CHIEF COMPLAINT: 1.  Insulin dependent diabetes mellitus.
2.  Pancreas after a kidney transplant.

PRESENT ILLNESS: The patient is a 46 year old
male status post renal transplant for insulin dependent
diabetes mellitus now here for a pancreas after kidney
transplant.  The patient denies nausea or vomiting.  The
patient denies recent history of the flu or lymphadenopathy.

MEDICAL HISTORY: 1.  Stroke five years ago secondary to hypertension.
2.  Hypertension.
3.  Insulin dependent diabetes mellitus.
4.  Hypothyroidism.
5.  End-stage renal disease.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Diabetes with other specified manifestations, type I [juvenile type], uncontrolled,Kidney replaced by transplant,Complications of transplanted pancreas,Paralytic ileus,Drug-induced delirium,Unspecified essential hypertension,Unspecified acquired hypothyroidism
DMI oth uncntrld,Kidney transplant status,Compl pancreas transplnt,Paralytic ileus,Drug-induced delirium,Hypertension NOS,Hypothyroidism NOS
Admission Date:  [**2187-12-12**]       Discharge Date:  [**2187-12-25**]

Date of Birth:   [**2141-2-6**]       Sex:  M

Service:  1

CHIEF COMPLAINT:
1.  Insulin dependent diabetes mellitus.
2.  Pancreas after a kidney transplant.

HISTORY OF PRESENT ILLNESS:   The patient is a 46 year old
male status post renal transplant for insulin dependent
diabetes mellitus now here for a pancreas after kidney
transplant.  The patient denies nausea or vomiting.  The
patient denies recent history of the flu or lymphadenopathy.

PAST MEDICAL HISTORY:
1.  Stroke five years ago secondary to hypertension.
2.  Hypertension.
3.  Insulin dependent diabetes mellitus.
4.  Hypothyroidism.
5.  End-stage renal disease.

PAST SURGICAL HISTORY:
1.  Renal transplant in [**2182-2-8**].
2.  Appendectomy.
3.  Foot surgery.

MEDICATIONS:
1.  Prograf 3 mg p.o. twice a day.
2.  Prednisone 7.5 mg p.o. q. day.
3.  Cozaar 25 mg Monday, Wednesday and Friday q. day.
4.  Levoxyl 100 micrograms p.o. q. day.
5.  Aspirin 81 mg p.o. Monday, Wednesday and Friday.
6.  Insulin 30 units q. a.m.
7.  Neurontin 100 mg p.o. q. two tablets q. h.s.
8.  Lipitor 10 mg p.o. q. day.

PHYSICAL EXAMINATION:  Initial physical temperature maximum
97.5 F.; pulse 64; blood pressure 132/80; respiratory rate
20; O2 saturation is 94% on room air.  Cardiovascular:
Regular rate and rhythm.  Respiratory is clear to
auscultation bilaterally.  Abdomen is soft, nontender,
nondistended.  Extremities:  No peripheral edema.

LABORATORY:  White cell count 10.0, hematocrit 38.7,
platelets 252.  Chem-7 is 139/4.5, 101/29 and 40/1.7.
Glucose of 216.

HOSPITAL COURSE:  The patient was admitted and brought to the
Operating Room with the initial diagnosis of status post
living related kidney transplant with diabetes mellitus.  The
patient had a pancreas after kidney transplant.  The patient
tolerated the procedure well and was transported to the
postoperative area in stable condition.

On postoperative day one, the patient continued to do well;
had his nasogastric tube continued for the postoperative
ileus and averaged urine output of roughly 60 to 180 cc. an
hour.  The patient's glucose also stayed in the range of 151
to 205.  On postoperative day two, the patient continued to
do well.  His renal dose Dopamine was discontinued.

On the fifth of [**Month (only) 404**] the patient was transferred to the
Floor without issues.  The patient continued to produce good
urine and had his blood glucose in control less than 250.
On postoperative day five, the patient continued to be NPO
because of increased distention and the lack of flatus.

On the eighth, the patient had a considerably increased
abdominal pain for which he was transferred back to the
Intensive Care Unit.  A CT scan of the abdomen showed a fluid
collection around the pancreas.  At that time, the patient's
blood sugar levels also increasing to levels well above 300.
That same night, Dr. [**Last Name (STitle) **] evaluated the patient in the
Intensive Care Unit and decided that the patient would be
brought back to the Operating Room to evaluate the pancreas
transplant.

