CHIEF COMPLAINT: DKA

PRESENT ILLNESS: Mr [**Known lastname 61289**] is a 24M with poorly-controlled DM who presents with
DKA.
He was well until approx 4d ago when he developed a
nonproductive cough, along with chills and sweats and some nasal
congestion but no fevers. The evening prior to admission he
developed periumbilical abdominal discomfort accompanied by
nausea and non-bloody vomiting. Has chronic constipation with
BMs usually 1x week, had 4 BMs the day prior to presentation.
His PO intake was poor. He last took his insulin approximately
24h prior to presentation. Has been making urine, but no
dysuria, hematuria, no NSAID use. Reports low back pain similar
to prior. Denies metalic taste, pruritis, dyspnea.
.
In the emergency department, vitals were 98.3 104 154/82 16 100%
on RA. On exam, writhing in abdominal pain. He was given zofran,
ativan, insulin (10 units x2 sq) currently on 7units/hr drip.
CXR showed a LLL pna and he was given levofloxacin. Had a
femoral line placed for access, 22 wrist PIV. Given 4L of normal
saline. Renal was not contact[**Name (NI) **]. HR low 100's BP 160's RR 22.

MEDICAL HISTORY: - Diabetes mellitus, type I. Diagnosed in [**2162**]. Poorly
controlled with past DKA. Complicated with retinopathy,
nephropathy
- Hypertension, poorly controlled
- Chronic kidney disease
- Chronic constipation

MEDICATION ON ADMISSION: metoprolol 50mg [**Hospital1 **]
amlodipine 10mg daily
simvastatin 20mg daily
hydralazine 50mg tid
aranesp 40mcg qweek
insulin galrgine 20 units qhs
insulin humalog sliding scale
miralax
senna

ALLERGIES: Codeine

PHYSICAL EXAM: Vitals 97.2 94 138/87 12 95% on RA
General Lying in bed appearing comfortable
HEENT Sclera anicteric, MMM
Neck Supple no JVD
Pulm Lungs clear bilaterally, no rales or wheezing
CV Regular S1 S2 no m/r/g
Abd Soft nontender +bowel sounds
Extrem Warm no edema palpable pulses
Neuro Sleepy but arousable, responds to commands, answering
appropriately, moving all extremities without focal deficits
Derm No rash
Lines/tubes/drains

FAMILY HISTORY: Father, grandmother with diabetes mellitus. No relatives
currently on dialysis.

SOCIAL HISTORY: Lives with aunt in [**Location (un) 686**]. Smokes 2 packs per week since age
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Influenza with pneumonia,Chronic kidney disease, Stage IV (severe),Acute kidney failure, unspecified,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Constipation, unspecified,Anemia in chronic kidney disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Gastroparesis,Personal history of noncompliance with medical treatment, presenting hazards to health
DMI ketoacd uncontrold,Influenza with pneumonia,Chr kidney dis stage IV,Acute kidney failure NOS,Diabetic retinopathy NOS,Nephritis NOS in oth dis,Constipation NOS,Anemia in chr kidney dis,Hy kid NOS w cr kid I-IV,Gastroparesis,Hx of past noncompliance
Admission Date:  [**2185-7-1**]              Discharge Date:   [**2185-7-4**]

