CHIEF COMPLAINT: diabetic foot ulcer, hypotension

PRESENT ILLNESS: 61yo M with h/o DM, dementia, MR admitted to podiatry with
diabetic right foot ulcer s/p I+D in OR on [**2128-7-21**] transferred
from PACU to MICU for hypotension. Per records and ED attending
patient was found down at [**Hospital3 **] this morning in feces
and urine. He was brought to the ED where he had a temp to 101,
sinus tach to 150s, WBC 18, and cellulitis on right foot with
purulent ulcer and streaking up leg to groin with track. Mental
status was "alittle out of it" but at baseline per family. Got
4L NS in the ED and APAP and HR down to 120s. XR foot didnt show
evidence of osteo but had track with pus through ulcer. Broad
spec abx were given (vanc/ctz/cipro/flagyl) and he was evaluated
by podiatry and vascular surgery who recommended sending him to
the OR for I+D.
.
In the OR the patient underwent I+D, received fent (75mg)/midaz
(3mg), esmolol and metoprolol for sinus tach in the 150s and neo
for hypotension (100s/50s) and 5L drained 10cc pus from right
foot, EBL 50mL, packed with saline wet-dry dressing change. Per
anesthesia he's had tachycardia treated with esmolol and
hypotensive (100s/50s). superficial culture taken in ED and deep
cultures taken in OR as well. Will likely need debridement and
head of Metatarsal removed over the next few days by podiatry.
.
On the floor, patient is sleeping but arousable. Denies pain.
Denies chest pain and denies palpitations.

MEDICAL HISTORY: DM2
Vascular dementia
Asthma
Hypertension
Barretts esophagus
.
PAST SURGICAL HISTORY: (per OMR) Open reduction and internal
fixation
fracture both bones of the forearm [**6-/2117**], pheochromocytoma [**2110**]

MEDICATION ON ADMISSION: HCTZ 25', metformin 1000', lisinopril 40', remeron 45'qhs,
simvastatin 40', mertazipine 30'qhs, celexa 40', [**Last Name (LF) **], [**First Name3 (LF) 130**]

ALLERGIES: Penicillins / E-Mycin

PHYSICAL EXAM: Vitals: T:97.1 BP:91/40 P:140 R:25 O2:97 on 5L NC
General: somnolent but arousable, answers questions
appropriately but falls asleep mid-interview
HEENT: Sclera anicteric, very dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Upper airway snoring sounds but otherwise Clear to
auscultation bilaterally, no wheezes, rales, ronchi anteriorly
CV: tachycardic but regular
Abdomen: Obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding
GU: foley
Ext: warm, well perfused, no edema, bandage on right foot with
marker line on leg and inside marker line no erythema

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: (per OMR)
Smoking: Nonsmoker. ETOH: Social drinking.
Physical Exercise: Patient has been moderately physically
active.
Other specified septicemias,Acute kidney failure, unspecified,Septic shock,Acute osteomyelitis, ankle and foot,Atrial flutter,Cellulitis and abscess of foot, except toes,Ulcer of calf,Mixed acid-base balance disorder,Vascular dementia, with delirium,Severe sepsis,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Cellulitis and abscess of toe, unspecified,Long-term (current) use of insulin,Cerebral atherosclerosis,Unspecified intellectual disabilities,Asthma, unspecified type, unspecified,Barrett's esophagus,Anemia of other chronic disease,Abnormal coagulation profile,Conjunctivitis, unspecified,Rosacea,Personal history of traumatic fracture
Septicemia NEC,Acute kidney failure NOS,Septic shock,Ac osteomyelitis-ankle,Atrial flutter,Cellulitis of foot,Ulcer of calf,Mixed acid-base bal dis,Vasc dementia w delirium,Severe sepsis,DMII oth nt st uncntrld,Cellulitis, toe NOS,Long-term use of insulin,Cerebral atherosclerosis,Intellect disability NOS,Asthma NOS,Barrett's esophagus,Anemia-other chronic dis,Abnrml coagultion prfile,Conjunctivitis NOS,Rosacea,Hx traumatic fracture
Admission Date:  [**2128-7-21**]              Discharge Date:   [**2128-7-27**]

Date of Birth:  [**2067-1-7**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins / E-Mycin

Attending:[**First Name3 (LF) 800**]
Chief Complaint:
diabetic foot ulcer, hypotension