During the surgery, it was noted that the patient was most
likely rejecting the pancreas.  An allograft pancreatectomy
was performed.  The patient tolerated the procedure well and
was transported to the SICU in stable condition.
Postoperative day one from the allograft pancreatectomy, the
patient had his blood sugars controlled with insulin and was
overall doing well.  On [**12-19**], it was decided that the
patient could be transferred to the Floor.

On postoperative day 8 and 3, the patient continued to do
well, was on the insulin sliding scale and was restarted and
continued on his immunosuppressive regimen for his kidney
transplant.  The nasogastric tube was discontinued and the
patient had a Psychiatric consultation for a change in mood.

Psychiatry's impression was the patient was suffering from
resolving delirium which was complicated by a history of
bipolar disorder.  They recommended that the patient have his
Depakote level checked, B12 checked, thyroid function
checked, folate checked.  They also stated that the patient's
mental status was improving but there was a slight worry of
suicide at that time.

On postoperative day 9 and 4, the patient's mental condition
improved and the patient stated that he was less depressed.
On postoperative day 11 and 6, the patient's mental status
continued to improve.  His postoperative ileus was resolving.
His incision was clean, dry and intact, and the patient was
slated for discharge home.

On discharge physical, temperature maximum 99.1 F.; blood
pressure 126/78; heart rate 82; O2 saturation 99% on room
air.  Blood sugars were 156 to 240.  Cardiovascular:  Regular
rate and rhythm.  Lungs are clear to auscultation.  Abdomen
soft, nontender, nondistended.  Surgical wound was intact
with no significant tenderness.  Extremities with no
peripheral edema.

White blood cell count 6.2, platelets 181, hematocrit 20.7.
Chem-7 was 137/3.7, 105/24, 25/1.8, glucose of 142.

DISCHARGE DIAGNOSES:
1.  Status post pancreas after kidney transplant.
2.  Status post Allograft pancreatectomy.
3.  History of insulin dependent diabetes mellitus.
4.  Hypertension.
5.  Hypothyroidism.
6.  History of a stroke.
7.  Status post renal transplant in 03/98.

DISPOSITION:  The patient will be discharged home in stable
condition.

DISCHARGE MEDICATIONS:
1.  Prednisone 7.5 mg p.o. q. day.
2.  Prograf 3 mg p.o. twice a day.
3.  Regular insulin sliding scale.
4.  Ganciclovir 500 mg p.o. three times a day.
5.  Aspirin 81 mg p.o. q. day.
6.  Bactrim SS 1 tablet p.o. q. day.
7.  Zantac 150 mg p.o. twice a day.
8.  Levoxyl 100 mEq p.o. q. day.
9.  Colace.
10. Epogen.
11. NPH.

DISCHARGE INSTRUCTIONS:
1.  The patient will be discharged home.
2.  The patient will follow-up with Dr. [**Last Name (STitle) **] per
prescheduled plans.
3.  The patient will also follow-up with his preoperative
laboratory schedule for his Prograf.


                            [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 3598**], MD  [**MD Number(1) 3599**]

Dictated By:[**Last Name (NamePattern4) 959**]
MEDQUIST36

D:  [**2188-1-14**]  19:41
T:  [**2188-1-14**]  20:06
JOB#:  [**Job Number 35792**]
{'Diabetes with other specified manifestations, type I [juvenile type], uncontrolled,Kidney replaced by transplant,Complications of transplanted pancreas,Paralytic ileus,Drug-induced delirium,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}


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: 1.  Insulin dependent diabetes mellitus.
2.  Pancreas after a kidney transplant.

PRESENT ILLNESS: The patient is a 46 year old
male status post renal transplant for insulin dependent
diabetes mellitus now here for a pancreas after kidney
transplant.  The patient denies nausea or vomiting.  The
patient denies recent history of the flu or lymphadenopathy.

MEDICAL HISTORY: 1.  Stroke five years ago secondary to hypertension.
2.  Hypertension.
3.  Insulin dependent diabetes mellitus.
4.  Hypothyroidism.
5.  End-stage renal disease.

MEDICATION ON ADMISSION: 

ALLERGIES: 

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Diabetes with other specified manifestations, type I [juvenile type], uncontrolled,Kidney replaced by transplant,Complications of transplanted pancreas,Paralytic ileus,Drug-induced delirium,Unspecified essential hypertension,Unspecified acquired hypothyroidism'}
