloody material.  He walked to CVS to
buy something to drink, about 3 blocks away, and had to stop
several times due to fatigue and lightheadedness.  He felt
unsteady on his feet and had a pre-syncopal episode with chills,
lightheadedness, and shortness of breath.  On returning home he
again felt nauseous and vomited again.  He then called EMS for
hospital transfer.  During the day he ate 2 glucernas and [**First Name8 (NamePattern2) **]
[**Location (un) 2452**] and drank copious amounts of water.

MEDICAL HISTORY: - HIV: Diagnosed in [**2183**]. Started treatment [**2189**], now on Truvada
and Sustiva. No history of OIs. CD4 870 1/[**2193**].
- HCV. Diagnosed in [**9-8**]. Not being treated. Baseline LFTs 100s

MEDICATION ON ADMISSION: (per Discharge Summary [**2194-4-7**]):
- melatonin 1 mg QHS
- Sustiva 600 mg QPM.
- emtricitabine-tenofovir 200-300 mg Tablet QODHS (every other
day at bedtime)
- pravastatin 20 mg HS
- aspirin 81 mg daily
- multivitamin daily
- Lantus Solostar 40 Units SC QHS
- Humalog SS (for breakfast, lunch, and dinner)
Blood sugar     Humalog
71-110          8 units
111-150         9 units
151-190        10 units
191-230        14 units
231-270        15 units
271-310        16 units
311-350        17 units
- Humalog SS (QHS)
Blood sugar     Humalog
71-110          0 units
111-150         0 units
151-190         2 units
191-230         3 units
231-270         4 units
271-310         5 units
311-350         6 units

ALLERGIES: Glucophage / vancomycin

PHYSICAL EXAM: Physical Exam on Admission:
Vitals: afebrile 115/74  122  15  99% RA  weight 68  FSBS
critical high
General: Alert, oriented, no acute distress. Odd affect but
cooperative with exam.
HEENT: Sclera anicteric, slightly dry MM, oropharynx clear,
EOMI, PERRL
Neck: Supple, JVP not elevated
CV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: Soft, mildly tender to palpation, non-distended, bowel
sounds hypoactive but present, no organomegaly
Ext: warm, well perfused, 2+ DP pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII tested and intact.  Strength exam deferred.
Gait not tested.  No gross deficits.
.
Discharge physical exam:
Vitals: Tmax 99.0 Tc 97.9 BP 124/84 (115-130/72-88) HR 88 RR 18
O2 Sat 100% on RA
FSBG 233, 222, 401 (this AM)
General: Well-appearing patient, engaged in coversation, in NAD
HEENT: Left pupil dilated when compared with the right pupil.
Both pupils round. Tonuge midline. MMM. OP without erythema,
exudate, or ulcerations.
CV: RRR. No M/R/G.
Lungs: Clear to auscultation bilaterally. No crackles of
wheezes. Nml work of breathing, no accessory muscle use.
Abdomen: NABS+. Soft. NT/ND.
Ext: WWP. 2+ DPs bilaterally. No clubbing, cyanosis, or pitting
edema

FAMILY HISTORY: Both parents still living and in fairly good health. Grandfather
had a stroke.

SOCIAL HISTORY: Lives alone in an apartment in [**Location (un) 686**].
- Tobacco: None
- Alcohol: Rare
- Illicits: None current (former drug user)
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Long-term (current) use of insulin,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic hepatitis C without mention of hepatic coma,Dehydration,Chronic kidney disease, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Insomnia, unspecified
DMI ketoacd uncontrold,Acute kidney failure NOS,Long-term use of insulin,Asymp hiv infectn status,Chrnc hpt C wo hpat coma,Dehydration,Chronic kidney dis NOS,Hx of past noncompliance,Insomnia NOS
Admission Date:  [**2194-4-30**]              Discharge Date:   [**2194-5-3**]

Date of Birth:  [**2154-1-4**]             Sex:   M

Service: MEDICINE

Allergies:
Glucophage / vancomycin

Attending:[**First Name3 (LF) 4232**]
Chief Complaint:
Diabetic ketoacidosis, nausea, vomiting

