CHIEF COMPLAINT: Nausea vomiting

PRESENT ILLNESS: CC: Dry heaving, wretching
HPI:  This 19 year old male with history of DM went to a
graduation party last night and presented to [**Hospital1 34**] with dry
heaving and wretching complaining of abdominal pain secondary to
wretching.  His last dose of insulin was Sunday morning and he
missed 2 dosages.  He had several beers and some shots at the
party.  He denies any other drug use.  He was diagnosed with
diabetes 5 years prior, he has had several other episodes of DKA
in the past.
  At [**Hospital6 33**] he was treated with an insulin drip
and fluids.  His initial labs showed a Na 135, K 4.0, Cl 95,
HCO3 11 with an anion gap of 29.  ABG with Ph7.16 His glucose at
that time was 332.  He had an increased WBC to 15.7, his other
labs were within normal limits.  VS on presentation to [**Hospital1 34**]
120s/60s, 80-90s, 96-98% on RA

MEDICAL HISTORY: Past Medical history:  1. DM type 1 diagnosed 5 years ago

MEDICATION ON ADMISSION: Insulin, Lantus 20 units in the AM, 10 units at night, Humalog
SS to cover.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp 98.0, BP 102/41, Pulse 70, RR 20
Gen: alert, oriented, cooperative male in NAD
HEENT: PERRL, EOMI, MMM, OP clear
Lungs: CTA bilaterally
CV: RRR, nl S1S2 no murmers
Abd: soft, NT, ND positive BS
Ext: no edema

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: High school student, graduating on [**2138-5-7**], smokes 1 pack/day,
drinks
Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled
DMI keto nt st uncntrld
Admission Date:  [**2138-5-6**]              Discharge Date:   [**2138-5-7**]

Date of Birth:  [**2118-11-27**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 58802**]
Chief Complaint:
Nausea vomiting

Major Surgical or Invasive Procedure:
none

History of Present Illness:
CC: Dry heaving, wretching
HPI:  This 19 year old male with history of DM went to a
graduation party last night and presented to [**Hospital1 34**] with dry
heaving and wretching complaining of abdominal pain secondary to
wretching.  His last dose of insulin was Sunday morning and he
missed 2 dosages.  He had several beers and some shots at the
party.  He denies any other drug use.  He was diagnosed with
diabetes 5 years prior, he has had several other episodes of DKA
in the past.
  At [**Hospital6 33**] he was treated with an insulin drip
and fluids.  His initial labs showed a Na 135, K 4.0, Cl 95,
HCO3 11 with an anion gap of 29.  ABG with Ph7.16 His glucose at
that time was 332.  He had an increased WBC to 15.7, his other
labs were within normal limits.  VS on presentation to [**Hospital1 34**]
120s/60s, 80-90s, 96-98% on RA

Past Medical History:
Past Medical history:  1. DM type 1 diagnosed 5 years ago


Social History:
High school student, graduating on [**2138-5-7**], smokes 1 pack/day,
drinks

Family History:
non-contributory

Physical Exam:
Temp 98.0, BP 102/41, Pulse 70, RR 20
Gen: alert, oriented, cooperative male in NAD
HEENT: PERRL, EOMI, MMM, OP clear
Lungs: CTA bilaterally
CV: RRR, nl S1S2 no murmers
Abd: soft, NT, ND positive BS
Ext: no edema

Pertinent Results:
[**2138-5-7**] 07:16AM BLOOD WBC-8.6 RBC-4.68 Hgb-14.6 Hct-40.6 MCV-87
MCH-31.2 MCHC-36.0* RDW-13.2 Plt Ct-270
[**2138-5-6**] 01:59PM BLOOD WBC-12.3* RBC-4.95 Hgb-15.3 Hct-42.4
MCV-86 MCH-30.9 MCHC-36.1* RDW-12.2 Plt Ct-387
[**2138-5-6**] 05:57AM BLOOD WBC-16.5* RBC-4.96 Hgb-15.1 Hct-42.2
MCV-85 MCH-30.4 MCHC-35.8* RDW-13.0 Plt Ct-392
[**2138-5-7**] 07:16AM BLOOD Plt Ct-270
[**2138-5-7**] 07:16AM BLOOD Glucose-177* UreaN-6 Creat-0.6 Na-137
K-4.2 Cl-106 HCO3-22 AnGap-13
[**2138-5-6**] 10:32PM BLOOD Glucose-136* UreaN-10 Creat-0.5 Na-138
K-3.7 Cl-109* HCO3-22 AnGap-11
[**2138-5-6**] 01:59PM BLOOD Glucose-267* UreaN-9 Creat-0.6 Na-137
K-3.8 Cl-109* HCO3-20* AnGap-12
[**2138-5-6**] 10:59AM BLOOD Glucose-246* K-3.8 HCO3-21*
[**2138-5-6**] 05:57AM BLOOD Glucose-132* UreaN-12 Creat-0.8 Na-140
K-4.5 Cl-108 HCO3-17* AnGap-20
[**2138-5-7**] 07:16AM BLOOD Calcium-9.0 Phos-2.3* Mg-1.5
[**2138-5-6**] 10:32PM BLOOD Albumin-3.3* Calcium-8.7 Phos-2.9 Mg-1.9
[**2138-5-6**] 01:59PM BLOOD Calcium-8.6 Phos-2.3*# Mg-1.6

