CHIEF COMPLAINT: dka

PRESENT ILLNESS: 22 yo male with hx of IDDM, depression, brought to ER by EMS for
n/v and abdominal pain.  His FS was critically high in the ER
and he was given iv insulin and placed on an insulin gtt and
transferred to the [**Hospital Unit Name 153**] for further management.  He denied
noncompliance with meds, sick contacts or recent travel.

MEDICAL HISTORY: -DM type 1 dx [**2130**]
DKA [**2138-5-6**] after a night of drinking and and missing insulin
doses, multiple admits per report of DKA/N/V
-?gastroparesis, reportedly normal gastric emptying study
-depression
-HTN
-hypothyroidism
-esophageal tear

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: afebrile bp 118/72 HR 93 R 18 96% on RA
nad, blunted affect
poor dentition
CTAB
RRR no murmur
abd:  s/nt/nd +bs
Ext: no edema

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: PT lives at home with his parents and reports that he does a
"minimum wage job". Smokes [**11-30**] ppd, denies ETOH or drug use
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Benign essential hypertension
DMI ketoacd uncontrold,Dehydration,Hypothyroidism NOS,Depressive disorder NEC,Benign hypertension
Admission Date:  [**2141-3-9**]              Discharge Date:   [**2141-3-12**]

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

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 1162**]
Chief Complaint:
dka

Major Surgical or Invasive Procedure:
none


History of Present Illness:
22 yo male with hx of IDDM, depression, brought to ER by EMS for
n/v and abdominal pain.  His FS was critically high in the ER
and he was given iv insulin and placed on an insulin gtt and
transferred to the [**Hospital Unit Name 153**] for further management.  He denied
noncompliance with meds, sick contacts or recent travel.

Past Medical History:
-DM type 1 dx [**2130**]
DKA [**2138-5-6**] after a night of drinking and and missing insulin
doses, multiple admits per report of DKA/N/V
-?gastroparesis, reportedly normal gastric emptying study
-depression
-HTN
-hypothyroidism
-esophageal tear

Social History:
PT lives at home with his parents and reports that he does a
"minimum wage job". Smokes [**11-30**] ppd, denies ETOH or drug use

Family History:
Non-contributory

Physical Exam:
afebrile bp 118/72 HR 93 R 18 96% on RA
nad, blunted affect
poor dentition
CTAB
RRR no murmur
abd:  s/nt/nd +bs
Ext: no edema

Pertinent Results:
[**2141-3-9**] 07:51PM   GLUCOSE-202* UREA N-10 CREAT-0.7 SODIUM-133
POTASSIUM-3.7 CHLORIDE-98 TOTAL CO2-22 ANION GAP-17
[**2141-3-9**] 07:51PM   CALCIUM-9.3 PHOSPHATE-3.6 MAGNESIUM-1.5*
[**2141-3-9**] 03:39PM   GLUCOSE-163* UREA N-10 CREAT-0.7 SODIUM-134
POTASSIUM-3.9 CHLORIDE-99 TOTAL CO2-21* ANION GAP-18
[**2141-3-9**] 08:48AM   CALCIUM-8.9 PHOSPHATE-4.0 MAGNESIUM-1.7
[**2141-3-9**] 08:48AM   WBC-8.9 RBC-4.89 HGB-14.9 HCT-42.0 MCV-86
MCH-30.5 MCHC-35.6* RDW-13.2
[**2141-3-9**] 05:55AM   GLUCOSE-88 UREA N-12 CREAT-0.8 SODIUM-137
POTASSIUM-4.3 CHLORIDE-103 TOTAL CO2-19* ANION GAP-19
[**2141-3-9**] 05:55AM   ASA-NEG ETHANOL-NEG ACETMNPHN-NEG
bnzodzpn-NEG barbitrt-NEG tricyclic-NEG
[**2141-3-9**] 04:00AM   GLUCOSE-151* UREA N-14 CREAT-0.7 SODIUM-138
POTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-17* ANION GAP-21*
[**2141-3-9**] 12:30AM   GLUCOSE-492* UREA N-15 CREAT-1.0 SODIUM-132*
POTASSIUM-4.9 CHLORIDE-91* TOTAL CO2-12* ANION GAP-34*
[**2141-3-9**] 12:30AM   ALT(SGPT)-19 AST(SGOT)-14 ALK PHOS-112 TOT
BILI-0.8
[**2141-3-9**] 12:30AM   LIPASE-10
[**2141-3-9**] 12:30AM   OSMOLAL-302

CXR:
IMPRESSION: No acute cardiopulmonary process.

