CHIEF COMPLAINT: 1. Nausea
2. Vomiting
3. Abdominal pain

PRESENT ILLNESS: 47-year-old woman with a history of coronary artery disease,
status post myocardial infarction, type I diabetes mellitus
intermittently on dialysis, peptic ulcer disease, and
gastroparesis who presents with a two-day history of nausea and
vomiting. These symptoms lead to four hospitalizations in the
last 4 weeks. Two hospitalizations were at [**Hospital6 5016**]
([**Location (un) 7661**], MA), one was at [**Hospital6 3105**], and the
last was here when she was discharged on [**2172-11-29**]. She states
that for the last two days she has had intractable nausea and
vomiting.  It was particularly bad after hemodialysis on [**12-5**].
The patient experienced epigastric pain but is passing gas.  She
does not report any bloody vomitus or melanotic stools, fever,
chills, chest pain, shortness of breath, or cough.  These
episodes are normally well treated with Zofran and Reglan as the
patient feels well goes home for a short period of time before
they start up again.  Upon her [**11-29**] discharge from here, the
patient was to go for gastric emptying study.

MEDICAL HISTORY: 1. Diabetes Mellitus Type 1
- nephropathy
- retinopathy
- neuropathy
2. Gastroparesis
3. Myocardial infarction ([**2169**])
- status post CABG x 4 vessels
4. Hypertension
5. Renal Disease
- dialysis x 5 weeks
6. Peptic ulcer disease
- status post GI bleed
7. Status post c-sections x2

MEDICATION ON ADMISSION: 1. Valsartan 40 mg PO once a day
2. Metoclopramide HCl 10 mg PO 4 times a day before meals and at
bedtime
3. Aspirin 81 mg PO once a day
4. Atorvastatin Calcium 10 mg PO every other day
5. Carvedilol 6.25 mg PO 2 times a day
6. Calcitriol 0.25 mcg PO every other day
7. Sertraline HCl 50 mg PO once a day
8. B Complex-Vitamin C-Folic Acid 1 mg PO once a day
9. Sevelamer HCl 400 mg PO 3 times a day with meals
10. Docusate Sodium 100 mg PO twice daily as needed for
constipation
11. Pantoprazole Sodium 40 mg PO once daily

ALLERGIES: Lopressor / Penicillins / Keflex / Percocet / Erythromycin Base

PHYSICAL EXAM: T 97.6 BP 165/85  P 88  RR 24

FAMILY HISTORY: No history of diabetes, heart disease, or cancer.

SOCIAL HISTORY: Lives with husband and two children in [**Name (NI) 7661**]. Worked as a
probation officer up 3 years PTA. No history of smoking, no EtOH
or other drugs. Gets physical therapy 3x/week at home.
Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Gastroparesis,Polyneuropathy in diabetes,Background diabetic retinopathy,Old myocardial infarction,Aortocoronary bypass status
DMI neuro nt st uncntrld,Hyp kid NOS w cr kid V,CHF NOS,React-oth vasc dev/graft,Bacteremia,Gastroparesis,Neuropathy in diabetes,Diabetic retinopathy NOS,Old myocardial infarct,Aortocoronary bypass
Admission Date:  [**2172-12-5**]              Discharge Date:   [**2172-12-16**]

Date of Birth:  [**2125-10-24**]             Sex:   F

Service: MED

Allergies:
Lopressor / Penicillins / Keflex / Percocet / Erythromycin Base

Attending:[**First Name3 (LF) 2181**]
Chief Complaint:
1. Nausea
2. Vomiting
3. Abdominal pain

