CHIEF COMPLAINT: chest pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 41yo gentleman with h/o type 1 DM, hepatitis C
and polysubstance abuse who presented with chest pain and was
found to have hyperglycemia to 600.
.
Three days before admission, he went on a drinking and cocaine
binge. During this time, he stopped taking his lantus. He denies
any other drugs and specifically denies opiates. He states that
he only snorts the cocaine. In addition, he reports successful
sobriety from narcotics ever since being on suboxone. His last
drink was just prior to arrival to the emergency room at 3am
[**1-22**]. He came in to the ED because he developed substernal
heavy chest pressure associated with shortness of breath. No
diaphoresis or palpitations. No pleuritic chest pain.
.
In the emergency department, initial VS were: 98.4 144/58 92 28
98%. He became chest pain free without intervention, and there
was no evidence of alcohol withdrawal. EKG did not show evidence
of ischemia. Labs were notable for glucose of 615, anion gap of
25 (ABG not done). WBC was 7 and CEs were normal x 1. CXR was
felt to be normal. He was given ASA 325mg and started on an
insulin gtt.
.
Upon arrival to the ICU, he was sleepy but comfortable. Over the
next couple of hours, he started to feel shaky and sweaty. He
denied chest pain. He has persistent problems with depression
but specifically denied suicidality.
.
REVIEW OF SYSTEMS:
(+)ve: chest pain as above
(-)ve: fever, chills, night sweats, loss of appetite, fatigue,
palpitations, rhinorrhea, nasal congestion, cough, sputum
production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia,
melena, dysuria, urinary frequency, urinary urgency, focal
numbness, focal weakness, myalgias, arthralgias

MEDICAL HISTORY: Type 1 DM followed at [**Last Name (un) **]
Chronic Hepatitis C - has been referred to Liver Center
Polysubstance abuse - heroin overdose in 96 and 00, has been on
suboxone from Dr. [**Last Name (STitle) 93335**]
Alcohol abuse - reports gets shaky but no known h/o seizures or
DTs
Bipolar disorder h/o suicide attempts (by cutting himself, by
overdose)
s/p appendectomy
Cardiac cath in [**2189**] with non-obstructive coronary disease
Dyslipidemia

MEDICATION ON ADMISSION: (confirmed with patient and pharmacy):
ASA 81mg daily
Insulin lantus 30 units QHS and lispro sliding scale -- has not
taken lantus for 2 days
Simvastatin 40mg daily
Seroquel 50mg
Wellbutrin SR 150mg daily
Abilify 15mg daily
Multivitamin
Suboxone 24mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 97.1 112/49 80 13 97% RA
GENERAL: Pleasant gentleman who is sleepy but not otherwise in
distress. Sweaty forehead. Yawning frequently
HEENT: No conjunctival pallor. No scleral icterus. PERRL/EOMI.
MMM. OP clear. Neck Supple, No LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally. No crackles or wheeze

FAMILY HISTORY: Both parents were alcoholics.

SOCIAL HISTORY: Per psych notes, he had brief incarceration in [**Month (only) 116**] for Domestic
Violence. Works as roofer but has had trouble getting work.
Longest period of sobriety was 17 months with help of NA/AA. Has
had frequent lapses and Dr. [**Last Name (STitle) 93335**] (his suboxone provider) notes
that he has presented with sedation and suspects that he
continues to use opiates despite the suboxone. Mr. [**Known lastname **] only
smokes tobacco when he is on a drinking binge. Drug of choice
used to be heroin but now it is cocaine.
.
He states that financial stress due to difficulty finding work
was a major contributor to his lapse. Denies legal trouble. He
has a 9yo daughter with whom he is close. Lives with his
girlfriend, who does not use drugs or drink.
.
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Combinations of opioid type drug with any other drug dependence, continuous,Personal history of noncompliance with medical treatment, presenting hazards to health,Long-term (current) use of insulin,Other and unspecified alcohol dependence, continuous,Other chest pain,Chronic hepatitis C without mention of hepatic coma,Bipolar disorder, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder
DMI ketoacd uncontrold,Opioid/other dep-contin,Hx of past noncompliance,Long-term use of insulin,Alcoh dep NEC/NOS-contin,Chest pain NEC,Chrnc hpt C wo hpat coma,Bipolar disorder NOS,Hyperlipidemia NEC/NOS,Tobacco use disorder
Admission Date:  [**2191-1-22**]              Discharge Date:   [**2191-1-23**]

Date of Birth:  [**2149-8-30**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 23197**]
Chief Complaint:
chest pain