Date of Birth:  [**2160-11-6**]             Sex:   M

Service: MEDICINE

Allergies:
Codeine

Attending:[**First Name3 (LF) 1257**]
Chief Complaint:
DKA

Major Surgical or Invasive Procedure:
Femoral line placement

History of Present Illness:
Mr [**Known lastname 61289**] is a 24M with poorly-controlled DM who presents with
DKA.
He was well until approx 4d ago when he developed a
nonproductive cough, along with chills and sweats and some nasal
congestion but no fevers. The evening prior to admission he
developed periumbilical abdominal discomfort accompanied by
nausea and non-bloody vomiting. Has chronic constipation with
BMs usually 1x week, had 4 BMs the day prior to presentation.
His PO intake was poor. He last took his insulin approximately
24h prior to presentation. Has been making urine, but no
dysuria, hematuria, no NSAID use. Reports low back pain similar
to prior. Denies metalic taste, pruritis, dyspnea.
.
In the emergency department, vitals were 98.3 104 154/82 16 100%
on RA. On exam, writhing in abdominal pain. He was given zofran,
ativan, insulin (10 units x2 sq) currently on 7units/hr drip.
CXR showed a LLL pna and he was given levofloxacin. Had a
femoral line placed for access, 22 wrist PIV. Given 4L of normal
saline. Renal was not contact[**Name (NI) **]. HR low 100's BP 160's RR 22.


Past Medical History:
- Diabetes mellitus, type I. Diagnosed in [**2162**]. Poorly
controlled with past DKA. Complicated with retinopathy,
nephropathy
- Hypertension, poorly controlled
- Chronic kidney disease
- Chronic constipation


Social History:
Lives with aunt in [**Location (un) 686**]. Smokes 2 packs per week since age

16. Denies recent alcohol use. Denies illicit drug use, now or
in the past.


Family History:
Father, grandmother with diabetes mellitus. No relatives
currently on dialysis.


Physical Exam:
Vitals 97.2 94 138/87 12 95% on RA
General Lying in bed appearing comfortable
HEENT Sclera anicteric, MMM
Neck Supple no JVD
Pulm Lungs clear bilaterally, no rales or wheezing
CV Regular S1 S2 no m/r/g
Abd Soft nontender +bowel sounds
Extrem Warm no edema palpable pulses
Neuro Sleepy but arousable, responds to commands, answering
appropriately, moving all extremities without focal deficits
Derm No rash
Lines/tubes/drains


Brief Hospital Course:
24 year old man with poorly controlled DM and HTN with ESRD not
yet on HD presents with DKA in setting of insulin noncompliance
and an underlying viral pneumonia versus viral URI. He was
admitted to the ICU and started on an insulin drip. The anion
gap closed and he was transitioned to glargine in the morning
(22 units) and maintained on a sliding scale. He was followed by
the [**Last Name (un) 387**] consult team while hospitalized and will see them as
an outpatient this week. He had abnormal chest film along with
cough and chills.  He was started on empiric levofloxacin,
however, his flu swab came back positive for influenza A and the
antibiotics were discontinued. The influenza was not H1N1 by
state lab testing. He was afebrile for 24 hours prior to
discharge. We found normocytic anemia likely from CKD. Iron
studies were sent and were pending at the time of discharge.
They will be followed up by the [**Hospital **] clinic and he will likely
be started on epoetin as an outpatient. He was discharged on
empiric iron.


Medications on Admission:
metoprolol 50mg [**Hospital1 **]
amlodipine 10mg daily
simvastatin 20mg daily
hydralazine 50mg tid
aranesp 40mcg qweek
insulin galrgine 20 units qhs
insulin humalog sliding scale
miralax
senna

Discharge Medications:
1. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID
(2 times a day).
2. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).

3. Hydralazine 25 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8
hours).
4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for constipation.
5. Metoclopramide 10 mg Tablet Sig: 0.5 Tablet PO QIDACHS (4
times a day (before meals and at bedtime)).
Disp:*30 Tablet(s)* Refills:*2*
6. Insulin Glargine 100 unit/mL Solution Sig: Twenty Two (22)
units Subcutaneous once a day.
7. Insulin Lispro 100 unit/mL Solution Sig: AS DIR  Subcutaneous
four times a day: As needed per sliding scale.
8. Iron (Ferrous Sulfate) 325 mg (65 mg Iron) Tablet Sig: One
(1) Tablet PO twice a day.
Disp:*60 Tablet(s)* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Diabetic Keto-acidosis
Influenza A
Chronic Kidney Disease
Anemia of Chronic Disease


Discharge Condition:
Afebrile, hemodynamically stable.


Discharge Instructions:
You were admitted to the hospital with the flu. Because you were
sick your diabetes was not in good control and you needed
insulin through an IV for a couple of days. You have been able
to eat and take your insulin now and should continue doing this
when you are discharged.

