CHIEF COMPLAINT: Hypoglycemia

PRESENT ILLNESS: This is a 55yo F w/hx of ESRD on HD (TTS), failed renal
transplant on prednisone, dCM EF 25%, Dm1 on lantus who presents
with  hypoglycemia and associated encephalopathy. PEr patient
since leaving the hospital a week ago she has not felt her
normal self. She has been very fatigued (worse than normal) and
has had occasional episodes of nausea that resolve with sugar
free mints. The nausea is not necessarily associated with food,
movement, or medications. She has not been eating her usual
amount but says her appetite is not decreased and she does not
have abdominal pain, nausea, vomiting, bloody stools or black
stools. She reports that last night she was planning on eating
dinner and took her home dose of 3 units of lantus. Her family
then brought home chinese food which she doesnt like. She was
going to order herself something different but ended up falling
asleep and never ate anything.
 This morning per the ED physicians her family found her to be
"not herself". Her FSBS at home was 40. Her family gave her some
glucose but per the Ed physicians her family says was not
herself even after taking glucose at home so they brought her to
the ED
.
In the ED, initial VS were: 95.4 59 140/85 18 94% RA. On exam
she appeared slow to respond compared to her usual baseline
according to family. Also c/o chronic discomfort between both
shoulders. A & O x3 but sleepy. Said she was just tired. CXR
revealed recurrence of her pleural effusion (tapped on last
admission).
.
She was admitted for HD given her hyperkalemia and for FSBS
monitoring. She was taken directly from the ED to HD.
.
vs on transfer: 60 141/92 16 96 2lnc.
.
On the floor, patient was receiving dialysis. She noted
continued chronic fatigue and says that although she was able to
work up until her recent admission she has not felt able to go
back since being discharged a week ago. She notes occasional
nausea that is relieved with mints. She denies fever, cough,
chills, abdominal pain, vomiting, diarrhea, constipation. She
does not make urine. She notes a 5kg weight gain and increased
peripheral edema.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats. Denies rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest
pain. Denied  vomiting, diarrhea, constipation or abdominal
pain. No recent change in bowel or bladder habits.

MEDICAL HISTORY: (per OMR)
s/p placement of right upper extremity arteriovenous graft
[**2162-10-19**]
-Type 1 DM, since age 20
-Dilated cardiomyopathy, EF 25% by echo [**4-/2164**]
-Hypertension
-ESRD s/p transplant in [**2152**], undergoing evaluation for possible

MEDICATION ON ADMISSION: Per patient these medications have not changed since her
discharge <1 week ago.
1. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Percocet

PHYSICAL EXAM: Vitals: T:95 (on HD) BP:132/84 P:60 R:20 O2:  100% on 2L NC
General: Alert, oriented X 3, no acute distress but does stop in
the middle of a sentence to catch her breath occasionally
HEENT: Sclera anicteric, [**Month/Year (2) 5674**], oropharynx clear
Neck: supple, JVP 4 cm above the clavicle when she is sitting at
90 degrees
Lungs: Clear to auscultation on left with diminished breath
sounds on the right. No wheezes, rales, or rhonchi.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
soft S3 gallop
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding
Ext: Warm 2+ pitting edema to knee
Neuro:  A+OX3. Able to recite the days of the week backward.
Recalls her entire medical history, her son's cell phone number,
and all of her grandchildren's ages. Gait and strength not
assessed as patient is on HD. PERRL, face symmetric, tongue
midline.

FAMILY HISTORY: No history of renal or cardiac disease. All of her children and
grandchildren are healthy.

SOCIAL HISTORY: Lives at home with her son, [**Name (NI) 101512**] and 4 grandchildren.
Smoked but quit many years ago. Previously drank ETOH socially
now does not drink at all. Was working up until admission [**4-16**].
Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled,Acute on chronic systolic heart failure,Acute respiratory failure,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,Other primary cardiomyopathies,Unspecified pleural effusion,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Anorexia,Toxic encephalopathy,End stage renal disease,Renal dialysis status,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified viral hepatitis C without hepatic coma,Arthrodesis status,Esophageal reflux,Abnormal coagulation profile,Obstructive sleep apnea (adult)(pediatric),Hypotension of hemodialysis,Cardiac arrest,Encounter for palliative care,Do not resuscitate status
DMI oth nt st uncntrld,Ac on chr syst hrt fail,Acute respiratry failure,Acidosis,Hyp kid NOS w cr kid V,Compl kidney transplant,Prim cardiomyopathy NEC,Pleural effusion NOS,Long-term use of insulin,Adv eff insulin/antidiab,Anorexia,Toxic encephalopathy,End stage renal disease,Renal dialysis status,Abn react-org transplant,Hyperlipidemia NEC/NOS,Hpt C w/o hepat coma NOS,Arthrodesis status,Esophageal reflux,Abnrml coagultion prfile,Obstructive sleep apnea,Hemododialysis hypotensn,Cardiac arrest,Encountr palliative care,Do not resusctate status
Admission Date:  [**2164-4-24**]              Discharge Date:   [**2164-4-28**]