Major Surgical or Invasive Procedure:
None


History of Present Illness:
Mr. [**Known lastname 32713**] is a 40M with a history of HIV (CD4 870, on HAART),
HCV (untreated), type I diabetes who presents with nausea and
vomiting, found to be in DKA.  He states that about 3pm on the
day of presentation he started to feel dehydrated and nauseous.
He vomited non-bilious non-bloody material.  He walked to CVS to
buy something to drink, about 3 blocks away, and had to stop
several times due to fatigue and lightheadedness.  He felt
unsteady on his feet and had a pre-syncopal episode with chills,
lightheadedness, and shortness of breath.  On returning home he
again felt nauseous and vomited again.  He then called EMS for
hospital transfer.  During the day he ate 2 glucernas and [**First Name8 (NamePattern2) **]
[**Location (un) 2452**] and drank copious amounts of water.

He notes that he has not checked a fingerstick blood sugar in a
couple of days.  He gave himself 2 insulin injections with
Humalog yesterday, although he does not recall how many units.
He states that he uses his sliding scale, but he does not check
his fingersticks so it is not clear how he determines how much
insulin to use.  He states simply that he "knew it would be
high".  He did not use Lantus the night prior to presentation,
but thinks he may have the night before that.  He does not use
Lantus every night, and uses Humalog 1-2 times daily.  His last
insulin injection was just over 24 hours prior to presentation.

Prior to presentation the patient does not recall any other
change in his health.  He denies fever, cough, wheezing,
nausea/vomiting, (prior to day of presentation), diarrhea, skin
changes, or any other problems.  [**Name (NI) **] does note that a week prior
to presentation he sprained his ankle while moving and had some
muscle cramps.

Of note, the patient had a recent admission in early [**Month (only) 547**] for
DKA and on previous occasions at clinic visits was noted to have
hyperglycemia > 500.  These episodes appear to be secondary to
insulin non-compliance.

In the ED, initial vitals were 121, 102/60, 21, 100% RA with
FSBS critically high.  He received 2L NS, the 2nd liter with 40
mEq of KCl.  He was bolused 7 units insulin (0.1 unit/kg) and
started on insulin gtt at 7 units/hr.  Per report at 2300 his
FSBS was 249, however this is not documented and chemistry at
2340 showed glucose of 655.  He also received Zofran 4mg for
nausea.

On arrival to CCU, the patient complains of gastric discomfort
("hunger pains") and thirst, no other complaints.  He is
breathing comfortably on room air.


Past Medical History:
- HIV: Diagnosed in [**2183**]. Started treatment [**2189**], now on Truvada
and Sustiva. No history of OIs. CD4 870 1/[**2193**].
- HCV. Diagnosed in [**9-8**]. Not being treated. Baseline LFTs 100s

- Diabetes Mellitus Type 1. Diagnosed in [**2179**]. Poorly controlled
with most recent A1C of 13.0% on [**2194-4-5**]. Followed by Dr.
[**Last Name (STitle) **] at [**Last Name (un) **]. Multiple prior hospitalization for DKA.
- CKD. Baseline creatinine of 1.6-1.9. Assumed to be diabetic
nephropathy.
- h/o MRSA cellulitis. Multiple prior infections, hospitalized
previously at [**Hospital3 **].
- Left posterior cervical lymph node biopsy in [**2185**]. Negative
work-up.
- Intramuscular lipoma on back. Resected in [**2187**].


Social History:
Lives alone in an apartment in [**Location (un) 686**].
- Tobacco: None
- Alcohol: Rare
- Illicits: None current (former drug user)


Family History:
Both parents still living and in fairly good health. Grandfather
had a stroke.