CT abd/pelvis:
CT OF THE ABDOMEN: The lung bases are clear. The visualized
heart and pericardium are unremarkable. Mild thickening of the
distal esophagus is identified. The liver, gallbladder, adrenal
glands, spleen, pancreas, and kidneys are unremarkable. Loops of
small and large bowel are normal in caliber. Contrast has
reached the mid small bowel. Mild prominence of the terminal
ileum is noted, which is fluid filled. There is no wall
thickening, however. The appendix is not visualized. There is no
free air, free fluid, or lymphadenopathy. The abdominal aorta is
of normal caliber.

CT OF THE PELVIS: The bladder, prostate, seminal vesicles, and
rectum appear unremarkable. No free fluid is seen in the pelvis.
No lymphadenopathy is appreciated.

OSSEOUS STRUCTURES: No concerning lytic or sclerotic lesions are
appreciated. A bone island is seen in the right ilium.

IMPRESSION: No acute pathology detected in the abdomen or
pelvis.


Brief Hospital Course:
22 year old man with DM1 p/w abd pain found to be in DKA.
.
1) Diabetes mellitus type 1 uncontrolled/DKA: The patient was
placed on an insulin gtt and transferred to the [**Hospital Unit Name 153**] for further
care.  It was unclear what triggered the patient's presentation
as there was no sign of infection by hx or imaging. AG closed
with fluids and FSBS normalized.  [**Last Name (un) **] consult was obtained
who helped transition the patient back to a sc regimen.  The
patient's BG was moderately controlled on this regimen however
he refused to stay for titration.  He was deemed competent to
make his own decisions and left AMA.  His family was aware of
his decisions and our recommendations that he stay.

2.  Depression:  was seen by psychiatry.  Continued on
wellbutrin.

3.  HTN--ACE-I for benign essential.  Well controlled during his
stay.

4.  Hypothyroidism:  synthroid.

Discharge Medications:
1. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One
(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).
Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
3. Metoclopramide 5 mg Tablet Sig: One (1) Tablet PO three times
a day: with meals.
Disp:*90 Tablet(s)* Refills:*2*
4. Bupropion 150 mg Tablet Sustained Release Sig: One (1) Tablet
Sustained Release PO BID (2 times a day).
5. Famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day).
Disp:*60 Tablet(s)* Refills:*2*
6. Lantus 100 unit/mL Solution Sig: Twenty Seven (27) units
Subcutaneous once a day.
7. Humalog Sliding scale
Please see attached humalog sliding scale.  Check your finger
sticks four times daily.
8. Synthroid 25 mcg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Home

Discharge Diagnosis:
DKA
depression
hypertension
hypothyroidism


Discharge Condition:
stable


Discharge Instructions:
You were admitted with DKA that required an ICU admission.  Your
glucose is still high and we have recommended that you stay for
further treatment.  Please take all insulin that is prescribed.
You should follow up with PCP and psychiatrist.

Followup Instructions:
Provider: [**First Name11 (Name Pattern1) 31804**] [**Last Name (NamePattern1) 31805**], MD Phone:[**Telephone/Fax (1) 250**]
Date/Time:[**2141-5-3**] 1:30
Please call your PCP and psychiatrist for follow up
appointments.
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Benign essential hypertension'}


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

PRESENT ILLNESS: 22 yo male with hx of IDDM, depression, brought to ER by EMS for
n/v and abdominal pain.  His FS was critically high in the ER
and he was given iv insulin and placed on an insulin gtt and
transferred to the [**Hospital Unit Name 153**] for further management.  He denied
noncompliance with meds, sick contacts or recent travel.

MEDICAL HISTORY: -DM type 1 dx [**2130**]
DKA [**2138-5-6**] after a night of drinking and and missing insulin
doses, multiple admits per report of DKA/N/V
-?gastroparesis, reportedly normal gastric emptying study
-depression
-HTN
-hypothyroidism
-esophageal tear

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: afebrile bp 118/72 HR 93 R 18 96% on RA
nad, blunted affect
poor dentition
CTAB
RRR no murmur
abd:  s/nt/nd +bs
Ext: no edema

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: PT lives at home with his parents and reports that he does a
"minimum wage job". Smokes [**11-30**] ppd, denies ETOH or drug use 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Unspecified acquired hypothyroidism,Depressive disorder, not elsewhere classified,Benign essential hypertension'}