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Mr. [**Known lastname **] is a 41yo gentleman with h/o type 1 DM, hepatitis C
and polysubstance abuse who presented with chest pain and was
found to have hyperglycemia to 600.
.
Three days before admission, he went on a drinking and cocaine
binge. During this time, he stopped taking his lantus. He denies
any other drugs and specifically denies opiates. He states that
he only snorts the cocaine. In addition, he reports successful
sobriety from narcotics ever since being on suboxone. His last
drink was just prior to arrival to the emergency room at 3am
[**1-22**]. He came in to the ED because he developed substernal
heavy chest pressure associated with shortness of breath. No
diaphoresis or palpitations. No pleuritic chest pain.
.
In the emergency department, initial VS were: 98.4 144/58 92 28
98%. He became chest pain free without intervention, and there
was no evidence of alcohol withdrawal. EKG did not show evidence
of ischemia. Labs were notable for glucose of 615, anion gap of
25 (ABG not done). WBC was 7 and CEs were normal x 1. CXR was
felt to be normal. He was given ASA 325mg and started on an
insulin gtt.
.
Upon arrival to the ICU, he was sleepy but comfortable. Over the
next couple of hours, he started to feel shaky and sweaty. He
denied chest pain. He has persistent problems with depression
but specifically denied suicidality.
.
REVIEW OF SYSTEMS:
(+)ve: chest pain as above
(-)ve: fever, chills, night sweats, loss of appetite, fatigue,
palpitations, rhinorrhea, nasal congestion, cough, sputum
production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia,
melena, dysuria, urinary frequency, urinary urgency, focal
numbness, focal weakness, myalgias, arthralgias


Past Medical History:
Type 1 DM followed at [**Last Name (un) **]
Chronic Hepatitis C - has been referred to Liver Center
Polysubstance abuse - heroin overdose in 96 and 00, has been on
suboxone from Dr. [**Last Name (STitle) 93335**]
Alcohol abuse - reports gets shaky but no known h/o seizures or
DTs
Bipolar disorder h/o suicide attempts (by cutting himself, by
overdose)
s/p appendectomy
Cardiac cath in [**2189**] with non-obstructive coronary disease
Dyslipidemia


Social History:
Per psych notes, he had brief incarceration in [**Month (only) 116**] for Domestic
Violence. Works as roofer but has had trouble getting work.
Longest period of sobriety was 17 months with help of NA/AA. Has
had frequent lapses and Dr. [**Last Name (STitle) 93335**] (his suboxone provider) notes
that he has presented with sedation and suspects that he
continues to use opiates despite the suboxone. Mr. [**Known lastname **] only
smokes tobacco when he is on a drinking binge. Drug of choice
used to be heroin but now it is cocaine.
.
He states that financial stress due to difficulty finding work
was a major contributor to his lapse. Denies legal trouble. He
has a 9yo daughter with whom he is close. Lives with his
girlfriend, who does not use drugs or drink.
.


Family History:

Both parents were alcoholics.


Physical Exam:
VS: 97.1 112/49 80 13 97% RA
GENERAL: Pleasant gentleman who is sleepy but not otherwise in
distress. Sweaty forehead. Yawning frequently
HEENT: No conjunctival pallor. No scleral icterus. PERRL/EOMI.
MMM. OP clear. Neck Supple, No LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally. No crackles or wheeze

ABDOMEN: NABS. Soft, NT, ND. No HSM. Well healed scar in RLQ
EXTREMITIES: No edema or calf pain, 2+ dorsalis pedis pulses
SKIN: Very dirty hands. Mildly diaphoretic.
NEURO: A&Ox3, sleepy but easily rousable. Appropriate. CN 2-12
grossly intact. Preserved sensation throughout. 5/5 strength
throughout. Mild intention tremor of LUE. Finger to nose is
slightly slow b/l but otherwise intact. Gait assessment deferred

PSYCH: Listens and responds to questions appropriately,
pleasant. Reasonable insight into his drug use, reports mild
anxiety.


Pertinent Results:
admission:
7.4>42.8<180
no leukocytosis during admission, there was a drop in all three
cell lines which was likely dilutional

PT 12.9, PTT 26.6, INR 1.1

132/5.4/90/17/21/1.3<615

at discharge: 138/3.7/106/26/15/0.9<87

ALT 29, AST 28, CKs 48-58, AlkPhos 68, TB 0.4
MBs not elevated, Trops 0.01 X3

Ca 8.4, Mg 2.2, Phos 2.3

tox screen serum negative

ABG 7.37/43/91

urine culture [**1-22**]
pending at discharge
UA [**1-22**]: neg UTI, >1000 glu, pos cocaine, oxycodone pnd at
discharge, 40 ketone

CXR [**2191-1-22**]:
FINDINGS: The patient is rotated slightly to the right. No focal

consolidation, pleural effusion, or evidence of pneumothorax is
seen. The
heart is not enlarged. No overt pulmonary edema is seen.
IMPRESSION: No acute cardiopulmonary process.