Physical Exam:
Physical Exam on Admission:
Vitals: afebrile 115/74  122  15  99% RA  weight 68  FSBS
critical high
General: Alert, oriented, no acute distress. Odd affect but
cooperative with exam.
HEENT: Sclera anicteric, slightly dry MM, oropharynx clear,
EOMI, PERRL
Neck: Supple, JVP not elevated
CV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: Soft, mildly tender to palpation, non-distended, bowel
sounds hypoactive but present, no organomegaly
Ext: warm, well perfused, 2+ DP pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII tested and intact.  Strength exam deferred.
Gait not tested.  No gross deficits.
.
Discharge physical exam:
Vitals: Tmax 99.0 Tc 97.9 BP 124/84 (115-130/72-88) HR 88 RR 18
O2 Sat 100% on RA
FSBG 233, 222, 401 (this AM)
General: Well-appearing patient, engaged in coversation, in NAD
HEENT: Left pupil dilated when compared with the right pupil.
Both pupils round. Tonuge midline. MMM. OP without erythema,
exudate, or ulcerations.
CV: RRR. No M/R/G.
Lungs: Clear to auscultation bilaterally. No crackles of
wheezes. Nml work of breathing, no accessory muscle use.
Abdomen: NABS+. Soft. NT/ND.
Ext: WWP. 2+ DPs bilaterally. No clubbing, cyanosis, or pitting
edema

Pertinent Results:
Admission labs:
[**2194-4-30**] 08:37PM BLOOD WBC-10.6 RBC-5.07 Hgb-15.7 Hct-49.1
MCV-97 MCH-31.0 MCHC-32.0 RDW-12.5 Plt Ct-231
[**2194-4-30**] 08:37PM BLOOD Neuts-79.6* Lymphs-16.7* Monos-3.0 Eos-0
Baso-0.7
[**2194-4-30**] 08:37PM BLOOD Glucose-709* UreaN-43* Creat-2.4* Na-129*
K-4.4 Cl-79* HCO3-20* AnGap-34*

[**2194-5-1**] 05:25AM BLOOD ALT-42* AST-39 AlkPhos-75 TotBili-0.6
[**2194-5-1**] 02:04AM BLOOD Calcium-8.5 Phos-2.4* Mg-1.6
[**2194-4-30**] 11:40PM BLOOD Osmolal-317*
[**2194-5-1**] 05:25AM BLOOD TSH-PND

[**2194-5-1**] 12:40AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.017
[**2194-5-1**] 12:40AM URINE Blood-TR Nitrite-NEG Protein-TR
Glucose-1000 Ketone-40 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2194-5-1**] 12:40AM URINE RBC-1 WBC-<1 Bacteri-NONE Yeast-NONE
Epi-0
[**2194-5-1**] 12:40AM URINE Mucous-RARE
[**2194-5-1**] 02:50AM URINE bnzodzp-NEG barbitr-NEG opiates-NEG
cocaine-NEG amphetm-POS mthdone-NEG

Microbiology:
[**2194-5-1**] 12:40 am URINE      Source: CVS.

                            **FINAL REPORT [**2194-5-2**]**

   URINE CULTURE (Final [**2194-5-2**]):    <10,000 organisms/ml.

HIV Viral load: PENDING

Imaging:
[**2194-4-30**] PA and lateral views of the chest: Lungs are clear.
Cardiomediastinal Preliminary Reportsilhouette and hilar
contours are unremarkable. There is no pneumothorax or pleural
effusion. IMPRESSION: No acute cardiopulmonary process

.
Discharge labs:
[**2194-5-3**] 08:15AM BLOOD WBC-9.6 RBC-5.04 Hgb-15.5 Hct-47.0 MCV-93
MCH-30.7 MCHC-32.9 RDW-12.2 Plt Ct-184
[**2194-5-3**] 08:15AM BLOOD Glucose-203* UreaN-23* Creat-1.3* Na-142
K-3.3 Cl-100 HCO3-33* AnGap-12
[**2194-5-3**] 08:15AM BLOOD Calcium-9.3 Phos-2.5* Mg-1.5*

