CHIEF COMPLAINT: abd. pain, odynophagia, acidosis

PRESENT ILLNESS: 47 yo man w/ diet treated diabetes (dx 4 yrs ago) presented to
the ED with c/o chest burning sensation, SOB, anorexia and
malaise.
.
Pt. has been in poor state of usual health over the past six
months (fatigue, decreased appetite, weight loss) until today,
when he noted worsening malaise, inability to take PO, burning
sensation in his chest (from neck to epigastric area) and
presented to the ED. He has not sought medical care for any of
his symptoms until now and over the past 2 months had stopped
checking his BG, thinking he did not need to.
.
Additional notable hx includes unintentional weight loss over
the past 6 mo (waist size 36->32) which he attributed to
anorexia and odynophagia.  He does not have a globus sensation,
no hemoptysis.  He does endorse chills w/o nightsweats.  Chest
burning does not radiate, he does not feel diphoretic. It occurs
mostly with and right after food intake.
.
He has had marked DOE over the past 3 months, even with minimal
exertion (walking to kitchen from living room). No SOB at rest.
No diaphoresis, palpitations.  + PND, no orthopnea, no LE edema.
.
In the ED, initial vs were: 98.2 124 145/92 18 100% RA. Labs
notable for bicarb of 6, BG of 399 with all other labs negative,
including negative ASA and EtOH levels.  VBG was 7.1/23/43.
Patient was given 3 LNS, ASA 81mg, regular insulin 5U and
started on insulin gtt, GI cocktail with reported resolution of
his symptoms w/ AG 23 -> 17.  He was admitted to ICU for further
treatment.  EKG was sinus tachycardia.  At time of transfer, VS
were 97.8, 115/77 88 22 100% RA with Kussmaul respirations.
.

MEDICAL HISTORY: - Diet controlled diabetes.
- central right paracentral disc bulging at C4-5
- Colonoscopy [**2146**] wnl.

MEDICATION ON ADMISSION: none.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam:
VS 97.8, 115/77 88 22 100% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Fa - DM, MI at older age.
Mo - died in 50s from PNA as complication from hip fx.

SOCIAL HISTORY: Lives alone, former carpenter, lost his job recently.
- Tobacco: [**12-6**] ppd x 4 yrs
- Alcohol: 2 pints weekly
- Illicits:  denies.
Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Blood in stool,Other respiratory abnormalities,Esophageal reflux,Hypopotassemia
DMII ketoacd uncontrold,Blood in stool,Respiratory abnorm NEC,Esophageal reflux,Hypopotassemia
Admission Date:  [**2150-8-30**]              Discharge Date:   [**2150-9-3**]

Date of Birth:  [**2103-1-28**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3021**]
Chief Complaint:
abd. pain, odynophagia, acidosis

Major Surgical or Invasive Procedure:
none

History of Present Illness:
47 yo man w/ diet treated diabetes (dx 4 yrs ago) presented to
the ED with c/o chest burning sensation, SOB, anorexia and
malaise.
.
Pt. has been in poor state of usual health over the past six
months (fatigue, decreased appetite, weight loss) until today,
when he noted worsening malaise, inability to take PO, burning
sensation in his chest (from neck to epigastric area) and
presented to the ED. He has not sought medical care for any of
his symptoms until now and over the past 2 months had stopped
checking his BG, thinking he did not need to.
.
Additional notable hx includes unintentional weight loss over
the past 6 mo (waist size 36->32) which he attributed to
anorexia and odynophagia.  He does not have a globus sensation,
no hemoptysis.  He does endorse chills w/o nightsweats.  Chest
burning does not radiate, he does not feel diphoretic. It occurs
mostly with and right after food intake.
.
He has had marked DOE over the past 3 months, even with minimal
exertion (walking to kitchen from living room). No SOB at rest.
No diaphoresis, palpitations.  + PND, no orthopnea, no LE edema.
.
In the ED, initial vs were: 98.2 124 145/92 18 100% RA. Labs
notable for bicarb of 6, BG of 399 with all other labs negative,
including negative ASA and EtOH levels.  VBG was 7.1/23/43.
Patient was given 3 LNS, ASA 81mg, regular insulin 5U and
started on insulin gtt, GI cocktail with reported resolution of
his symptoms w/ AG 23 -> 17.  He was admitted to ICU for further
treatment.  EKG was sinus tachycardia.  At time of transfer, VS
were 97.8, 115/77 88 22 100% RA with Kussmaul respirations.
.

Past Medical History:
- Diet controlled diabetes.
- central right paracentral disc bulging at C4-5
- Colonoscopy [**2146**] wnl.

Social History:
Lives alone, former carpenter, lost his job recently.
- Tobacco: [**12-6**] ppd x 4 yrs
- Alcohol: 2 pints weekly
- Illicits:  denies.