Major Surgical or Invasive Procedure:
None

History of Present Illness:
47-year-old woman with a history of coronary artery disease,
status post myocardial infarction, type I diabetes mellitus
intermittently on dialysis, peptic ulcer disease, and
gastroparesis who presents with a two-day history of nausea and
vomiting. These symptoms lead to four hospitalizations in the
last 4 weeks. Two hospitalizations were at [**Hospital6 5016**]
([**Location (un) 7661**], MA), one was at [**Hospital6 3105**], and the
last was here when she was discharged on [**2172-11-29**]. She states
that for the last two days she has had intractable nausea and
vomiting.  It was particularly bad after hemodialysis on [**12-5**].
The patient experienced epigastric pain but is passing gas.  She
does not report any bloody vomitus or melanotic stools, fever,
chills, chest pain, shortness of breath, or cough.  These
episodes are normally well treated with Zofran and Reglan as the
patient feels well goes home for a short period of time before
they start up again.  Upon her [**11-29**] discharge from here, the
patient was to go for gastric emptying study.

Past Medical History:
1. Diabetes Mellitus Type 1
- nephropathy
- retinopathy
- neuropathy
2. Gastroparesis
3. Myocardial infarction ([**2169**])
- status post CABG x 4 vessels
4. Hypertension
5. Renal Disease
- dialysis x 5 weeks
6. Peptic ulcer disease
- status post GI bleed
7. Status post c-sections x2

Social History:
Lives with husband and two children in [**Name (NI) 7661**]. Worked as a
probation officer up 3 years PTA. No history of smoking, no EtOH
or other drugs. Gets physical therapy 3x/week at home.

Family History:
No history of diabetes, heart disease, or cancer.

Physical Exam:
T 97.6 BP 165/85  P 88  RR 24

General: Pt appears slightly lethargic, slow to answer
questions, NAD.
HEENT: sclera anicteric, PEERL, EOMI
Chest: CTA bilateraly, no wheezes, crackles, rhonchi
CV: RRR S1 S2 III/VI systolic @ RSB
Abdom: Soft, mild epigastric tenderness, ND + BS moderate
distension.
Extremities: no c/c/e
Neuro: A&O x 3


Pertinent Results:
[**2172-12-5**] 06:20PM BLOOD WBC-5.4 RBC-6.04* Hgb-16.9* Hct-52.4*
MCV-87 MCH-27.9 MCHC-32.2 RDW-15.8* Plt Ct-204
[**2172-12-7**] 06:00AM BLOOD WBC-6.7 RBC-5.11 Hgb-14.1 Hct-45.0 MCV-88
MCH-27.6 MCHC-31.3 RDW-16.1* Plt Ct-192
[**2172-12-11**] 06:44AM BLOOD WBC-6.6 RBC-4.57 Hgb-12.8 Hct-39.2 MCV-86
MCH-28.1 MCHC-32.8 RDW-15.6* Plt Ct-167
[**2172-12-6**] 07:15AM BLOOD Neuts-87.0* Lymphs-7.8* Monos-3.7 Eos-1.0
Baso-0.5
[**2172-12-11**] 06:44AM BLOOD Neuts-52 Bands-1 Lymphs-12* Monos-15*
Eos-19* Baso-1 Atyps-0 Metas-0 Myelos-0
[**2172-12-8**] 06:10AM BLOOD PT-13.2 PTT-50.2* INR(PT)-1.1
[**2172-12-8**] 03:20PM BLOOD PT-16.6* PTT-50.2* INR(PT)-1.7
[**2172-12-11**] 06:44AM BLOOD PT-13.0 PTT-32.0 INR(PT)-1.1
[**2172-12-5**] 06:20PM BLOOD Glucose-159* UreaN-26* Creat-2.1*# Na-138
K-4.3 Cl-100 HCO3-26 AnGap-16
[**2172-12-7**] 05:00PM BLOOD Glucose-280* UreaN-42* Creat-3.1* Na-136
K-4.9 Cl-104 HCO3-14* AnGap-23*
[**2172-12-9**] 09:20AM BLOOD Glucose-158* UreaN-27* Creat-2.4* Na-137
K-4.0 Cl-107 HCO3-22 AnGap-12
[**2172-12-11**] 06:44AM BLOOD Glucose-150* UreaN-30* Creat-3.0* Na-138
K-4.1 Cl-104 HCO3-25 AnGap-13
[**2172-12-6**] 07:15AM BLOOD Calcium-9.4 Phos-4.9* Mg-1.8

