CHIEF COMPLAINT: seizure and hypoglycemia

PRESENT ILLNESS: This is a 27 yo M with a past medical history significant for
ESRD secondary to HTN on HD, beginning in [**2192**].  He reports one
previous incident of seizure also in the setting of a
hypoglycemic episode following HD.  He presents today with
hypoglycemia following a witnessed seizure in his cousin's car
after HD.  HD today was uncomplicated, though he states that
more fluid was removed and faster than usual (3L in 2.5 hours).
He denies any recent illnesses or ingestions.
.
He states that before these seizures he experiences an aura in
which he "blacks out" and cannot see anything.  He frequently
has these auras during or immediately after dialysis, but
without the seizures.  He receives dialysis on Tues/Thurs/Sat at
[**Location (un) 105764**]. Kidney Center.
.
In the ED, his neuro exam was felt to be nonfocal. He was given
1 amp of D50 x 1 to which he responded from a FS of 57 to a FS
of 120. Following eating, however, his glucose began to drift
downwards once again to a nadir in the 60's, for which he was
given another amp of D50. He is admitted to the MICU for
frequent blood glucose monitoring and to initiate further
work-up for hypoglycemia in a non-diabetic.

MEDICAL HISTORY: HTN - diagnosed [**2191**] (?"small stroke" per [**State **] OSH)
ESRD - diagnosed [**2191**], felt [**2-15**] HTN (dx [**2191**] also). pt on
dialysis
since [**12/2192**] (kidney center, comme ave, [**Telephone/Fax (1) **],
nephrologist
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], on transplant list, s/p failed R AVF, with L AVF

MEDICATION ON ADMISSION: Labetalol 300 mg PO BID
Felodipine SR 2.5 mg PO QAM
Catapres 2 patch QWeek
Lisinopril 5 mg PO QD
Calcium Acetate 667 mg capsules, 2 PO TID
Acetaminophen prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - T 98.4 BP 153/102 HR 76 RR 18 99%RA
GENERAL: laying in bed, NAD
SKIN: warm and well perfused, no excoriations or lesions, no
rashes
HEENT: AT/NC, EOMI, PERRLA, anicteric sclera, pink conjunctiva,
MMM, good dentition, supple neck, no LAD, no JVD
CARDIAC: regular rate. III/VI holosystolic murmur heard at the
LUSB, radiating up to clavicle on left, but not to carotids.
Breast: Left breast with subareolar mass, about 2x2cm, tender to
palpation, no discharge, no skin changes
LUNG: CTAB no w/r/r
ABDOMEN: nondistended, +BS, nontender in all quadrants, no
rebound/guarding, no hepatosplenomegaly
M/S: moving all extremities well, no cyanosis, clubbing or
edema, no obvious deformities
PULSES: 2+ DP pulses bilaterally. thrill over fistula L arm.
NEURO: CN II-XII intact, strength 5/5 bilaterally, sensation to
light touch in tact bilaterally. A&Ox3. Normal speech, prosidy,
cerebellar function. Normal gait.

FAMILY HISTORY: denies family history of premature cad, dm, htn, or seizures.
Father has psoriasis.  Grandmother died of cancer, type unknown.

SOCIAL HISTORY: worked in construction, now on disability, denies tobbacco,
alcohol, or IVDU.
Other specified hypoglycemia,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Other convulsions,Person awaiting admission to adequate facility elsewhere,Family history of unspecified malignant neoplasm
Oth spcf hypoglycemia,End stage renal disease,Hyp kid NOS w cr kid V,Acidosis,Convulsions NEC,Wait adm to oth facility,Family hx-malignancy NOS
Admission Date:  [**2194-7-26**]              Discharge Date:   [**2194-7-27**]

Date of Birth:  [**2167-7-22**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 8961**]
Chief Complaint:
seizure and hypoglycemia

Major Surgical or Invasive Procedure:
None.


History of Present Illness:
This is a 27 yo M with a past medical history significant for
ESRD secondary to HTN on HD, beginning in [**2192**].  He reports one
previous incident of seizure also in the setting of a
hypoglycemic episode following HD.  He presents today with
hypoglycemia following a witnessed seizure in his cousin's car
after HD.  HD today was uncomplicated, though he states that
more fluid was removed and faster than usual (3L in 2.5 hours).
He denies any recent illnesses or ingestions.
.
He states that before these seizures he experiences an aura in
which he "blacks out" and cannot see anything.  He frequently
has these auras during or immediately after dialysis, but
without the seizures.  He receives dialysis on Tues/Thurs/Sat at
[**Location (un) 105764**]. Kidney Center.
.
In the ED, his neuro exam was felt to be nonfocal. He was given
1 amp of D50 x 1 to which he responded from a FS of 57 to a FS
of 120. Following eating, however, his glucose began to drift
downwards once again to a nadir in the 60's, for which he was
given another amp of D50. He is admitted to the MICU for
frequent blood glucose monitoring and to initiate further
work-up for hypoglycemia in a non-diabetic.

