CHIEF COMPLAINT: s/p cardiac arrest [**1-25**] DKA

PRESENT ILLNESS: Patient is a 66 year old male with past medical history
significant for type 1 diabetes mellitus complicated by
hypoglycemic episodes that leads to passing out or seizures. His
wife reports he has been upper respiratory symptoms for past few
days and had acute episode of nausea and vomiting last night
along with confusion and multiple falls thereafter. He was
unarousable this morning and when EMS arrived he initially very
bradycardic. He got 1 mg atropine on site. En route had several
asystolic arrests x3 but would come back spontaneously.
Intubated in the field. Fasting glucose critical high in the
field. Hemodynamically stable in the ED. Making gestures. On
fentanyl/versed for sedation. Easy to ventilate.
.
In the ED, initial VBG was acidotic (6.89/32/195) and K+ of 7.2
EKG with diffuse peaked T-s. Given calcium gluconate, kayexalte
and started on insulin gtt @ 10 units/hr and IV fluids (4LNS).
QRS narrowed from 118 to 108. Bicarb gtt started for pH < 7.0.
Vitals prior to transfer HR of 81, BP of 100/53 Vent 550 x14
PEEP 5 FiO2 100%, overbreathing at rate of 30.
.
OG with 400 ccs of coffee ground emesis. Did not clear with 500
ccs of lavage. GI decided not scope as they suspected gastritis
in acute illness vs [**First Name9 (NamePattern2) **] [**Last Name (un) **] tear. IV protonix was started.

MEDICAL HISTORY: DM type 1 dx'ed [**2151**], c/b ulnar and median neuropathies, PVD,
retinopathy, and gastroparesis
Diabetic foot ulcers with multiple prior infections including
MRSA isolates, s/p L 4th toe osteomyelitis with gas gangrene in
[**3-29**] requiring amputation
OSA
PVD s/p L femoral bypass
GERD
HTN
Hypercholestolemia
Depression
Erectile dysfunction
h/o broken neck at age 13 with C1-C2 repair.

MEDICATION ON ADMISSION: Amlodipine 10 mg po qdaily
Atorvastatin 80 mg po qdaily
Buproprion 300 mg po qdaily
Fluticasone 2 puff inhalation qdaily
Insulin 70/30 as directed
lisinopril 40 mg po qdaily
Meloxicam 15 mg po qdaily
Pantoprazole 40 mg po qdaily
Trazodone 200 mg po qhs prn insomnia
Valsartan 80 mg po qdaily
Venlafaxine 300 mg po qdaily
Aspirin 81 mg po qdaily

ALLERGIES: Penicillins / Cephalosporins / Aztreonam / Latex

PHYSICAL EXAM: VS: HR:85 BP:105/54 RR:22 O2sat:100% CMV 100%FiO2 PEEP:5cm
GEN: Intubated. Sedated.
HEENT: PERRLA.
NECK: Supple neck
PULM: Clear to auscultation bilaterally
CARD: Regular rate and rhythm. No murmurs or gallops
appreciated.
ABD: Soft, nontender and nondistended
EXT: No edema. Appropriate temperature at the extremities. 1+
pulses @ posterior tibial and radial artery
SKIN: Bruises b/l legs
NEURO: Sedated. PERRLA

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: (+) tobacco use x40 years, currently smokes 3 cigs/day, patient
denies past etoh abuse, although OMR notes indicate past chronic
alcohol use. Denies illicit drug use. Married.
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Subendocardial infarction, initial episode of care,Acute respiratory failure,Unspecified gastritis and gastroduodenitis, with hemorrhage,Acute kidney failure, unspecified,Closed fracture of three ribs,Hyperpotassemia,Intestinal infection due to other organism, not elsewhere classified,Encounter for palliative care,Tobacco use disorder,Polyneuropathy in diabetes,Peripheral angiopathy in diseases classified elsewhere,Background diabetic retinopathy,Gastroparesis,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Fall from other slipping, tripping, or stumbling,Home accidents,Thrombocytopenia, unspecified
DMI ketoacd uncontrold,Subendo infarct, initial,Acute respiratry failure,Gstr/ddnts NOS w hmrhg,Acute kidney failure NOS,Fracture three ribs-clos,Hyperpotassemia,Viral enteritis NOS,Encountr palliative care,Tobacco use disorder,Neuropathy in diabetes,Angiopathy in other dis,Diabetic retinopathy NOS,Gastroparesis,Obstructive sleep apnea,Pure hypercholesterolem,Depressive disorder NEC,Hy kid NOS w cr kid I-IV,Chronic kidney dis NOS,Fall from slipping NEC,Accident in home,Thrombocytopenia NOS
Admission Date:  [**2191-12-31**]              Discharge Date:   [**2192-1-5**]

