CHIEF COMPLAINT: nausea, vomiting

PRESENT ILLNESS: Mr. [**Known lastname 28221**] is a 57 year-old male with a history of diabetes who
presents with nausea and vomiting, found to have DKA.
.
Three days prior to admission, reports "falling off the bus".
Did hit his head and came to the ED for evaluation. A head CT
was normal and the patient was discharged home.
.
Two days prior to admission, reports thathis gastroperesis began
acting up. Nausea with vomiting; unable to keep down his PO
medications or food.
.
One day prior to admission, the nausea/vomiting continued. He
was at a family gathering after the death of a son; there he had
two whiskey shots (his first alcohol in "20 years"). Later went
to the ED. Was observed for possible alcohol intoxication and
discharged to home.
.
On the morning of admission, finger stick was 60. He did not
take his AM lantus. Came to the ED for further evaluation.
.
In the ED, was afebrile, HR 77, BP 164/60. Placed on insulin
gtt, got zofran 4mg IV and was given KCl. Was given 5 liters of
NS (including one wit 40mEq of KCl).
.
ROS: No fevers. Occasional "chills". No cough, dysuria,
shortness of breath. Occasional chest pain since falling on his
chest. Reports some "coffee grinds" in emesis with one episode.
No blood in emesis. No blood in stool.

MEDICAL HISTORY: 1. Diabetes: Insulin-dependent diagnosed in [**2143**], followed by
Dr. [**Last Name (STitle) **] at the [**Hospital **] Clinic.
2. Gastroparesis on Reglan.
3. Iron deficiency anemia.
4. TIA x3. Reports having three episodes of left hemiparesis
with no long-term deficits.
5. Gastritis diagnosed by EGD.
6. Arthritis (neck, hip, hands) secondary to hockey and
carpenter work.
7. Osteoarthritis of the left knee followed by Dr. [**Last Name (STitle) **] at
the [**Hospital 36721**] Clinic, s/p arthoscopy [**2163**].
8. Cervical radiculopathy followed by Dr. [**Last Name (STitle) 21721**].
9. Right shoulder supraspinatus tendonitis.
10. Asthma. Remote and no longer active.
11. Tobacco use. 4 ppd x 17 yrs quit in [**2137**].
12. Carpal tunnel with release surgery.
13. Vocal cord polyps.
14. Grade III esophagitis diagnosed [**2161**].
15. Hiatal hernia, [**2162**].
16. R ulnar decompression [**5-6**].
17. R shoulder arthroscopy [**9-5**].
18. C5-6, C6-7 surgery [**2162**].

MEDICATION ON ADMISSION: 1. Lantus 6 units [**Hospital1 **] with humalog sliding scale
2. Aspirin 81mg daily
3. Atorvastatin 20mg daily
4. Reglan 20mg QID
5. Neurontin 300mg AM/lunch and 600mg QHS
6. Amitryptyline 20mg QHS
7. Folic acid 1mg daily
8. Prilosec 20mg daily
9. Oxycodone 5mg [**12-6**] Q4-6 hours
10. B12 500mg daily
11. B6 25mg daily
12. Vitamin C 500mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals - Afebrile, HR 87, 100% on room air.
gen - In no distress. Speaking somewhat slowing but clearly.
heent - No palor or icterus. Oral mucosa somewhat dry.
cv - Regular without any murmurs.
pulm - Clear bilaterally.
abd - Soft but with some voluntary guarding. No rebound.
ext - Warm and without edema.
neuro - Alert and oriented x3.

FAMILY HISTORY: [**Name (NI) 100537**], sister-DM, CAD s/p MI x 3.

SOCIAL HISTORY: Patient is sole caregiver for daughter and mother. Mother has
spina bifida. She recently had a another stroke but has
recovered well. He quit tobacco in [**2137**]. Prior to that he smoked
four packs a day for 17 years. Still has an occasional cigar. He
used cocaine in the 70s but has not used since. He states that
once a friend put [**12-6**] [**Name2 (NI) **] of cocaine in his coffee. This was
several years ago. He is an artist and works with oils; he does
not currently work. Other than alcohol earlier this week, no use
in 20 years.
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Gastroparesis,Volume depletion, unspecified
DMI ketoacd uncontrold,Acute kidney failure NOS,Gastroparesis,Volume depletion NOS
Admission Date:  [**2169-9-23**]              Discharge Date:   [**2169-9-26**]

Date of Birth:  [**2112-7-16**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1162**]
Chief Complaint:
nausea, vomiting