Major Surgical or Invasive Procedure:
I+D of R diabetic foot ulcer

History of Present Illness:
61yo M with h/o DM, dementia, MR admitted to podiatry with
diabetic right foot ulcer s/p I+D in OR on [**2128-7-21**] transferred
from PACU to MICU for hypotension. Per records and ED attending
patient was found down at [**Hospital3 **] this morning in feces
and urine. He was brought to the ED where he had a temp to 101,
sinus tach to 150s, WBC 18, and cellulitis on right foot with
purulent ulcer and streaking up leg to groin with track. Mental
status was "alittle out of it" but at baseline per family. Got
4L NS in the ED and APAP and HR down to 120s. XR foot didnt show
evidence of osteo but had track with pus through ulcer. Broad
spec abx were given (vanc/ctz/cipro/flagyl) and he was evaluated
by podiatry and vascular surgery who recommended sending him to
the OR for I+D.
.
In the OR the patient underwent I+D, received fent (75mg)/midaz
(3mg), esmolol and metoprolol for sinus tach in the 150s and neo
for hypotension (100s/50s) and 5L drained 10cc pus from right
foot, EBL 50mL, packed with saline wet-dry dressing change. Per
anesthesia he's had tachycardia treated with esmolol and
hypotensive (100s/50s). superficial culture taken in ED and deep
cultures taken in OR as well. Will likely need debridement and
head of Metatarsal removed over the next few days by podiatry.
.
On the floor, patient is sleeping but arousable. Denies pain.
Denies chest pain and denies palpitations.


Past Medical History:
DM2
Vascular dementia
Asthma
Hypertension
Barretts esophagus
.
PAST SURGICAL HISTORY: (per OMR) Open reduction and internal
fixation
fracture both bones of the forearm [**6-/2117**], pheochromocytoma [**2110**]



Social History:
(per OMR)
Smoking: Nonsmoker. ETOH: Social drinking.
Physical Exercise: Patient has been moderately physically
active.


Family History:
non-contributory

Physical Exam:
Vitals: T:97.1 BP:91/40 P:140 R:25 O2:97 on 5L NC
General: somnolent but arousable, answers questions
appropriately but falls asleep mid-interview
HEENT: Sclera anicteric, very dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Upper airway snoring sounds but otherwise Clear to
auscultation bilaterally, no wheezes, rales, ronchi anteriorly
CV: tachycardic but regular
Abdomen: Obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding
GU: foley
Ext: warm, well perfused, no edema, bandage on right foot with
marker line on leg and inside marker line no erythema


Pertinent Results:
[**2128-7-21**] 08:05PM BLOOD WBC-18.1*# RBC-4.26* Hgb-11.0* Hct-33.0*
MCV-78* MCH-25.9* MCHC-33.5 RDW-16.8* Plt Ct-269
[**2128-7-21**] 08:05PM BLOOD Neuts-88.5* Lymphs-4.4* Monos-6.4 Eos-0.2
Baso-0.5
[**2128-7-23**] 12:58AM BLOOD WBC-6.3 RBC-3.40* Hgb-8.8* Hct-25.8*
MCV-76* MCH-25.8* MCHC-34.1 RDW-16.7* Plt Ct-219
[**2128-7-21**] 08:05PM BLOOD PT-16.4* PTT-29.3 INR(PT)-1.5*
[**2128-7-22**] 12:54AM BLOOD Fibrino-640*
[**2128-7-21**] 08:05PM BLOOD Glucose-434* UreaN-34* Creat-1.3* Na-127*
K-4.6 Cl-92* HCO3-22 AnGap-18
[**2128-7-21**] 08:05PM BLOOD ALT-41* AST-49* LD(LDH)-332* AlkPhos-90
TotBili-0.8
[**2128-7-22**] 12:54AM BLOOD Albumin-2.4* Calcium-7.0* Phos-3.2 Mg-1.8
[**2128-7-22**] 12:54AM BLOOD Hapto-182
[**2128-7-21**] 08:05PM BLOOD Osmolal-296
[**2128-7-22**] 12:54AM BLOOD TSH-0.92
[**2128-7-23**] 12:58AM BLOOD Cortsol-13.5
[**2128-7-22**] 01:05AM BLOOD Type-[**Last Name (un) **] pO2-56* pCO2-50* pH-7.23*
calTCO2-22 Base XS--6
[**2128-7-22**] 01:40AM BLOOD Type-ART pO2-96 pCO2-51* pH-7.23*
calTCO2-22 Base XS--6 Intubat-NOT INTUBA
[**2128-7-21**] 08:13PM BLOOD Glucose-386* Lactate-2.1* K-4.6
[**2128-7-22**] 09:37AM BLOOD freeCa-1.06*
[**2128-7-21**] 09:45PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.023
[**2128-7-21**] 09:45PM URINE Blood-LG Nitrite-NEG Protein-75
Glucose-1000 Ketone-15 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2128-7-21**] 09:45PM URINE RBC-2 WBC-1 Bacteri-FEW Yeast-NONE Epi-0
.
[**2128-7-22**] MRSA SCREEN MRSA SCREEN-PENDING INPATIENT
[**2128-7-22**] SWAB GRAM STAIN-FINAL; WOUND
CULTURE-PRELIMINARY; ANAEROBIC CULTURE-PRELIMINARY INPATIENT
[**2128-7-22**] SWAB GRAM STAIN-FINAL; WOUND
CULTURE-PRELIMINARY; ANAEROBIC CULTURE-PRELIMINARY INPATIENT
[**2128-7-22**] URINE URINE CULTURE-FINAL INPATIENT
[**2128-7-21**] SWAB GRAM STAIN-FINAL; WOUND
CULTURE-PRELIMINARY; ANAEROBIC CULTURE-FINAL EMERGENCY [**Hospital1 **]
[**2128-7-21**] BLOOD CULTURE Blood Culture, Routine-PENDING
EMERGENCY [**Hospital1 **]
[**2128-7-21**] BLOOD CULTURE Blood Culture, Routine-PENDING