Brief Hospital Course:
Patient is a 40yo M with PMHx of HIV (most recent CD4 870), HCV
(not treated), poorly controlled type I DM (HbA1c 13.0%) who
presented with nausea/vomiting found to have DKA.
.
# DKA: The patient presented in DKA with an anion gap of 30. The
precipitant of his DKA on this occasion is once again poor
compliance with his insulin regimen. Infectious etiology was
unlikely given negative work-up (chest x-ray and urine culture)
and lack of infectious symptoms.  He has had multiple admissions
for DKA for this reason and his A1c was 13.0% earlier this
month. The patient was initially on an insulin gtt, which was
discontinued on the morning of transfer to the general medicine
floors. He was started on his home dose of insulin glargine and
his humalog insulin sliding scale according to his last
discharge summary. The patient was followed by [**Last Name (un) **]; he was
noted to have hypeglycemia in the morning. 10 units of Lantus at
bedtime was added to the patient's insulin regimen and the
patient's sliding scale was increased as follows: 	
(Insulin Type: Humalog)
FSBG             Breakfast      Lunch           Dinner
Bedtime
0-70   mg/dL	
71-110   mg/dL	8   Units	8   Units	8   Units	0   Units
111-150   mg/dL	9   Units	9   Units	9   Units	0   Units
151-190   mg/dL	10   Units	10   Units	10   Units	6   Units
191-230   mg/dL	15   Units	15   Units	15   Units	7   Units
231-270   mg/dL	16   Units	16   Units	16   Units	8   Units
271-310   mg/dL	17   Units	17   Units	17   Units	9   Units
311-350   mg/dL	18   Units	18   Units	18   Units	10   Units
351-400   mg/dL	19   Units	19   Units	19   Units	10   Units .
Electrolytes were monitored and repleted as necessary.
Outpatient follow-up was scheduled with the patient's primary
care physician as well as with [**Last Name (un) **] and a diabetes educator.
.
# HIV: Diagnosed in [**2183**]. Started treatment [**2189**], now on Truvada
and Sustiva. No history of OIs. CD4 870 1/[**2193**]. CD4 count and
HIV viral load were drawn during this admission. HIV viral load
and CD4 count was pending on day of discharge.
  OUTPATIENT ISSUES: Follow-up of pending HIV viral load and CD4
count.
.
# HCV: Diagnosed in [**9-8**]. Not being treated. Baseline LFTs
100s.
.
# CKD: Thought to be secondary to DM, baseline Cr 1.6-1.9.
Elevated to 2.4 on presentation, possibly due to pre-renal state
from DKA. Patient's serum creatinine within baseline upon
transfer from ICU and upon discharge.
.
# Insomnia: Patient has disturbed sleep-wake cycle that may
contribute to poor medication compliance and dietary choices.
Seen previously by Social Work, hoped that this would improve
with changes in his living situation.  Medication reconciliation
showed that the patient was prescribed trazodone 50-100mg qHS
PRN insomnia by his outpatient provider.

# DKA/T1DM, [**1-30**] non-compliance with insulin use.  The patient
presented in DKA with an anion gap of 30.  HgbA1C was 13 earlier
this month.  He missed [**Last Name (un) **] follow-up.  Nausea/vomiting could
be precipitant but more likely the result of the DKA.    He was
transitioned to po by the morning.  [**Last Name (un) **] was consulted.  SW
was also consulted for further exploration of barrier to
compliance

# Contact: Sister [**Name (NI) **] is emergency contact; however, FAMILY
DOES NOT KNOW HE IS HIV+
# Code: Full (confirmed with patient)


Medications on Admission:
(per Discharge Summary [**2194-4-7**]):
- melatonin 1 mg QHS
- Sustiva 600 mg QPM.
- emtricitabine-tenofovir 200-300 mg Tablet QODHS (every other
day at bedtime)
- pravastatin 20 mg HS
- aspirin 81 mg daily
- multivitamin daily
- Lantus Solostar 40 Units SC QHS
- Humalog SS (for breakfast, lunch, and dinner)
Blood sugar     Humalog
71-110          8 units
111-150         9 units
151-190        10 units
191-230        14 units
231-270        15 units
271-310        16 units
311-350        17 units
- Humalog SS (QHS)
Blood sugar     Humalog
71-110          0 units
111-150         0 units
151-190         2 units
191-230         3 units
231-270         4 units
271-310         5 units
311-350         6 units