Family History:
Fa - DM, MI at older age.
Mo - died in 50s from PNA as complication from hip fx.

Physical Exam:
Physical Exam:
VS 97.8, 115/77 88 22 100% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

Pertinent Results:
Admission Labs

[**2150-8-30**] 06:13PM BLOOD WBC-7.9 RBC-4.62 Hgb-15.6 Hct-46.2
MCV-100* MCH-33.7* MCHC-33.7 RDW-13.6 Plt Ct-237
[**2150-8-30**] 06:13PM BLOOD Neuts-70.4* Lymphs-24.1 Monos-3.7 Eos-1.0
Baso-0.8
[**2150-8-30**] 06:13PM BLOOD Glucose-399* UreaN-10 Creat-1.2 Na-135
K-4.8 Cl-106 HCO3-6* AnGap-28*
[**2150-8-30**] 06:13PM BLOOD ALT-22 AST-13 AlkPhos-88 TotBili-0.3
[**2150-8-30**] 06:13PM BLOOD cTropnT-<0.01
[**2150-8-31**] 02:28AM BLOOD Calcium-7.3* Phos-1.2* Mg-1.9
[**2150-8-30**] 06:13PM BLOOD Albumin-4.9

[**2150-8-30**] 06:19PM BLOOD %HbA1c-15.4* eAG-395*

[**2150-8-31**] 06:04AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2150-8-30**] 07:36PM BLOOD pO2-43* pCO2-23* pH-7.10* calTCO2-8* Base
XS--22 Comment-GREEN
[**2150-8-30**] 07:36PM BLOOD Lactate-1.8
[**2150-8-31**] 07:25AM BLOOD BETA-HYDROXYBUTYRATE-PND

Discharge Labs:
[**2150-9-2**] 06:06AM BLOOD WBC-4.0 RBC-3.73* Hgb-12.3* Hct-35.5*
MCV-95 MCH-32.9* MCHC-34.5 RDW-13.6 Plt Ct-182
[**2150-9-2**] 06:06AM BLOOD Glucose-111* UreaN-7 Creat-0.7 Na-141
K-3.4 Cl-107 HCO3-25 AnGap-12
[**2150-8-30**] 06:13PM BLOOD ALT-22 AST-13 AlkPhos-88 TotBili-0.3
[**2150-9-2**] 06:06AM BLOOD Calcium-8.7 Phos-3.8# Mg-2.0

Brief Hospital Course:
# Anion gap acidosis, with an AG of 28 on admission, secondary
to DKA (blood glucose 399 on admission, A1C was 15.4).  Improved
with insulin drip, which was started on admission and d/c'd on
[**8-31**] in favor of Lantus 40U daily and HISS once he began
feeding.  Electrolytes were closely monitored QID and AG
eventually closed.  He also developed hypokalemia likely from K+
shifts [**1-6**] aggressive glucose management and was treated with
KCl [**Hospital1 **] which was changed to PRN repletion once K+ normalized.
[**Last Name (un) **] was consulted who recommended to continue glargine and
HISS.  He received injection teaching as well as diet/nutrition
teaching while in the ICU.  He was sent home with prescriptions
for diabetic supplies and insulin, and will be receiving PCP and
[**Name9 (PRE) **] follow up.
.
# Weight loss, anorexia, odynophagia.  Differential is broad,
Possibly candidal esophagitis given diabetes, could also be CMV,
but most likely etiology is GERD.  He was put on daily protonix,
and should be considered for outpt EGD.  Also may warrant a
discussion of HIV test given ongoing anorexia.
.
# DOE/SOB. Pt. reported SOB/DOE, with minimal exercise and
fatigue on admission, but no pulmonary pathology based on hx.
Given diabetes, there was concern that this was an anginal
equivalent, but he was ruled out for MI in the [**Hospital Unit Name 153**] and started
on ASA.  Pt did not endorse these symptoms in-house.
.
# Bloody stool. Not appreciated in-house, and his HCT remained
stable.  This should be adressed with his PCP regarding need for
further workup.

Medications on Admission:
none.