Past Medical History:
HTN - diagnosed [**2191**] (?"small stroke" per [**State **] OSH)
ESRD - diagnosed [**2191**], felt [**2-15**] HTN (dx [**2191**] also). pt on
dialysis
since [**12/2192**] (kidney center, comme ave, [**Telephone/Fax (1) **],
nephrologist
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], on transplant list, s/p failed R AVF, with L AVF

placed [**10/2192**], usual dialysis day Tu/Th/Sa).
seizure presumed to be [**2-15**] hypoglycemia [**1-20**] (seen by neuro, no
intervention)
Seizures as noted above

Social History:
worked in construction, now on disability, denies tobbacco,
alcohol, or IVDU.


Family History:
denies family history of premature cad, dm, htn, or seizures.
Father has psoriasis.  Grandmother died of cancer, type unknown.


Physical Exam:
Vitals - T 98.4 BP 153/102 HR 76 RR 18 99%RA
GENERAL: laying in bed, NAD
SKIN: warm and well perfused, no excoriations or lesions, no
rashes
HEENT: AT/NC, EOMI, PERRLA, anicteric sclera, pink conjunctiva,
MMM, good dentition, supple neck, no LAD, no JVD
CARDIAC: regular rate. III/VI holosystolic murmur heard at the
LUSB, radiating up to clavicle on left, but not to carotids.
Breast: Left breast with subareolar mass, about 2x2cm, tender to
palpation, no discharge, no skin changes
LUNG: CTAB no w/r/r
ABDOMEN: nondistended, +BS, nontender in all quadrants, no
rebound/guarding, no hepatosplenomegaly
M/S: moving all extremities well, no cyanosis, clubbing or
edema, no obvious deformities
PULSES: 2+ DP pulses bilaterally. thrill over fistula L arm.
NEURO: CN II-XII intact, strength 5/5 bilaterally, sensation to
light touch in tact bilaterally. A&Ox3. Normal speech, prosidy,
cerebellar function. Normal gait.

Pertinent Results:
Admission Labs:
WBC-8.5 Hgb-14.3 Hct-44.8 MCV-94 MCH-29.9 Plt Ct-204
Neuts-67.2 Lymphs-25.6 Monos-4.8 Eos-1.9 Baso-0.6
UreaN-28* Creat-16.0*# Na-143 K-3.9 Cl-89* HCO3-17*
ALT-19 AST-31 AlkPhos-81 TotBili-0.4
Lipase-59
Calcium-9.7 Phos-5.5* Mg-3.1*
[**2194-7-27**] 02:54AM BLOOD Cortsol-18.0
[**2194-7-27**] 04:31AM BLOOD Cortsol-32.1*
.
Studies:
[**2194-7-26**] CT FINDINGS: Non-contrast head CT. There is no
intra-axial or extra-axial hemorrhage, mass effect, shift of
normally midline structures, or evidence of major vascular
territorial infarction. [**Doctor Last Name **]-white matter differentiation is
preserved. There is no hydrocephalus. Paranasal sinuses are well
aerated as are the mastoid air cells and middle ear cavities.
The surrounding calvarium and soft tissue structures are
unremarkable.
IMPRESSION: No acute intracranial process.


Brief Hospital Course:
27 yo M with history of ESRD on HD with history of seizures in
the setting of hypoglycemia, who presents with hypoglycemia
after a witnessed seizure.
.
1. Hypoglycemia: Unclear etiology, however he is clearly
symptomatic given seizure in this setting.  Etiologies in a
non-diabetic include insulinoma, adrenal insufficiency, and
malignancy. Adrenal insufficiency is unlikely given high blood
pressures, cosyntropin stim test performed with good response.
His blood sugars remained entirely normal with q1 hour
fingerstick monitoring.
- c peptide checked and pending
- ultrasound of breast mass, as outpt.
.
2. Seizure: No further seizures following admission and thought
to have occurred in the setting of hypovolemia and hypoglycemia.
 CT head was negative for bleed and mass.  As below, he was
advised to eat prior to each dialysis session.  Hypoglycemia
evaluation pending as above.
.
3. AG Metabolic Acidosis:  Likely uremia exacerbated by s/p
seizure.  Lactate normal at 1.3.
.
4. ESRD:  Continue HD as outpatient.  Patient advised to make
sure to eat prior to hemodialysis.
.
5. HTN:  Home antihypertensives continued.
.
6. FEN:  Low Na diet.
.
7. PPx:  Heparin sc for DVT prophylaxis


Medications on Admission:
Labetalol 300 mg PO BID
Felodipine SR 2.5 mg PO QAM
Catapres 2 patch QWeek
Lisinopril 5 mg PO QD
Calcium Acetate 667 mg capsules, 2 PO TID
Acetaminophen prn

Discharge Medications:
1. Labetalol 200 mg Tablet Sig: 1.5 Tablets PO BID (2 times a
day).
2. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

3. Calcium Acetate 667 mg Capsule Sig: Two (2) Capsule PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
4. Sevelamer HCl 800 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
Disp:*90 Tablet(s)* Refills:*2*
5. Felodipine 2.5 mg Tablet Sustained Release 24 hr Sig: One (1)
Tablet Sustained Release 24 hr PO DAILY (Daily).
6. Catapres-TTS-2 0.2 mg/24 hr Patch Weekly Sig: One (1)
Transdermal once a week.