Date of Birth:  [**2108-12-6**]             Sex:   F

Service: MEDICINE

Allergies:
Percocet

Attending:[**First Name3 (LF) 99**]
Chief Complaint:
Hypoglycemia

Major Surgical or Invasive Procedure:
HD


History of Present Illness:
This is a 55yo F w/hx of ESRD on HD (TTS), failed renal
transplant on prednisone, dCM EF 25%, Dm1 on lantus who presents
with  hypoglycemia and associated encephalopathy. PEr patient
since leaving the hospital a week ago she has not felt her
normal self. She has been very fatigued (worse than normal) and
has had occasional episodes of nausea that resolve with sugar
free mints. The nausea is not necessarily associated with food,
movement, or medications. She has not been eating her usual
amount but says her appetite is not decreased and she does not
have abdominal pain, nausea, vomiting, bloody stools or black
stools. She reports that last night she was planning on eating
dinner and took her home dose of 3 units of lantus. Her family
then brought home chinese food which she doesnt like. She was
going to order herself something different but ended up falling
asleep and never ate anything.
 This morning per the ED physicians her family found her to be
"not herself". Her FSBS at home was 40. Her family gave her some
glucose but per the Ed physicians her family says was not
herself even after taking glucose at home so they brought her to
the ED
.
In the ED, initial VS were: 95.4 59 140/85 18 94% RA. On exam
she appeared slow to respond compared to her usual baseline
according to family. Also c/o chronic discomfort between both
shoulders. A & O x3 but sleepy. Said she was just tired. CXR
revealed recurrence of her pleural effusion (tapped on last
admission).
.
She was admitted for HD given her hyperkalemia and for FSBS
monitoring. She was taken directly from the ED to HD.
.
vs on transfer: 60 141/92 16 96 2lnc.
.
On the floor, patient was receiving dialysis. She noted
continued chronic fatigue and says that although she was able to
work up until her recent admission she has not felt able to go
back since being discharged a week ago. She notes occasional
nausea that is relieved with mints. She denies fever, cough,
chills, abdominal pain, vomiting, diarrhea, constipation. She
does not make urine. She notes a 5kg weight gain and increased
peripheral edema.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats. Denies rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest
pain. Denied  vomiting, diarrhea, constipation or abdominal
pain. No recent change in bowel or bladder habits.


Past Medical History:
(per OMR)
s/p placement of right upper extremity arteriovenous graft
[**2162-10-19**]
-Type 1 DM, since age 20
-Dilated cardiomyopathy, EF 25% by echo [**4-/2164**]
-Hypertension
-ESRD s/p transplant in [**2152**], undergoing evaluation for possible

second transplant- on HD T/T/S
-Hepatitis C, chronic, untreated
-Intracranial right ICA aneurysm, s/p clipping [**2159-5-16**]
-s/p C4-5 and C5-6 anterior decompression and fusion after MVA
[**2157**]
-s/p diskectomy at C6-C7 and fusion in [**2157**], with
instrumentation removal and reinsertion on [**2159-9-28**]
-Ulnar nerve impingement bilaterally
-S/p Rotator cuff repair
-s/p release of right carpal tunnel
-GERD
-Asthma as a child
-Sleep apnea, unable tolerate CPAP
-s/p right carpal tunnel release
-s/p rotator cuff repair
-Resting tremor
-h/o Pneumonia
-Anemia
-h/o CMV in [**2155**]


Social History:
Lives at home with her son, [**Name (NI) 101512**] and 4 grandchildren.
Smoked but quit many years ago. Previously drank ETOH socially
now does not drink at all. Was working up until admission [**4-16**].


Family History:
 No history of renal or cardiac disease. All of her children and
grandchildren are healthy.