Major Surgical or Invasive Procedure:
none

History of Present Illness:
Mr. [**Known lastname 28221**] is a 57 year-old male with a history of diabetes who
presents with nausea and vomiting, found to have DKA.
.
Three days prior to admission, reports "falling off the bus".
Did hit his head and came to the ED for evaluation. A head CT
was normal and the patient was discharged home.
.
Two days prior to admission, reports thathis gastroperesis began
acting up. Nausea with vomiting; unable to keep down his PO
medications or food.
.
One day prior to admission, the nausea/vomiting continued. He
was at a family gathering after the death of a son; there he had
two whiskey shots (his first alcohol in "20 years"). Later went
to the ED. Was observed for possible alcohol intoxication and
discharged to home.
.
On the morning of admission, finger stick was 60. He did not
take his AM lantus. Came to the ED for further evaluation.
.
In the ED, was afebrile, HR 77, BP 164/60. Placed on insulin
gtt, got zofran 4mg IV and was given KCl. Was given 5 liters of
NS (including one wit 40mEq of KCl).
.
ROS: No fevers. Occasional "chills". No cough, dysuria,
shortness of breath. Occasional chest pain since falling on his
chest. Reports some "coffee grinds" in emesis with one episode.
No blood in emesis. No blood in stool.


Past Medical History:
1. Diabetes: Insulin-dependent diagnosed in [**2143**], followed by
Dr. [**Last Name (STitle) **] at the [**Hospital **] Clinic.
2. Gastroparesis on Reglan.
3. Iron deficiency anemia.
4. TIA x3. Reports having three episodes of left hemiparesis
with no long-term deficits.
5. Gastritis diagnosed by EGD.
6. Arthritis (neck, hip, hands) secondary to hockey and
carpenter work.
7. Osteoarthritis of the left knee followed by Dr. [**Last Name (STitle) **] at
the [**Hospital 36721**] Clinic, s/p arthoscopy [**2163**].
8. Cervical radiculopathy followed by Dr. [**Last Name (STitle) 21721**].
9. Right shoulder supraspinatus tendonitis.
10. Asthma. Remote and no longer active.
11. Tobacco use. 4 ppd x 17 yrs quit in [**2137**].
12. Carpal tunnel with release surgery.
13. Vocal cord polyps.
14. Grade III esophagitis diagnosed [**2161**].
15. Hiatal hernia, [**2162**].
16. R ulnar decompression [**5-6**].
17. R shoulder arthroscopy [**9-5**].
18. C5-6, C6-7 surgery [**2162**].


Social History:
Patient is sole caregiver for daughter and mother. Mother has
spina bifida. She recently had a another stroke but has
recovered well. He quit tobacco in [**2137**]. Prior to that he smoked
four packs a day for 17 years. Still has an occasional cigar. He
used cocaine in the 70s but has not used since. He states that
once a friend put [**12-6**] [**Name2 (NI) **] of cocaine in his coffee. This was
several years ago. He is an artist and works with oils; he does
not currently work. Other than alcohol earlier this week, no use
in 20 years.

Family History:
[**Name (NI) 100537**], sister-DM, CAD s/p MI x 3.

Physical Exam:
vitals - Afebrile, HR 87, 100% on room air.
gen - In no distress. Speaking somewhat slowing but clearly.
heent - No palor or icterus. Oral mucosa somewhat dry.
cv - Regular without any murmurs.
pulm - Clear bilaterally.
abd - Soft but with some voluntary guarding. No rebound.
ext - Warm and without edema.
neuro - Alert and oriented x3.


Pertinent Results:
139 96 38 (2am)
============ 515
4.7 12 2.0
.
140 103 40 (5am)
============ 424
3.2 14 1.9
.
ALT: 23 AP: 74 Tbili: 1.5
AST: 25
[**Doctor First Name **]: 29
.
Acetone:Large
.
WBC: 16.2
PLT: 272
HCT: 36.2
N:89 Band:0 L:10 M:1 E:0 Bas:0
PT: 11.8 PTT: 21.8 INR: 1.0
.
Urine Benzos, Barbs, Opiates, Cocaine, Amphet, Mthdne Negative
UA: 1.021 / 5.0 Glu 1000 Ket 50
.
CXR: No acute cardiopulmonary process.
.
EKG: Sinus at 90bpm. Flattened T-waves diffusely. Possible LAA.