Discharge Medications:
1. 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*
2. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
Disp:*30 Tablet, Chewable(s)* Refills:*2*
3. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime)
as needed for insomnia.
Disp:*30 Tablet(s)* Refills:*0*
4. Insulin Glargine 100 unit/mL Solution Sig: Forty (40) units
Subcutaneous Before breakfast.
Disp:*30 ml* Refills:*2*
5. Insulin Lispro 100 unit/mL Solution Sig: see sliding scale
see sliding scale Subcutaneous four times a day.
Disp:*100 ml* Refills:*2*
6. Glucocard 01 Meter     Kit Sig: One (1)  Miscellaneous once a
day.
Disp:*1 unit* Refills:*2*
7. Glucosource     Misc Sig: One (1)  Miscellaneous four times a
day.
Disp:*1 box* Refills:*2*
8. Insulin syringes
Please provide syringes for insulin administration: 3 months
supply.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
Diabetic Ketoacidosis
Diabetes mellitus
Odynophagia


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


Discharge Instructions:
Mr. [**Known lastname 6692**],

You were admitted to the ICU because of very high blood sugars
which were causing you significant symptoms.  In the ICU you
were started on an insulin drip to control your sugars which
worked well, and you were eventually switched over to insulin
injections once you began eating.  Your blood sugars have
stablized and your symptoms improved.  You were given teaching
on how to inject insulin and diet management, and doctors from
the [**Name5 (PTitle) **] Clinic followed you in the hospital, and will be
scheduling an appointment with you for next week.

You also described burning throat pain with swallowing.  We
think that this was likely gastric reflux and we treated it with
an anti-acid drug. You will be given a prescription for this
upon discharge.  However, we recommend outpatient follow up with
a gastroenterologist to further assess this, and this should be
arranged through your PCP

You also described some blood in your stool leading up to
admission, but this did not seem to be an issue in the hospital.
 Your blood count remained stable indicating that you were not
bleeding.  This issue should also be adressed by your PCP.

Please note your follow up appointments below.

It was a pleasure participating in your care.

Followup Instructions:
You have an appointment scheduled with your PCP:

[**2150-9-11**]  12:30PM
Name: [**Last Name (LF) 5533**],[**First Name3 (LF) **] M.
Location: [**Hospital 3578**] COMMUNITY HEALTH CENTER
Address: [**Hospital1 3579**], [**Location (un) **],[**Numeric Identifier 3580**]
Phone: [**Telephone/Fax (1) 3581**]

You will also be scheduled for follow-up at the [**Hospital **] Clinic.
Please call ([**Telephone/Fax (1) 19850**].  You need to be seen within two
weeks.
{'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Blood in stool,Other respiratory abnormalities,Esophageal reflux,Hypopotassemia'}


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: abd. pain, odynophagia, acidosis

PRESENT ILLNESS: 47 yo man w/ diet treated diabetes (dx 4 yrs ago) presented to
the ED with c/o chest burning sensation, SOB, anorexia and
malaise.
.
Pt. has been in poor state of usual health over the past six
months (fatigue, decreased appetite, weight loss) until today,
when he noted worsening malaise, inability to take PO, burning
sensation in his chest (from neck to epigastric area) and
presented to the ED. He has not sought medical care for any of
his symptoms until now and over the past 2 months had stopped
checking his BG, thinking he did not need to.
.
Additional notable hx includes unintentional weight loss over
the past 6 mo (waist size 36->32) which he attributed to
anorexia and odynophagia.  He does not have a globus sensation,
no hemoptysis.  He does endorse chills w/o nightsweats.  Chest
burning does not radiate, he does not feel diphoretic. It occurs
mostly with and right after food intake.
.
He has had marked DOE over the past 3 months, even with minimal
exertion (walking to kitchen from living room). No SOB at rest.
No diaphoresis, palpitations.  + PND, no orthopnea, no LE edema.
.
In the ED, initial vs were: 98.2 124 145/92 18 100% RA. Labs
notable for bicarb of 6, BG of 399 with all other labs negative,
including negative ASA and EtOH levels.  VBG was 7.1/23/43.
Patient was given 3 LNS, ASA 81mg, regular insulin 5U and
started on insulin gtt, GI cocktail with reported resolution of
his symptoms w/ AG 23 -> 17.  He was admitted to ICU for further
treatment.  EKG was sinus tachycardia.  At time of transfer, VS
were 97.8, 115/77 88 22 100% RA with Kussmaul respirations.
.

MEDICAL HISTORY: - Diet controlled diabetes.
- central right paracentral disc bulging at C4-5
- Colonoscopy [**2146**] wnl.

MEDICATION ON ADMISSION: none.

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Physical Exam:
VS 97.8, 115/77 88 22 100% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, dMM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Clear to auscultation bilaterally, no wheezes, rales,
ronchi
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
gallops
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding, no organomegaly
GU: no foley
Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or
edema

FAMILY HISTORY: Fa - DM, MI at older age.
Mo - died in 50s from PNA as complication from hip fx.

SOCIAL HISTORY: Lives alone, former carpenter, lost his job recently.
- Tobacco: [**12-6**] ppd x 4 yrs
- Alcohol: 2 pints weekly
- Illicits:  denies. 

### Response:
{'Diabetes with ketoacidosis, type II or unspecified type, uncontrolled,Blood in stool,Other respiratory abnormalities,Esophageal reflux,Hypopotassemia'}
