CHIEF COMPLAINT: 

PRESENT ILLNESS: Patient is a 40-year-old female
with a history of type 1 diabetes mellitus complicated by
diabetic ketoacidosis in the past, who was in usual state of
health until morning of [**2121-1-30**] when she awoke with vomiting
at approximately 7 a.m.  She presented to [**Hospital3 **]
ED, where noted to have a FSBG of 438, pH 7.03, positive
serum acetone, positive urine ketones.

MEDICAL HISTORY: 1. Type 1 diabetes mellitus diagnosed in [**2105**] complicated by
prior episodes of diabetic ketoacidosis x4.
2. History of pancreatitis secondary to EtOH in [**2118**].

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Lives with husband.  Smokes half pack per
day.  Reports moderate alcohol use on the weekends.
Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Other specified disease of white blood cells,Acute pharyngitis
DMI keto nt st uncntrld,Wbc disease NEC,Acute pharyngitis
Admission Date:  [**2121-1-31**]     Discharge Date:  [**2121-2-2**]

Date of Birth:   [**2079-7-26**]     Sex:  F

Service:  VICU and transferred to [**Company 191**] service

HISTORY OF PRESENT ILLNESS:  Patient is a 40-year-old female
with a history of type 1 diabetes mellitus complicated by
diabetic ketoacidosis in the past, who was in usual state of
health until morning of [**2121-1-30**] when she awoke with vomiting
at approximately 7 a.m.  She presented to [**Hospital3 **]
ED, where noted to have a FSBG of 438, pH 7.03, positive
serum acetone, positive urine ketones.

Patient states on morning of admission she developed vomiting
which continued, but was nonbilious.  No hematemesis.
Positive diarrhea, moderate stools, no abdominal pain.
Reports drinking greater than two glasses of wine on the
evening of [**1-30**].  Denies recent illness.  No fever, no
chills, and no dysuria, no recent antibiotics.

REVIEW OF SYSTEMS:  Reveals dry throat with cough, chronic
headaches.  Denies myalgias, chest pain, shortness of breath.
No medicine noncompliance.

Patient was transferred to [**Hospital1 188**] ED because of lack of ICU beds at outside hospital.

PAST MEDICAL HISTORY:
1. Type 1 diabetes mellitus diagnosed in [**2105**] complicated by
prior episodes of diabetic ketoacidosis x4.
2. History of pancreatitis secondary to EtOH in [**2118**].

MEDICATIONS:  Humulin 25 units q.a.m., 10 units q.p.m.  Plus
Humalog sliding scale.

ALLERGIES:  Penicillin.

SOCIAL HISTORY:  Lives with husband.  Smokes half pack per
day.  Reports moderate alcohol use on the weekends.

FAMILY HISTORY:  Noncontributory.

EXAMINATION:  Temperature 98.9, heart rate 108, blood
pressure 105/68, respiratory rate of 18, and satting 100% on
room air.  Fasting sugar 168.  General:  Patient pleasant in
no acute distress.  HEENT:  Anicteric.  PERRL.  Mucous
membranes dry.  Neck was supple without lymphadenopathy.
Cardiovascular:  Tachycardic with regular rhythm, no murmurs.
Lungs are clear to auscultation bilaterally.  Abdomen:
Positive bowel sounds, soft, nondistended with diffuse lower
abdomen tenderness, no rebound or guarding, no
hepatosplenomegaly.  Extremities:  Warm, no edema.  Skin
without rash.  Neurologic:  Alert and oriented times three.
Grossly nonfocal.

DATA:  CBC:  18.7/36.8/199.  Chem-7:  142/4.8/111/11/13/0.7.
Glucose 192.  LFTs within normal limits.  Amylase and lipase
within normal limits.  Serum ketone positive.  Urinalysis:
greater than 80 ketones, greater than 1000 glucose.

CT of abdomen:  No intraabdominal process, no pancreatitis,
diverticulitis, or appendicitis.

HOSPITAL COURSE:  In summary, patient is a 41-year-old female
with a significant history of diabetes mellitus type 1, who
presents with nausea and vomiting secondary to diabetic
ketoacidosis likely precipitated by excessive EtOH on the
night prior.

1. Diabetes mellitus/DKA:  Patient was admitted to the ICU
and maintained on an insulin drip and IV fluids.  Her anion
gap closed and blood sugars normalized.  She was seen by the
[**Last Name (un) **] Diabetes Center while in the ICU, who recommended a
new insulin regimen of glargine 25 units q.h.s. and a Humalog
sliding scale q.i.d.

She was maintained on this regimen until time of discharge.
Despite numerous conversations, patient was uncomfortable
switching regimens and preferred to stay on her prior regimen
of Humulin-U with sliding scale.  She was to discuss risks
and benefits of each regimen with her PCP at followup.  A
hemoglobin A1C was checked, but was pending at time of
discharge.

2. Pharyngitis:  Patient had initially an extremely sore
throat which limited her p.o. intake.  Etiology presumed
viral.  Patient had negative influenza aspirate and Strep
throat culture was sent and pending at time of discharge.
However, she was started empirically on IV clindamycin
secondary to penicillin allergy empirically by the ICU team,
and was continued on this regimen for a total of seven day
course at time of discharge.  Her sore throat was treated
supportively and she was tolerating adequate p.o. at the time
of discharge.

3. FEN:  Patient's electrolytes were monitored closely and
repleted as needed.

CONDITION ON DISCHARGE:  Patient was in stable condition.
She was afebrile and tolerating adequate p.o.  Her blood
sugars were within normal limits.

DISCHARGE STATUS:  Patient was discharged to home.

DISCHARGE DIAGNOSES:
1. Diabetic ketoacidosis.
2. Diabetes mellitus type 1.
3. Hypokalemia.
4. Hypophosphatemia.
5. Pharyngitis unspecified.

DISCHARGE MEDICATIONS:
1. Humulin-U 25 units subQ q.a.m., 10 units subQ q.p.m.
2. Humalog sliding scale.
3. Clindamycin 300 mg p.o. q.i.d. for five days.

FOLLOWUP:  Patient was instructed to followup with her PCP,
[**Last Name (NamePattern4) **]. [**First Name4 (NamePattern1) 333**] [**Last Name (NamePattern1) **] at [**Telephone/Fax (1) 52559**] within one week of
discharge.



                          [**Doctor Last Name **] [**Name6 (MD) **] [**Name8 (MD) **], M.D.  [**MD Number(1) 5712**]

Dictated By:[**Last Name (NamePattern1) 8478**]

MEDQUIST36

D:  [**2121-2-2**]  15:16
T:  [**2121-2-3**]  11:31
JOB#:  [**Job Number 52560**]
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Other specified disease of white blood cells,Acute pharyngitis'}


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: 

PRESENT ILLNESS: Patient is a 40-year-old female
with a history of type 1 diabetes mellitus complicated by
diabetic ketoacidosis in the past, who was in usual state of
health until morning of [**2121-1-30**] when she awoke with vomiting
at approximately 7 a.m.  She presented to [**Hospital3 **]
ED, where noted to have a FSBG of 438, pH 7.03, positive
serum acetone, positive urine ketones.

MEDICAL HISTORY: 1. Type 1 diabetes mellitus diagnosed in [**2105**] complicated by
prior episodes of diabetic ketoacidosis x4.
2. History of pancreatitis secondary to EtOH in [**2118**].

MEDICATION ON ADMISSION: 

ALLERGIES: Penicillin.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: Lives with husband.  Smokes half pack per
day.  Reports moderate alcohol use on the weekends. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Other specified disease of white blood cells,Acute pharyngitis'}