Discharge Medications:
1. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
3. pravastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.
4. efavirenz 600 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

5. emtricitabine-tenofovir 200-300 mg Tablet Sig: One (1) Tablet
PO DAILY (Daily).
6. insulin glargine 100 unit/mL Solution Sig: Forty (40) units
Subcutaneous qAM.
7. insulin glargine 100 unit/mL Solution Sig: Ten (10) units
Subcutaneous at bedtime.
8. Humalog 100 unit/mL Solution Sig: According to sliding scale
Units Subcutaneous qACHS: Please see the attached sheet. .
9. trazodone 50 mg Tablet Sig: 1-2 Tablets PO HS (at bedtime) as
needed for insomnia.
10. magnesium oxide 400 mg Tablet Sig: One (1) Tablet PO once a
day.
Disp:*30 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
Diabetic Ketoacidosis
Type 1 Diabetes Mellitus

Secondary diagnosis:
HIV
Hepatitis C
Chronic kidney disease


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


Discharge Instructions:
Dear Mr. [**Known lastname 32713**],

You were hospitalized for Diabetic Ketoacidosis as a result of
not taking your insulin. Initially, you were in the Medical
Intensive Care Unit on an insulin drip. With stabilization of
your labs, you were transferred to the medicine floor for
further stabilization of your blood sugars.

While on the medicine floor, your blood sugars were very
elevated. However, they improved with long-acting insulin.

The [**Last Name (un) **] Diabetes Center followed you during the
hospitalization and made modifications to your insulin regimen:
1. **ADDED** 10 units of insulin glargine at bedtime
2. **INCREASED** your Humalog insulin sliding scale- see the
attached sheet.
3. Magnesium supplement every day

If you only can remember to take one type of insulin, take the
insulin glargline (also known as Lantus) regularly.

Keep all hospital follow-up appointments. Your up-coming
appointments are listed below.


Followup Instructions:
Department: [**Last Name (un) **] Diabetes Center
Name: Dr. [**First Name8 (NamePattern2) 915**] [**Last Name (NamePattern1) 7852**] for Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
When: [**Last Name (NamePattern1) 766**] [**2194-5-5**] at 1:30 PM
Location: [**Last Name (un) **] DIABETES CENTER
Address: ONE [**Last Name (un) **] PLACE, [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 2378**]
Notes: You will see the Nurse Educator at 2:30 PM.

Department: Primary Care
Name: Dr. [**First Name (STitle) **] [**Name (STitle) **] for Dr. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]
When: Wednesday [**2194-5-7**] at 3:40 PM
Location: [**Hospital6 5242**] CENTER
Address: [**Location (un) 5243**], [**Location (un) **],[**Numeric Identifier 718**]
Phone: [**Telephone/Fax (1) 798**]


                             [**Name6 (MD) **] [**Name8 (MD) **] MD [**MD Number(1) 4236**]



Name:  [**Known lastname 11072**],[**Known firstname 4253**]                   Unit No:   [**Numeric Identifier 11537**]

Admission Date:  [**2194-4-30**]              Discharge Date:   [**2194-5-3**]

Date of Birth:  [**2154-1-4**]             Sex:   M

Service: MEDICINE

Allergies:
Glucophage / vancomycin

Attending:[**First Name3 (LF) 11538**]
Addendum:
HIV: Please note that on discharge, the patient's Truvada
frequency was increased to every 24 hours from every 48 hours
given the patient's creatinine clearance during this admission.
Defer further management of patient's HIV medication to
outpatient provider in light of HIV viral load results and CD4
count.