Date of Birth:  [**2125-1-31**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / Cephalosporins / Aztreonam / Latex

Attending:[**Last Name (NamePattern4) 290**]
Chief Complaint:
s/p cardiac arrest [**1-25**] DKA

Major Surgical or Invasive Procedure:
Intubation ([**2191-12-31**])
RIJ line placement ([**2191-12-31**])
A-line placement ([**2191-12-31**])

History of Present Illness:
Patient is a 66 year old male with past medical history
significant for type 1 diabetes mellitus complicated by
hypoglycemic episodes that leads to passing out or seizures. His
wife reports he has been upper respiratory symptoms for past few
days and had acute episode of nausea and vomiting last night
along with confusion and multiple falls thereafter. He was
unarousable this morning and when EMS arrived he initially very
bradycardic. He got 1 mg atropine on site. En route had several
asystolic arrests x3 but would come back spontaneously.
Intubated in the field. Fasting glucose critical high in the
field. Hemodynamically stable in the ED. Making gestures. On
fentanyl/versed for sedation. Easy to ventilate.
.
In the ED, initial VBG was acidotic (6.89/32/195) and K+ of 7.2
EKG with diffuse peaked T-s. Given calcium gluconate, kayexalte
and started on insulin gtt @ 10 units/hr and IV fluids (4LNS).
QRS narrowed from 118 to 108. Bicarb gtt started for pH < 7.0.
Vitals prior to transfer HR of 81, BP of 100/53 Vent 550 x14
PEEP 5 FiO2 100%, overbreathing at rate of 30.
.
OG with 400 ccs of coffee ground emesis. Did not clear with 500
ccs of lavage. GI decided not scope as they suspected gastritis
in acute illness vs [**First Name9 (NamePattern2) **] [**Last Name (un) **] tear. IV protonix was started.


Past Medical History:
DM type 1 dx'ed [**2151**], c/b ulnar and median neuropathies, PVD,
retinopathy, and gastroparesis
Diabetic foot ulcers with multiple prior infections including
MRSA isolates, s/p L 4th toe osteomyelitis with gas gangrene in
[**3-29**] requiring amputation
OSA
PVD s/p L femoral bypass
GERD
HTN
Hypercholestolemia
Depression
Erectile dysfunction
h/o broken neck at age 13 with C1-C2 repair.


Social History:
(+) tobacco use x40 years, currently smokes 3 cigs/day, patient
denies past etoh abuse, although OMR notes indicate past chronic
alcohol use. Denies illicit drug use. Married.


Family History:
Non-contributory

Physical Exam:
VS: HR:85 BP:105/54 RR:22 O2sat:100% CMV 100%FiO2 PEEP:5cm
GEN: Intubated. Sedated.
HEENT: PERRLA.
NECK: Supple neck
PULM: Clear to auscultation bilaterally
CARD: Regular rate and rhythm. No murmurs or gallops
appreciated.
ABD: Soft, nontender and nondistended
EXT: No edema. Appropriate temperature at the extremities. 1+
pulses @ posterior tibial and radial artery
SKIN: Bruises b/l legs
NEURO: Sedated. PERRLA