[**2128-7-21**] ECG: Narrow complex tachycardia which may be due to
sinus tachycardia or an atrial flutter or atrial tachycardia
with 2:1 conduction. Compared to the previous tracing of [**2124-5-20**]
the rate has increased substantially and there may be an atrial
arrhythmia present.
.
[**2128-7-21**] CT Head W/Out Contrast: 1. No acute intracranial
pathology. 2. Parenchymal atrophy and small vessel microvascular
disease.
.
[**2128-7-21**] R Foot AP,LAT & OBL X-Ray: : Soft tissue ulceration and
swelling at the medial forefoot at the level of the great toe
with soft tissue ulceration. Markedly limited study for
evaluation for osteomyelitis and if clinically warranted, MRI
may be obtained to further assess.
.
[**2128-7-21**] CXR: No evidence of pneumonia. Equivocal evidence of
mild congestion.
.
[**2128-7-22**] TEE: No spontaneous echo contrast or thrombus is seen in
the body of the left atrium/left atrial appendage or the body of
the right atrium/right atrial appendage. No spontaneous echo
contrast is seen in the left atrial appendage. No atrial septal
defect is seen by 2D or color Doppler. There is mild symmetric
left ventricular hypertrophy with normal cavity size. Overall
left ventricular systolic function is normal (LVEF>55%). Right
ventricular chamber size and free wall motion are normal. The
ascending, transverse and descending thoracic aorta are normal
in diameter and free of atherosclerotic plaque to 40 cm from the
incisors. The aortic valve leaflets (3) are mildly thickened. No
aortic regurgitation is seen. The mitral valve leaflets are
structurally normal. Mild (1+) mitral regurgitation is seen.
There is no pericardial effusion. .
.
[**7-24**]:
xray
HISTORY: Foot ulcer status post debridement.

FINDINGS: In comparison with the study of earlier in this date,
there has
been extensive debridement about the first MTP joint with bony
resection.
Area of gas in soft tissues could merely be trapped under the
bandage.
Further information can be gathered from the operative report.