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnoses:
Hypoglycemia
Seizure
Hypertension
End-stage renal disease on hemodialysis


Discharge Condition:
Stable, normoglycemic.


Discharge Instructions:
You were admitted to the hospital because of a seizure
associated with a low blood sugar after hemodialysis.  You were
monitored in the medical ICU with frequent blood sugar checks,
all of which were normal.

You should always eat something when you have hemodialysis.
Also, you should schedule an appointment with your physician,
[**Last Name (NamePattern4) **]. [**Last Name (STitle) **], to follow-up on the results of the tests that were
done  while you were in the hospital.  You should also make an
appointment to have the mass in your breast further evaluated.

You should continue to take your home medications, especially
your phosphate binders (Calcium acetate or Phoslo) as your
phosphate level is high.  In addition, you should also take the
phosphate binder Sevelamer or Renagel.

If you have any additional seizures, low blood sugar, or other
concerning symptoms, you should contact your physician or return
to the hospital.

Followup Instructions:
You should schedule an appointment to see Dr. [**Last Name (STitle) **] within the
next week or two.
You should make an appointment to have the mass in your breast
evaluated as you were instructed when you were seen in the
Emergency Department a few days ago.


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 8965**]
{'Other specified hypoglycemia,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Other convulsions,Person awaiting admission to adequate facility elsewhere,Family history of unspecified malignant neoplasm'}


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: seizure and hypoglycemia

PRESENT ILLNESS: This is a 27 yo M with a past medical history significant for
ESRD secondary to HTN on HD, beginning in [**2192**].  He reports one
previous incident of seizure also in the setting of a
hypoglycemic episode following HD.  He presents today with
hypoglycemia following a witnessed seizure in his cousin's car
after HD.  HD today was uncomplicated, though he states that
more fluid was removed and faster than usual (3L in 2.5 hours).
He denies any recent illnesses or ingestions.
.
He states that before these seizures he experiences an aura in
which he "blacks out" and cannot see anything.  He frequently
has these auras during or immediately after dialysis, but
without the seizures.  He receives dialysis on Tues/Thurs/Sat at
[**Location (un) 105764**]. Kidney Center.
.
In the ED, his neuro exam was felt to be nonfocal. He was given
1 amp of D50 x 1 to which he responded from a FS of 57 to a FS
of 120. Following eating, however, his glucose began to drift
downwards once again to a nadir in the 60's, for which he was
given another amp of D50. He is admitted to the MICU for
frequent blood glucose monitoring and to initiate further
work-up for hypoglycemia in a non-diabetic.

MEDICAL HISTORY: HTN - diagnosed [**2191**] (?"small stroke" per [**State **] OSH)
ESRD - diagnosed [**2191**], felt [**2-15**] HTN (dx [**2191**] also). pt on
dialysis
since [**12/2192**] (kidney center, comme ave, [**Telephone/Fax (1) **],
nephrologist
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], on transplant list, s/p failed R AVF, with L AVF

MEDICATION ON ADMISSION: Labetalol 300 mg PO BID
Felodipine SR 2.5 mg PO QAM
Catapres 2 patch QWeek
Lisinopril 5 mg PO QD
Calcium Acetate 667 mg capsules, 2 PO TID
Acetaminophen prn

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: Vitals - T 98.4 BP 153/102 HR 76 RR 18 99%RA
GENERAL: laying in bed, NAD
SKIN: warm and well perfused, no excoriations or lesions, no
rashes
HEENT: AT/NC, EOMI, PERRLA, anicteric sclera, pink conjunctiva,
MMM, good dentition, supple neck, no LAD, no JVD
CARDIAC: regular rate. III/VI holosystolic murmur heard at the
LUSB, radiating up to clavicle on left, but not to carotids.
Breast: Left breast with subareolar mass, about 2x2cm, tender to
palpation, no discharge, no skin changes
LUNG: CTAB no w/r/r
ABDOMEN: nondistended, +BS, nontender in all quadrants, no
rebound/guarding, no hepatosplenomegaly
M/S: moving all extremities well, no cyanosis, clubbing or
edema, no obvious deformities
PULSES: 2+ DP pulses bilaterally. thrill over fistula L arm.
NEURO: CN II-XII intact, strength 5/5 bilaterally, sensation to
light touch in tact bilaterally. A&Ox3. Normal speech, prosidy,
cerebellar function. Normal gait.

FAMILY HISTORY: denies family history of premature cad, dm, htn, or seizures.
Father has psoriasis.  Grandmother died of cancer, type unknown.

SOCIAL HISTORY: worked in construction, now on disability, denies tobbacco,
alcohol, or IVDU. 

### Response:
{'Other specified hypoglycemia,End stage renal disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Acidosis,Other convulsions,Person awaiting admission to adequate facility elsewhere,Family history of unspecified malignant neoplasm'}