Physical Exam:
Vitals: T:95 (on HD) BP:132/84 P:60 R:20 O2:  100% on 2L NC
General: Alert, oriented X 3, no acute distress but does stop in
the middle of a sentence to catch her breath occasionally
HEENT: Sclera anicteric, [**Month/Year (2) 5674**], oropharynx clear
Neck: supple, JVP 4 cm above the clavicle when she is sitting at
90 degrees
Lungs: Clear to auscultation on left with diminished breath
sounds on the right. No wheezes, rales, or rhonchi.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
soft S3 gallop
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding
Ext: Warm 2+ pitting edema to knee
Neuro:  A+OX3. Able to recite the days of the week backward.
Recalls her entire medical history, her son's cell phone number,
and all of her grandchildren's ages. Gait and strength not
assessed as patient is on HD. PERRL, face symmetric, tongue
midline.


Pertinent Results:
[**2164-4-24**] 10:40AM   LACTATE-2.6*
[**2164-4-24**] 10:25AM   GLUCOSE-246* UREA N-75* CREAT-6.8*
SODIUM-130* POTASSIUM-6.3* CHLORIDE-93* TOTAL CO2-20* ANION
GAP-23*
[**2164-4-24**] 10:25AM   NEUTS-66.0 LYMPHS-24.1 MONOS-5.6 EOS-2.8
BASOS-1.5
[**2164-4-24**] 10:25AM   PLT COUNT-300#
[**2164-4-24**] 10:25AM   PT-15.5* PTT-27.0 INR(PT)-1.4*

CXR: Recurrence of right-sided pleural effusion (previously
tapped) and stable cardiomegaly.


Brief Hospital Course:
# PEA arrest: Pt had episode of AMS after returning from HD,
with hypotension prior to transfer. Attributed to hypovolemia
[**2-8**] HD. CODE was called and pt received CPR, 1LNS, 1mg Epi with
return of spontaneous circulation. She was transferred to the
MICU. She was unresponsive s/p arrest, and was cooled per
protocol. She was rewarmed per protocol. Shortly after being
rewarmed she went into PEA arrest. She was resuscitated and a
family meeting was held. After careful discussion with the
family she was made CMO. She passed [**Doctor Last Name 8196**] that night with her
family at her side.


Medications on Admission:
Per patient these medications have not changed since her
discharge <1 week ago.
1. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

2. digoxin 125 mcg Tablet Sig: One (1) Tablet PO QTUES (every
Tuesday).
3. hydralazine 10 mg Tablet Sig: One (1) Tablet PO TID (3 times
a day).
4. insulin glargine 100 unit/mL Solution Sig: 6 units qam, 3
units qpm . Subcutaneous .
5. insulin lispro 100 unit/mL Solution Sig: sliding scale .
Subcutaneous four times a day.
6. isosorbide mononitrate 30 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO DAILY (Daily).
7. metoprolol succinate 100 mg Tablet Extended Release 24 hr
Sig: One (1) Tablet Extended Release 24 hr PO once a day.
8. pravastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
9. ranitidine HCl 15 mg/mL Syrup Sig: Seventy Five (75) mg PO
DAILY (Daily).
10. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) Cap

PO DAILY (Daily).
11. nifedipine 30 mg Tablet Extended Release Sig: One (1) Tablet

Extended Release PO DAILY (Daily).
12. sevelamer carbonate 800 mg Tablet Sig: Two (2) Tablet PO TID

W/MEALS (3 TIMES A DAY WITH MEALS).
13. torsemide 100 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).


Discharge Medications:
patient deceased

Discharge Disposition:
Expired

Discharge Diagnosis:
deceased

Discharge Condition:
deceased

Discharge Instructions:
deceased

Followup Instructions:
deceased
{'Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled,Acute on chronic systolic heart failure,Acute respiratory failure,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,Other primary cardiomyopathies,Unspecified pleural effusion,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Anorexia,Toxic encephalopathy,End stage renal disease,Renal dialysis status,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified viral hepatitis C without hepatic coma,Arthrodesis status,Esophageal reflux,Abnormal coagulation profile,Obstructive sleep apnea (adult)(pediatric),Hypotension of hemodialysis,Cardiac arrest,Encounter for palliative care,Do not resuscitate status'}