Brief Hospital Course:
61yo M with DM2, vascular dementia found down at [**Hospital3 **]
with infected foot ulcer s/p I+D in OR with hypotension likely
from sepsis.
.
# Sepsis/ right foot osteomyletis: - Resolved  following
aggressive IVF. Lactate normalized and he had improved mentation
and urination.  Covered broadly for infected diabetic foot ulcer
with Vanc/Ceftaz/Cipro/Flagyl initially. Cultures showed
multiple organisms. Was followed by vascular and podiatry.On
wound culture: UNABLE TO R/O OTHER PATHOGENS DUE TO OVERGROWTH
OF SWARMING PROTEUS.STAPH AUREUS COAG +=RARE GROWTH. ANAEROBIC
CULTURE (Preliminary):NO ANAEROBES ISOLATED. Blood pressures are
currently stable. Status post podiatric surgery ([**7-24**])-Resection
of first metatarsophalangeal joint. Radical debridement of skin,
muscle and subcutaneous  tissue, right foot. Delayed primary
closure, right foot. Will be discharged on levofloxacin which
will cover the MSSA which grew from his wound culture.
.
# Tachycardia: A flutter, s/p D/C cardioversion after
amiodarone loading, and beta blocking. TEE did not show
thrombus. Now in sinus with improved BP. Pt started on heparin
gtt which was transitioned to lovenox and coumadin. Has remained
in sinus rhythm. Currently being rate controlled with Metoprolol
75mg TID. Lovenox should be DC'd after INR therapeutic between
[**12-31**]. Anticoagulation should be continued until [**8-24**].
At that time need for anticoagulation should be reassessed.
.
# Acid/Base disturbance: had respiratory acidosis and non gap
met acidosis on admission to MICU. Thought to be secondary to
sepsis with procedural sedation. This issue has resolved since
and on the floor his acid/base status was stable.
.
# Hyponatremia: Hypovolemic hyponatremia likely [**12-30**] either tea
and toast diet/poor po intake from being on floor for unknown
number of days vs adrenal insufficiency vs insensible losses
from fevers, infection etc. Improved with hydration (normal
TSH, random cortisol was 13.2 ?????? equivocal).His sodium level on
the floor were normal.
.
# Anemia: Hct were 25-26 which is low for his baseline of
30s-40s. guaiac negative, hemolysis labs were negative.
Continued to trend Hct. Iron studies were obtained.
Iron: 25 calTIBC: 176 Ferritn: 871 TRF: 135, suggestive of
anemia with chronic disease. This should be followed by the
patient's primary care physician.

# Elevated INR: unclear etiology, patient not on coumadin,
heparin. Possibly nutritional deficiency but with anemia
concerning for hemolysis.  INR is now coming down and has been
stable at around 1.4.  No evidence of hemolysis. Started on
heparin gtt during stay which was transioned to lovenox and
coumadin bridge.
.
# [**Last Name (un) **]: Likely [**12-30**] hypotension/pre-renal given sepsis. Now
resolved.

# conjunctivitis: Found to have conjunctivitis on [**7-22**]. Started
on erythromycin drops. Resolving. Erythromycin stopped prior to
discharge.

# Dementia/MR: sedating meds were being held initially because
of low BP. Otherwise issue stable during admission.

# COPD: Standing atrovent and PRN albuterol nebs while in ICU
and floor. Breathing status has been stable and he is tolerating
room air well. Continued on home [**Month/Year (2) **] at discharge.
.
# DM: Standing insulin sliding scale.
.
_
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________________________________________________________________
-The patient will need at least 1 month of anticoagulation after
having atrial flutter cardioversion. The potential continuation
of anticoagulation will have to be assessed as an outpatient.

Medications on Admission:
HCTZ 25', metformin 1000', lisinopril 40', remeron 45'qhs,
simvastatin 40', mertazipine 30'qhs, celexa 40', [**Last Name (LF) **], [**First Name3 (LF) 130**]



Discharge Medications:
1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 10 days.
Disp:*10 Tablet(s)* Refills:*0*
2. Warfarin 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
3. Mirtazapine 15 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
4. Lovenox 80 mg/0.8 mL Syringe Sig: One (1)  Subcutaneous twice
a day.
5. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2)
Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for
Constipation.
6. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a
day) as needed for Constipation.
7. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1)  PO BID (2
times a day).
8. [**First Name3 (LF) 4010**] Diskus 250-50 mcg/Dose Disk with Device Sig: One (1)
Inhalation twice a day.
9. Metformin 1,000 mg Tablet Sig: One (1) Tablet PO twice a day.

10. Acetaminophen 500 mg Capsule Sig: One (1) Capsule PO Q6H
(every 6 hours) as needed for pain/fever.
11. Simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.

12. Metoprolol Tartrate 25 mg Tablet Sig: Three (3) Tablet PO
TID (3 times a day).


Discharge Disposition:
Extended Care

Facility:
[**Hospital 4316**] Rehabilitation & [**Hospital **] Care Center - [**Location (un) **]

Discharge Diagnosis:
1.Osteomyelitis, right first metatarsophalangeal joint.
2. Abscess and cellulitis, right foot.
3. Atrial flutter which was cardioverted


Discharge Condition:
Mental Status: Confused - sometimes.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - requires assistance or aid (walker
or cane).