Staphylococcus coagulase negative in blood cultures

Brief Hospital Course:
The patient was admitted to medicine for intractable nausea and
vomiting. Her symptoms triggered an episode of diabetic
ketoacidosis. These were treated with zofran, reglan, ativan and
an insulin sliding scale. She required a one-day ICU stay for
close monitoring and aggressive management. Upon transfer to the
floor, the patient's symptoms resolved and she could maintain
good oral intake. Although she remained asymptomatic and
afebrile throughout, she was found to have a gram positive
coagulase negative bacteremia at the site of her dialysis line
on [**12-9**]. The line was removed on [**12-12**] and a temporary femoral
line was inserted. She received renal doses of vancomycin. A
second tunneled line was placed on [**12-15**] after her blood
cultures were cleared for more than two days. The procedure was
successful and the patient was discharged on [**12-16**] on her usual
medications and with an appointment to visit Dr. [**Last Name (STitle) **] of
transplant surgery to schedule an arteriovenous fistula
placement. She will continue to take vancomycin for one week
post-discharge.

Medications on Admission:
1. Valsartan 40 mg PO once a day
2. Metoclopramide HCl 10 mg PO 4 times a day before meals and at
bedtime
3. Aspirin 81 mg PO once a day
4. Atorvastatin Calcium 10 mg PO every other day
5. Carvedilol 6.25 mg PO 2 times a day
6. Calcitriol 0.25 mcg PO every other day
7. Sertraline HCl 50 mg PO once a day
8. B Complex-Vitamin C-Folic Acid 1 mg PO once a day
9. Sevelamer HCl 400 mg PO 3 times a day with meals
10. Docusate Sodium 100 mg PO twice daily as needed for
constipation
11. Pantoprazole Sodium 40 mg PO once daily

Discharge Medications:
1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
2. Atorvastatin Calcium 10 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
3. Carvedilol 6.25 mg Tablet Sig: One (1) Tablet PO BID (2 times
a day).
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day).
5. Valsartan 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).

6. Sertraline HCl 50 mg Tablet Sig: One (1) Tablet PO DAILY
(Daily).
7. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap
PO DAILY (Daily).
8. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).

9. Metoclopramide HCl 10 mg Tablet Sig: Two (2) Tablet PO
QIDACHS (4 times a day (before meals and at bedtime)).
10. Sevelamer HCl 400 mg Tablet Sig: One (1) Tablet PO TID (3
times a day).
11. Vancomycin HCl 1,000 mg Recon Soln Sig: One (1)  Intravenous
 at dialysis for 7 days.
12. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed.
13. Morphine Sulfate 15 mg Tablet Sig: One (1) Tablet PO every
eight (8) hours as needed for pain for 4 days.
Disp:*12 Tablet(s)* Refills:*0*
14. Acetaminophen 500 mg Tablet Sig: 1-2 Tablets PO every [**7-21**]
hours.


Discharge Disposition:
Home With Service

Facility:
[**Last Name (LF) 486**], [**First Name3 (LF) 487**]

Discharge Diagnosis:
Primary:
1. Gastroparesis
2. Diabetic ketoacidosis
3. Nausea and vomiting
4. Gram positive coagulase negative bacteremia
Secondary:
5. Coronary heart disease
6. Hypertension
7. Peptic ulcer disease