Brief Hospital Course:
19 year old with history of DM type 1 presenting with DKA, most
likely caused by lack of insulin in the setting of a party where
he also consumed alcohol.  He was maintained on an Insulin drip
which had been going on transfer from the OSH.  His blood sugars
were checked q1hour.  He was aggressively hydrated with D5 [**12-1**]
NS and NS bolus.  His anion gap was 15 on admission and closed
with continued treatment.  Once his anion gap had closed he was
switched over to his home insulin regimen with overlap with the
insulin drip.  He was tolerating good PO diet and was no longer
nauseated.  He was discharged home on his home insulin regimen
with follow up with his endocrinologist in one week.
Other issues
1. Increased WBC, he has no fever or left shift, however WBC
count elevated.  Blood cultures were sent and urine cultures
were sent with no growth.  A CXR was performed which was clear
with no evidence of pneumonia.
2.  He was maintained on PPI and SC Heparin for prophylaxis
during this admission.

Medications on Admission:
Insulin, Lantus 20 units in the AM, 10 units at night, Humalog
SS to cover.


Discharge Medications:
1. Insulin Glargine 100 unit/mL Solution Sig: Ten (10) Units
Subcutaneous at bedtime.
Disp:*30 mL* Refills:*2*
2. Insulin Regular Human 100 unit/mL Solution Sig: 2-12 units
Injection at meals: Take finger stick and adjust insulin per
sliding scale and carbohydrate intake.
3. Insulin Glargine 100 unit/mL Cartridge Sig: Twenty (20) units
Subcutaneous once a day.
Disp:*600 mL* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Diabetic Ketoacidosis
Type 1 diabetes

Discharge Condition:
stable

Discharge Instructions:
Continue to take all medications as prescribed.  Return to the
hospital if you have any further nausea, vomiting, or other
concerning symptoms.  Follow up with your primary care doctor [**First Name (Titles) 3**] [**Last Name (Titles) 19379**]d.

Followup Instructions:
Follow up with Dr. [**Last Name (STitle) 61831**] as scheduled

                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 58803**]
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled'}


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: CC: Dry heaving, wretching
HPI:  This 19 year old male with history of DM went to a
graduation party last night and presented to [**Hospital1 34**] with dry
heaving and wretching complaining of abdominal pain secondary to
wretching.  His last dose of insulin was Sunday morning and he
missed 2 dosages.  He had several beers and some shots at the
party.  He denies any other drug use.  He was diagnosed with
diabetes 5 years prior, he has had several other episodes of DKA
in the past.
  At [**Hospital6 33**] he was treated with an insulin drip
and fluids.  His initial labs showed a Na 135, K 4.0, Cl 95,
HCO3 11 with an anion gap of 29.  ABG with Ph7.16 His glucose at
that time was 332.  He had an increased WBC to 15.7, his other
labs were within normal limits.  VS on presentation to [**Hospital1 34**]
120s/60s, 80-90s, 96-98% on RA

MEDICAL HISTORY: Past Medical history:  1. DM type 1 diagnosed 5 years ago

MEDICATION ON ADMISSION: Insulin, Lantus 20 units in the AM, 10 units at night, Humalog
SS to cover.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Temp 98.0, BP 102/41, Pulse 70, RR 20
Gen: alert, oriented, cooperative male in NAD
HEENT: PERRL, EOMI, MMM, OP clear
Lungs: CTA bilaterally
CV: RRR, nl S1S2 no murmers
Abd: soft, NT, ND positive BS
Ext: no edema

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: High school student, graduating on [**2138-5-7**], smokes 1 pack/day,
drinks 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled'}