Pertinent Results:
Admission Labs
[**2191-12-31**] 03:26PM BLOOD WBC-25.5* Hct-36.0* Plt Ct-426
[**2191-12-31**] 03:26PM BLOOD Neuts-66 Bands-4 Lymphs-21 Monos-7 Eos-0
Baso-0 Atyps-0 Metas-1* Myelos-1* NRBC-1*
[**2191-12-31**] 05:30PM BLOOD Glucose-883* UreaN-65* Creat-2.5* Na-129*
K-7.2* Cl-90* HCO3-8* AnGap-38*
[**2191-12-31**] 08:47PM BLOOD ALT-29 AST-40 CK(CPK)-968* AlkPhos-105
TotBili-0.4
[**2191-12-31**] 08:47PM BLOOD CK-MB-46* MB Indx-4.8 cTropnT-0.37*
[**2191-12-31**] 08:47PM BLOOD Calcium-7.7* Phos-5.5*# Mg-2.4
.
Pertinent Labs
[**2191-12-31**] 03:41PM BLOOD Type-ART Rates-/29 Tidal V-500 FiO2-98
pO2-195* pCO2-32* pH-6.89* calTCO2-7* Base XS--27 AADO2-481 REQ
O2-80 -ASSIST/CON Intubat-INTUBATED Comment-GREEN TOP
[**2191-12-31**] 05:39PM BLOOD Type-[**Last Name (un) **] pO2-110* pCO2-32* pH-6.97*
calTCO2-8* Base XS--24 Comment-GREEN TOP
[**2191-12-31**] 08:53PM BLOOD Type-MIX pO2-65* pCO2-43 pH-7.10*
calTCO2-14* Base XS--16
[**2191-12-31**] 10:09PM BLOOD Type-ART Temp-35.8 pO2-401* pCO2-44
pH-7.20* calTCO2-18* Base XS--10 Intubat-INTUBATED
[**2192-1-1**] 03:08AM BLOOD Type-ART Temp-33.1 FiO2-50 pO2-144*
pCO2-41 pH-7.35 calTCO2-24 Base XS--2 Intubat-INTUBATED
.
CT Torso ([**2191-12-31**]):
1)Acute fractures of left 3,4,5 ribs and sternum. remote fx of
left 6,7,8 ribs. remote fx rt transverse process L3, L5. age
indeterminate fx of right transverse process L2
2) penile implant with reservoir in pelvis, just right of
midline could correspond to fluid seen on FAST exam
3) extensive vascular calcifications.
.
CT Head ([**2191-12-31**]):
no acute intracranial process
.
CXR ([**2191-12-31**]):
Single supine AP portable view of the chest was obtained. There

has been interval placement of a right internal jugular central
venous catheter, terminating in the very distal SVC, without
evidence of pneumothorax. Endotracheal tube is seen, very distal
difficult to discern, but remains above the level of the carina.
Distal aspect of the nasogastric tube is also not well seen
below the level of the distal esophagus. Lungs remain clear.


Brief Hospital Course:
66 year old male with type 1 diabetes s/p asystolic arrests x 3
likely due to acidosis and hyperkalemia secondary to diabetic
ketoacidosis.  Anion gap was closed with fluids and insulin
drip. Onset thought to be due to acute viral gastroenteritis
leading to his diabetic ketoacidosis. Arctic arrest cooling
protocol initiated for neuro protection after multiple cardiac
arrests.  It was thought that arrests likely secondary to
hyperkalemia vs acidosis.  Pt noted to have elevated troponins
likely secondary to demand ischemia vs NSTEMI vs end organ
damage from his cardiac arrest.  On [**1-2**], pt noted to have
increased temperature, shivering, and increased secretions from
the ET tube.  He was started on antibiotics empirically.  Family
decision was made that pt would be CMO; however he was kept on
the vent until [**1-5**] so that family members could arrive from out
of state.  Extubation occurred on [**1-5**], and pt passed away
approximately 10 minutes later.  Family declined autopsy.

Medications on Admission:
Amlodipine 10 mg po qdaily
Atorvastatin 80 mg po qdaily
Buproprion 300 mg po qdaily
Fluticasone 2 puff inhalation qdaily
Insulin 70/30 as directed
lisinopril 40 mg po qdaily
Meloxicam 15 mg po qdaily
Pantoprazole 40 mg po qdaily
Trazodone 200 mg po qhs prn insomnia
Valsartan 80 mg po qdaily
Venlafaxine 300 mg po qdaily
Aspirin 81 mg po qdaily


Discharge Medications:
pt passed away

Discharge Disposition:
Expired

Discharge Diagnosis:
pt passed away

Discharge Condition:
pt passed away

Discharge Instructions:
pt passed away

Followup Instructions:
pt passed away

                             [**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] [**Name8 (MD) **] MD [**MD Number(1) 292**]

Completed by:[**2192-1-5**]
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Subendocardial infarction, initial episode of care,Acute respiratory failure,Unspecified gastritis and gastroduodenitis, with hemorrhage,Acute kidney failure, unspecified,Closed fracture of three ribs,Hyperpotassemia,Intestinal infection due to other organism, not elsewhere classified,Encounter for palliative care,Tobacco use disorder,Polyneuropathy in diabetes,Peripheral angiopathy in diseases classified elsewhere,Background diabetic retinopathy,Gastroparesis,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Fall from other slipping, tripping, or stumbling,Home accidents,Thrombocytopenia, unspecified'}