Brief Hospital Course:
ASSESSMENT/PLAN: 57 yo male with Type I DM, admitted with nausea
and vomiting, and found to be in DKA.
.
1. DKA: The patient was started on aggressive IVF resuscitation
in the emergency room.  He was found to have an anion gap
acidosis with positive ketones in the urine consistent with
diabetic ketoacidosis.  He was transferred to the intensive care
unit and cont. on high rate IVFs, q1hr fingersticks, and an
insulin drip.  Later the same day with this therapy, his anion
gap closed.  He was then overlapped on both insulin drip and
insulin sliding scale.  He maintained good BG control on the
insulin sliding scale with [**Hospital1 **] Lantus and gradually insulin drip
was weaned off.  he did have one episode of brief hypoglycemia
with BG in 20s which caused him to feel lightheaded and
diaphoretic, but resolved with 1 amp dextrose. His nausea and
vomiting soon abated and he had no episodes of dark or coffee
ground emesis.  He was started on a consistent carbohydrate diet
and treated with Reglan and antiemetics (as patient has history
of gastroparesis - and may have even been inciting event). He
tolerated a regular diet with no further nausea or vomiting.  Of
note, while his anion gap closed he did have a primary
respiratory alkalosis on blood gas.
.
2. Acute renal failure: Improved to baseline with hydration
.
3. Coffee grinds:  EGD in [**2165**] showed Schatzki's ring, hiatal
hernia, erythema, friability and nodularity in the stomach body
compatible with gastritis and granularity in the stomach body
and antrum compatible with mild gastritis. This could represent
upper GI bleed in the setting of vomiting, possibly
[**Doctor First Name 329**]-[**Doctor Last Name **] tear. Vomiting has been under control since coming
to ED. No further episodes of coffee ground or dark emesis since
admission to ICU. Tolerating po. Hematocrit remained stable
until discharge.
.
4. Gastroparesis:  Reglan/Zofran
.
5. Anemia:
Previously reported as iron deficiency in OMR with ferritins of
13-15 in [**2164**]/[**2165**]. This may have been in the setting of EGD
findings. Currently at baseline, but will cont. to follow.


Medications on Admission:
1. Lantus 6 units [**Hospital1 **] with humalog sliding scale
2. Aspirin 81mg daily
3. Atorvastatin 20mg daily
4. Reglan 20mg QID
5. Neurontin 300mg AM/lunch and 600mg QHS
6. Amitryptyline 20mg QHS
7. Folic acid 1mg daily
8. Prilosec 20mg daily
9. Oxycodone 5mg [**12-6**] Q4-6 hours
10. B12 500mg daily
11. B6 25mg daily
12. Vitamin C 500mg daily


Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
3. Amitriptyline 10 mg Tablet Sig: Two (2) Tablet PO HS (at
bedtime).
4. Metoclopramide 10 mg Tablet Sig: Two (2) Tablet PO QID (4
times a day).
5. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO DAILY
(Daily).
6. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO HS (at
bedtime).
7. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

8. Prilosec 20 mg Capsule, Delayed Release(E.C.) Sig: One (1)
Capsule, Delayed Release(E.C.) PO once a day.
9. Oxycodone 5 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6 hours)
as needed for pain.
10. Vitamin B-12 500 mcg Tablet Sig: One (1) Tablet PO once a
day.
11. Vitamin B-6 25 mg Tablet Sig: One (1) Tablet PO once a day.

12. med
Lantus 6mg sc twice daily
Resume your previous outpatient humalog sliding scale


Discharge Disposition:
Home With Service

Facility:
[**Location (un) 86**] VNA

Discharge Diagnosis:
diabetic ketoacidosis
gastroparesis
DM insulin dependent


Discharge Condition:
stable


Discharge Instructions:
You were admitted with diabetic ketoacidosis which has now
resolved.  You will need to continue to check your blood glucose
levels before each meal and prior to bedtime.  You have a
history of having a low glucose level in the morning and it is
important for you to eat a snack prior to bedtime.  You will
need to return to the ER if you develop nausea, vomiting,
abdominal pain or fevers.  You will need to follow up with the
[**Hospital **] clinic as described below.