Medication changes:
CHANGE: Glargine to 22units at breakfast time
START: Reglan 5mg by mouth with meals and at bedtime
START: Iron 325mg by mouth twice daily

Please come back to the hospital or call your doctor if you have
fevers, chills, abdominal pain, nausea, vomiting, inability to
take your insulin, inability to eat, chest pain, back pain,
rash, or any other concerning symptoms.

Followup Instructions:
Please follow up with your primary care provider, [**Last Name (NamePattern4) **]. [**Last Name (STitle) 14166**]
([**Telephone/Fax (1) 14167**]) in the next 1-2 weeks.

Please follow up with Dr.[**Name (NI) 33126**] nurse [**First Name8 (NamePattern2) 3639**] [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **]-[**Doctor Last Name **] ([**Telephone/Fax (1) 3637**]) on [**2185-7-7**] at 1:00pm.



Completed by:[**2185-7-4**]
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Influenza with pneumonia,Chronic kidney disease, Stage IV (severe),Acute kidney failure, unspecified,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Constipation, unspecified,Anemia in chronic kidney disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Gastroparesis,Personal history of noncompliance with medical treatment, presenting hazards to health'}


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: DKA

PRESENT ILLNESS: Mr [**Known lastname 61289**] is a 24M with poorly-controlled DM who presents with
DKA.
He was well until approx 4d ago when he developed a
nonproductive cough, along with chills and sweats and some nasal
congestion but no fevers. The evening prior to admission he
developed periumbilical abdominal discomfort accompanied by
nausea and non-bloody vomiting. Has chronic constipation with
BMs usually 1x week, had 4 BMs the day prior to presentation.
His PO intake was poor. He last took his insulin approximately
24h prior to presentation. Has been making urine, but no
dysuria, hematuria, no NSAID use. Reports low back pain similar
to prior. Denies metalic taste, pruritis, dyspnea.
.
In the emergency department, vitals were 98.3 104 154/82 16 100%
on RA. On exam, writhing in abdominal pain. He was given zofran,
ativan, insulin (10 units x2 sq) currently on 7units/hr drip.
CXR showed a LLL pna and he was given levofloxacin. Had a
femoral line placed for access, 22 wrist PIV. Given 4L of normal
saline. Renal was not contact[**Name (NI) **]. HR low 100's BP 160's RR 22.

MEDICAL HISTORY: - Diabetes mellitus, type I. Diagnosed in [**2162**]. Poorly
controlled with past DKA. Complicated with retinopathy,
nephropathy
- Hypertension, poorly controlled
- Chronic kidney disease
- Chronic constipation

MEDICATION ON ADMISSION: metoprolol 50mg [**Hospital1 **]
amlodipine 10mg daily
simvastatin 20mg daily
hydralazine 50mg tid
aranesp 40mcg qweek
insulin galrgine 20 units qhs
insulin humalog sliding scale
miralax
senna

ALLERGIES: Codeine

PHYSICAL EXAM: Vitals 97.2 94 138/87 12 95% on RA
General Lying in bed appearing comfortable
HEENT Sclera anicteric, MMM
Neck Supple no JVD
Pulm Lungs clear bilaterally, no rales or wheezing
CV Regular S1 S2 no m/r/g
Abd Soft nontender +bowel sounds
Extrem Warm no edema palpable pulses
Neuro Sleepy but arousable, responds to commands, answering
appropriately, moving all extremities without focal deficits
Derm No rash
Lines/tubes/drains

FAMILY HISTORY: Father, grandmother with diabetes mellitus. No relatives
currently on dialysis.

SOCIAL HISTORY: Lives with aunt in [**Location (un) 686**]. Smokes 2 packs per week since age 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Influenza with pneumonia,Chronic kidney disease, Stage IV (severe),Acute kidney failure, unspecified,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Constipation, unspecified,Anemia in chronic kidney disease,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified,Gastroparesis,Personal history of noncompliance with medical treatment, presenting hazards to health'}