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: s/p cardiac arrest [**1-25**] DKA

PRESENT ILLNESS: Patient is a 66 year old male with past medical history
significant for type 1 diabetes mellitus complicated by
hypoglycemic episodes that leads to passing out or seizures. His
wife reports he has been upper respiratory symptoms for past few
days and had acute episode of nausea and vomiting last night
along with confusion and multiple falls thereafter. He was
unarousable this morning and when EMS arrived he initially very
bradycardic. He got 1 mg atropine on site. En route had several
asystolic arrests x3 but would come back spontaneously.
Intubated in the field. Fasting glucose critical high in the
field. Hemodynamically stable in the ED. Making gestures. On
fentanyl/versed for sedation. Easy to ventilate.
.
In the ED, initial VBG was acidotic (6.89/32/195) and K+ of 7.2
EKG with diffuse peaked T-s. Given calcium gluconate, kayexalte
and started on insulin gtt @ 10 units/hr and IV fluids (4LNS).
QRS narrowed from 118 to 108. Bicarb gtt started for pH < 7.0.
Vitals prior to transfer HR of 81, BP of 100/53 Vent 550 x14
PEEP 5 FiO2 100%, overbreathing at rate of 30.
.
OG with 400 ccs of coffee ground emesis. Did not clear with 500
ccs of lavage. GI decided not scope as they suspected gastritis
in acute illness vs [**First Name9 (NamePattern2) **] [**Last Name (un) **] tear. IV protonix was started.

MEDICAL HISTORY: DM type 1 dx'ed [**2151**], c/b ulnar and median neuropathies, PVD,
retinopathy, and gastroparesis
Diabetic foot ulcers with multiple prior infections including
MRSA isolates, s/p L 4th toe osteomyelitis with gas gangrene in
[**3-29**] requiring amputation
OSA
PVD s/p L femoral bypass
GERD
HTN
Hypercholestolemia
Depression
Erectile dysfunction
h/o broken neck at age 13 with C1-C2 repair.

MEDICATION ON ADMISSION: Amlodipine 10 mg po qdaily
Atorvastatin 80 mg po qdaily
Buproprion 300 mg po qdaily
Fluticasone 2 puff inhalation qdaily
Insulin 70/30 as directed
lisinopril 40 mg po qdaily
Meloxicam 15 mg po qdaily
Pantoprazole 40 mg po qdaily
Trazodone 200 mg po qhs prn insomnia
Valsartan 80 mg po qdaily
Venlafaxine 300 mg po qdaily
Aspirin 81 mg po qdaily

ALLERGIES: Penicillins / Cephalosporins / Aztreonam / Latex

PHYSICAL EXAM: VS: HR:85 BP:105/54 RR:22 O2sat:100% CMV 100%FiO2 PEEP:5cm
GEN: Intubated. Sedated.
HEENT: PERRLA.
NECK: Supple neck
PULM: Clear to auscultation bilaterally
CARD: Regular rate and rhythm. No murmurs or gallops
appreciated.
ABD: Soft, nontender and nondistended
EXT: No edema. Appropriate temperature at the extremities. 1+
pulses @ posterior tibial and radial artery
SKIN: Bruises b/l legs
NEURO: Sedated. PERRLA

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: (+) tobacco use x40 years, currently smokes 3 cigs/day, patient
denies past etoh abuse, although OMR notes indicate past chronic
alcohol use. Denies illicit drug use. Married. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Subendocardial infarction, initial episode of care,Acute respiratory failure,Unspecified gastritis and gastroduodenitis, with hemorrhage,Acute kidney failure, unspecified,Closed fracture of three ribs,Hyperpotassemia,Intestinal infection due to other organism, not elsewhere classified,Encounter for palliative care,Tobacco use disorder,Polyneuropathy in diabetes,Peripheral angiopathy in diseases classified elsewhere,Background diabetic retinopathy,Gastroparesis,Obstructive sleep apnea (adult)(pediatric),Pure hypercholesterolemia,Depressive disorder, not elsewhere classified,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Chronic kidney disease, unspecified,Fall from other slipping, tripping, or stumbling,Home accidents,Thrombocytopenia, unspecified'}