Discharge Disposition:
Home

                             [**Name6 (MD) 634**] [**Name8 (MD) 635**] MD [**MD Number(1) 636**]

Completed by:[**2194-5-7**]
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Long-term (current) use of insulin,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic hepatitis C without mention of hepatic coma,Dehydration,Chronic kidney disease, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Insomnia, 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: Diabetic ketoacidosis, nausea, vomiting

PRESENT ILLNESS: Mr. [**Known lastname 32713**] is a 40M with a history of HIV (CD4 870, on HAART),
HCV (untreated), type I diabetes who presents with nausea and
vomiting, found to be in DKA.  He states that about 3pm on the
day of presentation he started to feel dehydrated and nauseous.
He vomited non-bilious non-bloody material.  He walked to CVS to
buy something to drink, about 3 blocks away, and had to stop
several times due to fatigue and lightheadedness.  He felt
unsteady on his feet and had a pre-syncopal episode with chills,
lightheadedness, and shortness of breath.  On returning home he
again felt nauseous and vomited again.  He then called EMS for
hospital transfer.  During the day he ate 2 glucernas and [**First Name8 (NamePattern2) **]
[**Location (un) 2452**] and drank copious amounts of water.

MEDICAL HISTORY: - HIV: Diagnosed in [**2183**]. Started treatment [**2189**], now on Truvada
and Sustiva. No history of OIs. CD4 870 1/[**2193**].
- HCV. Diagnosed in [**9-8**]. Not being treated. Baseline LFTs 100s

MEDICATION ON ADMISSION: (per Discharge Summary [**2194-4-7**]):
- melatonin 1 mg QHS
- Sustiva 600 mg QPM.
- emtricitabine-tenofovir 200-300 mg Tablet QODHS (every other
day at bedtime)
- pravastatin 20 mg HS
- aspirin 81 mg daily
- multivitamin daily
- Lantus Solostar 40 Units SC QHS
- Humalog SS (for breakfast, lunch, and dinner)
Blood sugar     Humalog
71-110          8 units
111-150         9 units
151-190        10 units
191-230        14 units
231-270        15 units
271-310        16 units
311-350        17 units
- Humalog SS (QHS)
Blood sugar     Humalog
71-110          0 units
111-150         0 units
151-190         2 units
191-230         3 units
231-270         4 units
271-310         5 units
311-350         6 units

ALLERGIES: Glucophage / vancomycin

PHYSICAL EXAM: Physical Exam on Admission:
Vitals: afebrile 115/74  122  15  99% RA  weight 68  FSBS
critical high
General: Alert, oriented, no acute distress. Odd affect but
cooperative with exam.
HEENT: Sclera anicteric, slightly dry MM, oropharynx clear,
EOMI, PERRL
Neck: Supple, JVP not elevated
CV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs,
gallops
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
Abdomen: Soft, mildly tender to palpation, non-distended, bowel
sounds hypoactive but present, no organomegaly
Ext: warm, well perfused, 2+ DP pulses, no clubbing, cyanosis or
edema
Neuro: CN II-XII tested and intact.  Strength exam deferred.
Gait not tested.  No gross deficits.
.
Discharge physical exam:
Vitals: Tmax 99.0 Tc 97.9 BP 124/84 (115-130/72-88) HR 88 RR 18
O2 Sat 100% on RA
FSBG 233, 222, 401 (this AM)
General: Well-appearing patient, engaged in coversation, in NAD
HEENT: Left pupil dilated when compared with the right pupil.
Both pupils round. Tonuge midline. MMM. OP without erythema,
exudate, or ulcerations.
CV: RRR. No M/R/G.
Lungs: Clear to auscultation bilaterally. No crackles of
wheezes. Nml work of breathing, no accessory muscle use.
Abdomen: NABS+. Soft. NT/ND.
Ext: WWP. 2+ DPs bilaterally. No clubbing, cyanosis, or pitting
edema

FAMILY HISTORY: Both parents still living and in fairly good health. Grandfather
had a stroke.

SOCIAL HISTORY: Lives alone in an apartment in [**Location (un) 686**].
- Tobacco: None
- Alcohol: Rare
- Illicits: None current (former drug user) 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Long-term (current) use of insulin,Asymptomatic human immunodeficiency virus [HIV] infection status,Chronic hepatitis C without mention of hepatic coma,Dehydration,Chronic kidney disease, unspecified,Personal history of noncompliance with medical treatment, presenting hazards to health,Insomnia, unspecified'}