Brief Hospital Course:
41 yo diabetic gentleman with chest pain and hyperglycemia in
the setting of an alcohol and cocaine binge.
.
# Hyperglycemia and concern for DKA:  Patient presented with
hyperglycemia and urinary ketones in the setting of missing at
least two days of his lantus. Although he had a low bicarbonate
with an elevated anion gap on presentation, he did not clearly
meet criteria for diabetic ketoacidosis. ABG upon arrival to ICU
was: 7.37/43/91/26. His anion gap in the ED was 25, which could
have been elevated due to early DKA vs alcoholic/starvation
ketosis. He did not have systemic signs or laboratory evidence
of infection.  He was initially treated with insulin gtt, but
transitioned to subq insulin after several hours, and able to
tolerate PO nutrition.  [**Last Name (un) **] was consulted and agreed with
plan to continue on home regigmen as his fingersticks in the
hospital were well controlled during the course of the day.
.
# Polysubstance abuse:  Patient's last drink was around 3am on
[**1-22**]. He was considered to be at risk for alcohol and opiate
withdrawal, and was started on CIWA scale. Per discussion with
his suboxone provider, [**Name10 (NameIs) **] has lied about opiate use in the past
and there is concern that he is using despite being on suboxone.
His urinary tox screen was positive for cocaine only.  He was
restarted on his home dose of suboxone on the evening of
admission.  He was also treated with thiamine and multivitamin x
3 days.  Addictions nursing was consulted however patient
refused.  He never required medication on his CIWA scale.
.
# Chest pain:  Patient has well-documented history of
presentations with chest pain in the setting of substance abuse;
had non-obstructive coronary disease on his cath from 08. He is
a diabetic and has been using cocaine, and so is at risk for
ischemia. His EKG and biomarkers were within normal limits and
his symptoms resolved.  He was monitored on telemetry and had no
signs of an ischemia or arrhythmic process.
.
# Chronic Hepatitis C:  LFTs within normal limits.

.
# Bipolar disorder:  Continued wellbutrin and abilify, seroquel
initially held.

.
# Dyslipidemia: continued statin.
.
.
# CODE STATUS: Confirmed full
.
# EMERGENCY CONTACT: girlfriend [**Name (NI) 1060**] [**Telephone/Fax (1) 93336**]
.
# Dispo: Patient's PCP and [**Name9 (PRE) **] physicians were notified and
an e-mail was sent to [**Hospital 191**] [**Hospital 1944**] clinic on day of
discharge.

Medications on Admission:
(confirmed with patient and pharmacy):
ASA 81mg daily
Insulin lantus 30 units QHS and lispro sliding scale -- has not
taken lantus for 2 days
Simvastatin 40mg daily
Seroquel 50mg
Wellbutrin SR 150mg daily
Abilify 15mg daily
Multivitamin
Suboxone 24mg daily


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
-hyperglycemia secondary to medication noncompliance
-drug and alcohol abuse

Secondary
-T1DM
-bipolar disorder
-HLD


Discharge Condition:
Mental Status improved, alert and oriented X3
Ambulating well


Discharge Instructions:
You were admitted to [**Hospital1 **] because of high blood
sugars.  This was likely due to the fact that you were not
taking your insulin as prescribed.  Your blood sugars came down
after you were on insulin in the hospital.  The [**Last Name (un) **] doctors
saw [**Name5 (PTitle) **] and recommended that you continue on your home insulin
regimen.

You also were admitted with chest pain.  While you were here you
had lab tests and an EKG which showed that you were not having a
heart attack.  The chest pain may have been due to cocaine use.

You required admission to the intesnive care unit because you
were very sick.  We strongly reccommend that you refrain from
using alcohol and drugs in the future, especially because you
are at high risk of a heart attack with diabetes and cocaine
puts you at even higher risk.

Followup Instructions:
You should follow-up with Dr.[**Name (NI) 14065**] office within the next 5
days.  If you do not hear from their office you should call on
Monday morning.  Their number is [**Telephone/Fax (1) 1300**].