Discharge Condition:
Good

Discharge Instructions:
You were hospitalized for an episode of nausea, vomiting and
abdominal pain. This caused your diabetes to be out of control
and required a short stay in the ICU. Your problems were
aggressively treated with intravenous medications and an insulin
sliding scale. Blood drawn from your dialysis line revealed some
microbes which required antibiotics and the removal of your
line. A dialysis line was replaced today prior to your
discharge. You must continue your vancomycin for another 10
days. This will be given to you during the dialysis sessions. It
is important that you follow up with your primary care provider
within one week of discharge.
Please call your doctor or go to the emergency department if you
develop:
* uncontrolled nausea, vomiting
* fever / chills
* shortness of breath
* any worrisome symptoms

Followup Instructions:
1. Follow up with primary care provider within one week of
discharge
2. Provider: [**Name10 (NameIs) 1344**] [**Last Name (NamePattern4) 3125**], MD Where: LM [**Hospital Unit Name 3126**] CENTER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2173-1-4**] 3:00



Completed by:[**2172-12-16**]
{'Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Gastroparesis,Polyneuropathy in diabetes,Background diabetic retinopathy,Old myocardial infarction,Aortocoronary bypass 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: 1. Nausea
2. Vomiting
3. Abdominal pain

PRESENT ILLNESS: 47-year-old woman with a history of coronary artery disease,
status post myocardial infarction, type I diabetes mellitus
intermittently on dialysis, peptic ulcer disease, and
gastroparesis who presents with a two-day history of nausea and
vomiting. These symptoms lead to four hospitalizations in the
last 4 weeks. Two hospitalizations were at [**Hospital6 5016**]
([**Location (un) 7661**], MA), one was at [**Hospital6 3105**], and the
last was here when she was discharged on [**2172-11-29**]. She states
that for the last two days she has had intractable nausea and
vomiting.  It was particularly bad after hemodialysis on [**12-5**].
The patient experienced epigastric pain but is passing gas.  She
does not report any bloody vomitus or melanotic stools, fever,
chills, chest pain, shortness of breath, or cough.  These
episodes are normally well treated with Zofran and Reglan as the
patient feels well goes home for a short period of time before
they start up again.  Upon her [**11-29**] discharge from here, the
patient was to go for gastric emptying study.

MEDICAL HISTORY: 1. Diabetes Mellitus Type 1
- nephropathy
- retinopathy
- neuropathy
2. Gastroparesis
3. Myocardial infarction ([**2169**])
- status post CABG x 4 vessels
4. Hypertension
5. Renal Disease
- dialysis x 5 weeks
6. Peptic ulcer disease
- status post GI bleed
7. Status post c-sections x2

MEDICATION ON ADMISSION: 1. Valsartan 40 mg PO once a day
2. Metoclopramide HCl 10 mg PO 4 times a day before meals and at
bedtime
3. Aspirin 81 mg PO once a day
4. Atorvastatin Calcium 10 mg PO every other day
5. Carvedilol 6.25 mg PO 2 times a day
6. Calcitriol 0.25 mcg PO every other day
7. Sertraline HCl 50 mg PO once a day
8. B Complex-Vitamin C-Folic Acid 1 mg PO once a day
9. Sevelamer HCl 400 mg PO 3 times a day with meals
10. Docusate Sodium 100 mg PO twice daily as needed for
constipation
11. Pantoprazole Sodium 40 mg PO once daily

ALLERGIES: Lopressor / Penicillins / Keflex / Percocet / Erythromycin Base

PHYSICAL EXAM: T 97.6 BP 165/85  P 88  RR 24

FAMILY HISTORY: No history of diabetes, heart disease, or cancer.

SOCIAL HISTORY: Lives with husband and two children in [**Name (NI) 7661**]. Worked as a
probation officer up 3 years PTA. No history of smoking, no EtOH
or other drugs. Gets physical therapy 3x/week at home. 

### Response:
{'Diabetes with neurological manifestations, type I [juvenile type], not stated as uncontrolled,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Congestive heart failure, unspecified,Infection and inflammatory reaction due to other vascular device, implant, and graft,Bacteremia,Gastroparesis,Polyneuropathy in diabetes,Background diabetic retinopathy,Old myocardial infarction,Aortocoronary bypass status'}