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: Hypoglycemia

PRESENT ILLNESS: This is a 55yo F w/hx of ESRD on HD (TTS), failed renal
transplant on prednisone, dCM EF 25%, Dm1 on lantus who presents
with  hypoglycemia and associated encephalopathy. PEr patient
since leaving the hospital a week ago she has not felt her
normal self. She has been very fatigued (worse than normal) and
has had occasional episodes of nausea that resolve with sugar
free mints. The nausea is not necessarily associated with food,
movement, or medications. She has not been eating her usual
amount but says her appetite is not decreased and she does not
have abdominal pain, nausea, vomiting, bloody stools or black
stools. She reports that last night she was planning on eating
dinner and took her home dose of 3 units of lantus. Her family
then brought home chinese food which she doesnt like. She was
going to order herself something different but ended up falling
asleep and never ate anything.
 This morning per the ED physicians her family found her to be
"not herself". Her FSBS at home was 40. Her family gave her some
glucose but per the Ed physicians her family says was not
herself even after taking glucose at home so they brought her to
the ED
.
In the ED, initial VS were: 95.4 59 140/85 18 94% RA. On exam
she appeared slow to respond compared to her usual baseline
according to family. Also c/o chronic discomfort between both
shoulders. A & O x3 but sleepy. Said she was just tired. CXR
revealed recurrence of her pleural effusion (tapped on last
admission).
.
She was admitted for HD given her hyperkalemia and for FSBS
monitoring. She was taken directly from the ED to HD.
.
vs on transfer: 60 141/92 16 96 2lnc.
.
On the floor, patient was receiving dialysis. She noted
continued chronic fatigue and says that although she was able to
work up until her recent admission she has not felt able to go
back since being discharged a week ago. She notes occasional
nausea that is relieved with mints. She denies fever, cough,
chills, abdominal pain, vomiting, diarrhea, constipation. She
does not make urine. She notes a 5kg weight gain and increased
peripheral edema.
.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats. Denies rhinorrhea or
congestion. Denied cough, shortness of breath. Denied chest
pain. Denied  vomiting, diarrhea, constipation or abdominal
pain. No recent change in bowel or bladder habits.

MEDICAL HISTORY: (per OMR)
s/p placement of right upper extremity arteriovenous graft
[**2162-10-19**]
-Type 1 DM, since age 20
-Dilated cardiomyopathy, EF 25% by echo [**4-/2164**]
-Hypertension
-ESRD s/p transplant in [**2152**], undergoing evaluation for possible

MEDICATION ON ADMISSION: Per patient these medications have not changed since her
discharge <1 week ago.
1. prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

ALLERGIES: Percocet

PHYSICAL EXAM: Vitals: T:95 (on HD) BP:132/84 P:60 R:20 O2:  100% on 2L NC
General: Alert, oriented X 3, no acute distress but does stop in
the middle of a sentence to catch her breath occasionally
HEENT: Sclera anicteric, [**Month/Year (2) 5674**], oropharynx clear
Neck: supple, JVP 4 cm above the clavicle when she is sitting at
90 degrees
Lungs: Clear to auscultation on left with diminished breath
sounds on the right. No wheezes, rales, or rhonchi.
CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs,
soft S3 gallop
Abdomen: soft, non-tender, non-distended, bowel sounds present,
no rebound tenderness or guarding
Ext: Warm 2+ pitting edema to knee
Neuro:  A+OX3. Able to recite the days of the week backward.
Recalls her entire medical history, her son's cell phone number,
and all of her grandchildren's ages. Gait and strength not
assessed as patient is on HD. PERRL, face symmetric, tongue
midline.

FAMILY HISTORY: No history of renal or cardiac disease. All of her children and
grandchildren are healthy.

SOCIAL HISTORY: Lives at home with her son, [**Name (NI) 101512**] and 4 grandchildren.
Smoked but quit many years ago. Previously drank ETOH socially
now does not drink at all. Was working up until admission [**4-16**]. 

### Response:
{'Diabetes with other specified manifestations, type I [juvenile type], not stated as uncontrolled,Acute on chronic systolic heart failure,Acute respiratory failure,Acidosis,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Complications of transplanted kidney,Other primary cardiomyopathies,Unspecified pleural effusion,Long-term (current) use of insulin,Insulins and antidiabetic agents causing adverse effects in therapeutic use,Anorexia,Toxic encephalopathy,End stage renal disease,Renal dialysis status,Surgical operation with transplant of whole organ causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Other and unspecified hyperlipidemia,Unspecified viral hepatitis C without hepatic coma,Arthrodesis status,Esophageal reflux,Abnormal coagulation profile,Obstructive sleep apnea (adult)(pediatric),Hypotension of hemodialysis,Cardiac arrest,Encounter for palliative care,Do not resuscitate status'}