You should also follow-up with Dr.[**Name (NI) **] office.
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Combinations of opioid type drug with any other drug dependence, continuous,Personal history of noncompliance with medical treatment, presenting hazards to health,Long-term (current) use of insulin,Other and unspecified alcohol dependence, continuous,Other chest pain,Chronic hepatitis C without mention of hepatic coma,Bipolar disorder, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder'}


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: chest pain

PRESENT ILLNESS: Mr. [**Known lastname **] is a 41yo gentleman with h/o type 1 DM, hepatitis C
and polysubstance abuse who presented with chest pain and was
found to have hyperglycemia to 600.
.
Three days before admission, he went on a drinking and cocaine
binge. During this time, he stopped taking his lantus. He denies
any other drugs and specifically denies opiates. He states that
he only snorts the cocaine. In addition, he reports successful
sobriety from narcotics ever since being on suboxone. His last
drink was just prior to arrival to the emergency room at 3am
[**1-22**]. He came in to the ED because he developed substernal
heavy chest pressure associated with shortness of breath. No
diaphoresis or palpitations. No pleuritic chest pain.
.
In the emergency department, initial VS were: 98.4 144/58 92 28
98%. He became chest pain free without intervention, and there
was no evidence of alcohol withdrawal. EKG did not show evidence
of ischemia. Labs were notable for glucose of 615, anion gap of
25 (ABG not done). WBC was 7 and CEs were normal x 1. CXR was
felt to be normal. He was given ASA 325mg and started on an
insulin gtt.
.
Upon arrival to the ICU, he was sleepy but comfortable. Over the
next couple of hours, he started to feel shaky and sweaty. He
denied chest pain. He has persistent problems with depression
but specifically denied suicidality.
.
REVIEW OF SYSTEMS:
(+)ve: chest pain as above
(-)ve: fever, chills, night sweats, loss of appetite, fatigue,
palpitations, rhinorrhea, nasal congestion, cough, sputum
production, hemoptysis, dyspnea, orthopnea, paroxysmal nocturnal
dyspnea, nausea, vomiting, diarrhea, constipation, hematochezia,
melena, dysuria, urinary frequency, urinary urgency, focal
numbness, focal weakness, myalgias, arthralgias

MEDICAL HISTORY: Type 1 DM followed at [**Last Name (un) **]
Chronic Hepatitis C - has been referred to Liver Center
Polysubstance abuse - heroin overdose in 96 and 00, has been on
suboxone from Dr. [**Last Name (STitle) 93335**]
Alcohol abuse - reports gets shaky but no known h/o seizures or
DTs
Bipolar disorder h/o suicide attempts (by cutting himself, by
overdose)
s/p appendectomy
Cardiac cath in [**2189**] with non-obstructive coronary disease
Dyslipidemia

MEDICATION ON ADMISSION: (confirmed with patient and pharmacy):
ASA 81mg daily
Insulin lantus 30 units QHS and lispro sliding scale -- has not
taken lantus for 2 days
Simvastatin 40mg daily
Seroquel 50mg
Wellbutrin SR 150mg daily
Abilify 15mg daily
Multivitamin
Suboxone 24mg daily

ALLERGIES: Penicillins

PHYSICAL EXAM: VS: 97.1 112/49 80 13 97% RA
GENERAL: Pleasant gentleman who is sleepy but not otherwise in
distress. Sweaty forehead. Yawning frequently
HEENT: No conjunctival pallor. No scleral icterus. PERRL/EOMI.
MMM. OP clear. Neck Supple, No LAD, No thyromegaly.
CARDIAC: Regular rhythm, normal rate. Normal S1, S2. No murmurs,
rubs or [**Last Name (un) 549**].
LUNGS: CTAB, good air movement biaterally. No crackles or wheeze

FAMILY HISTORY: Both parents were alcoholics.

SOCIAL HISTORY: Per psych notes, he had brief incarceration in [**Month (only) 116**] for Domestic
Violence. Works as roofer but has had trouble getting work.
Longest period of sobriety was 17 months with help of NA/AA. Has
had frequent lapses and Dr. [**Last Name (STitle) 93335**] (his suboxone provider) notes
that he has presented with sedation and suspects that he
continues to use opiates despite the suboxone. Mr. [**Known lastname **] only
smokes tobacco when he is on a drinking binge. Drug of choice
used to be heroin but now it is cocaine.
.
He states that financial stress due to difficulty finding work
was a major contributor to his lapse. Denies legal trouble. He
has a 9yo daughter with whom he is close. Lives with his
girlfriend, who does not use drugs or drink.
. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Combinations of opioid type drug with any other drug dependence, continuous,Personal history of noncompliance with medical treatment, presenting hazards to health,Long-term (current) use of insulin,Other and unspecified alcohol dependence, continuous,Other chest pain,Chronic hepatitis C without mention of hepatic coma,Bipolar disorder, unspecified,Other and unspecified hyperlipidemia,Tobacco use disorder'}