Followup Instructions:
Dr. [**Known firstname **] [**Last Name (NamePattern1) **] [**9-29**] at 11:30 at [**Telephone/Fax (1) 21119**] [**Hospital **] Clinic

Provider: [**Name10 (NameIs) **] [**Name11 (NameIs) 100538**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2169-10-24**] 2:00
Provider: [**Last Name (NamePattern4) **]. [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) 7676**] Phone:[**Telephone/Fax (1) 1387**]
Date/Time:[**2169-12-12**] 3:40
Provider: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 51535**], M.D. Phone:[**Telephone/Fax (1) 1971**]
Date/Time:[**2170-2-22**] 2:00
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Gastroparesis,Volume depletion, 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: nausea, vomiting

PRESENT ILLNESS: Mr. [**Known lastname 28221**] is a 57 year-old male with a history of diabetes who
presents with nausea and vomiting, found to have DKA.
.
Three days prior to admission, reports "falling off the bus".
Did hit his head and came to the ED for evaluation. A head CT
was normal and the patient was discharged home.
.
Two days prior to admission, reports thathis gastroperesis began
acting up. Nausea with vomiting; unable to keep down his PO
medications or food.
.
One day prior to admission, the nausea/vomiting continued. He
was at a family gathering after the death of a son; there he had
two whiskey shots (his first alcohol in "20 years"). Later went
to the ED. Was observed for possible alcohol intoxication and
discharged to home.
.
On the morning of admission, finger stick was 60. He did not
take his AM lantus. Came to the ED for further evaluation.
.
In the ED, was afebrile, HR 77, BP 164/60. Placed on insulin
gtt, got zofran 4mg IV and was given KCl. Was given 5 liters of
NS (including one wit 40mEq of KCl).
.
ROS: No fevers. Occasional "chills". No cough, dysuria,
shortness of breath. Occasional chest pain since falling on his
chest. Reports some "coffee grinds" in emesis with one episode.
No blood in emesis. No blood in stool.

MEDICAL HISTORY: 1. Diabetes: Insulin-dependent diagnosed in [**2143**], followed by
Dr. [**Last Name (STitle) **] at the [**Hospital **] Clinic.
2. Gastroparesis on Reglan.
3. Iron deficiency anemia.
4. TIA x3. Reports having three episodes of left hemiparesis
with no long-term deficits.
5. Gastritis diagnosed by EGD.
6. Arthritis (neck, hip, hands) secondary to hockey and
carpenter work.
7. Osteoarthritis of the left knee followed by Dr. [**Last Name (STitle) **] at
the [**Hospital 36721**] Clinic, s/p arthoscopy [**2163**].
8. Cervical radiculopathy followed by Dr. [**Last Name (STitle) 21721**].
9. Right shoulder supraspinatus tendonitis.
10. Asthma. Remote and no longer active.
11. Tobacco use. 4 ppd x 17 yrs quit in [**2137**].
12. Carpal tunnel with release surgery.
13. Vocal cord polyps.
14. Grade III esophagitis diagnosed [**2161**].
15. Hiatal hernia, [**2162**].
16. R ulnar decompression [**5-6**].
17. R shoulder arthroscopy [**9-5**].
18. C5-6, C6-7 surgery [**2162**].

MEDICATION ON ADMISSION: 1. Lantus 6 units [**Hospital1 **] with humalog sliding scale
2. Aspirin 81mg daily
3. Atorvastatin 20mg daily
4. Reglan 20mg QID
5. Neurontin 300mg AM/lunch and 600mg QHS
6. Amitryptyline 20mg QHS
7. Folic acid 1mg daily
8. Prilosec 20mg daily
9. Oxycodone 5mg [**12-6**] Q4-6 hours
10. B12 500mg daily
11. B6 25mg daily
12. Vitamin C 500mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: vitals - Afebrile, HR 87, 100% on room air.
gen - In no distress. Speaking somewhat slowing but clearly.
heent - No palor or icterus. Oral mucosa somewhat dry.
cv - Regular without any murmurs.
pulm - Clear bilaterally.
abd - Soft but with some voluntary guarding. No rebound.
ext - Warm and without edema.
neuro - Alert and oriented x3.

FAMILY HISTORY: [**Name (NI) 100537**], sister-DM, CAD s/p MI x 3.

SOCIAL HISTORY: Patient is sole caregiver for daughter and mother. Mother has
spina bifida. She recently had a another stroke but has
recovered well. He quit tobacco in [**2137**]. Prior to that he smoked
four packs a day for 17 years. Still has an occasional cigar. He
used cocaine in the 70s but has not used since. He states that
once a friend put [**12-6**] [**Name2 (NI) **] of cocaine in his coffee. This was
several years ago. He is an artist and works with oils; he does
not currently work. Other than alcohol earlier this week, no use
in 20 years. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Gastroparesis,Volume depletion, unspecified'}