Discharge Instructions:
It was a pleasure to care for you as your doctor.
.
You were brought to the hospital because of a foot infection.
You developed low blood pressure and spent a couple of days in
the intensive care unit. After intravenous fluids, antibiotics,
and surgery on your foot you improved and were transferred to
the regular floor. Your admisison was complicated by a abnormal
heart rhythm which required electrial conversion to a regular
heart rhythm.
.
We made the following changes to your home medication list:

-We added Coumadin which is a blood thinner you will need to
take because of the irregular heart rhythm you experienced.
Please take this medication as directed by your outpatient
physician.

-We added lovenox which is a blood thinner you must take for
your irregular heart rhythm you experienced, please take this
medication as directed by your physician at rehab. This will be
stopped once your INR is between [**12-31**].

-We started levofloxacin which is an antiobiotic for your foot
infection which you had surgery.

- Lisinopril and HCTZ were stopped during admission.
.
Please follow up with the outpatient appointments below:

Followup Instructions:
Department: PODIATRY
When: THURSDAY [**2128-8-5**] at 8:05 AM
With: [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 722**], DPM [**Telephone/Fax (1) 543**]
Building: Ba [**Hospital Unit Name 723**] ([**Hospital Ward Name 121**] Complex) [**Location (un) **]
Campus: WEST     Best Parking: [**Street Address(1) 592**] Garage

Department: HMFP
When: THURSDAY [**2128-9-9**] at 2:10 PM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D. [**Telephone/Fax (1) 1387**]
Building: Ra [**Hospital Unit Name 1825**] ([**Hospital Ward Name 1826**]/[**Hospital Ward Name 1827**] Complex) [**Location (un) 551**]
Campus: EAST     Best Parking: Main Garage

Department: [**State **]When: MONDAY [**2128-9-27**] at 9:00 AM
With: [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 8428**], MD [**Telephone/Fax (1) 2205**]
Building: [**State **] ([**Location (un) **], MA) [**Location (un) **]
Campus: OFF CAMPUS     Best Parking: On Street Parking


                             [**First Name11 (Name Pattern1) **] [**Last Name (NamePattern4) 810**] MD, [**MD Number(3) 811**]
{"Other specified septicemias,Acute kidney failure, unspecified,Septic shock,Acute osteomyelitis, ankle and foot,Atrial flutter,Cellulitis and abscess of foot, except toes,Ulcer of calf,Mixed acid-base balance disorder,Vascular dementia, with delirium,Severe sepsis,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Cellulitis and abscess of toe, unspecified,Long-term (current) use of insulin,Cerebral atherosclerosis,Unspecified intellectual disabilities,Asthma, unspecified type, unspecified,Barrett's esophagus,Anemia of other chronic disease,Abnormal coagulation profile,Conjunctivitis, unspecified,Rosacea,Personal history of traumatic fracture"}


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: diabetic foot ulcer, hypotension

PRESENT ILLNESS: 61yo M with h/o DM, dementia, MR admitted to podiatry with
diabetic right foot ulcer s/p I+D in OR on [**2128-7-21**] transferred
from PACU to MICU for hypotension. Per records and ED attending
patient was found down at [**Hospital3 **] this morning in feces
and urine. He was brought to the ED where he had a temp to 101,
sinus tach to 150s, WBC 18, and cellulitis on right foot with
purulent ulcer and streaking up leg to groin with track. Mental
status was "alittle out of it" but at baseline per family. Got
4L NS in the ED and APAP and HR down to 120s. XR foot didnt show
evidence of osteo but had track with pus through ulcer. Broad
spec abx were given (vanc/ctz/cipro/flagyl) and he was evaluated
by podiatry and vascular surgery who recommended sending him to
the OR for I+D.
.
In the OR the patient underwent I+D, received fent (75mg)/midaz
(3mg), esmolol and metoprolol for sinus tach in the 150s and neo
for hypotension (100s/50s) and 5L drained 10cc pus from right
foot, EBL 50mL, packed with saline wet-dry dressing change. Per
anesthesia he's had tachycardia treated with esmolol and
hypotensive (100s/50s). superficial culture taken in ED and deep
cultures taken in OR as well. Will likely need debridement and
head of Metatarsal removed over the next few days by podiatry.
.
On the floor, patient is sleeping but arousable. Denies pain.
Denies chest pain and denies palpitations.

MEDICAL HISTORY: DM2
Vascular dementia
Asthma
Hypertension
Barretts esophagus
.
PAST SURGICAL HISTORY: (per OMR) Open reduction and internal
fixation
fracture both bones of the forearm [**6-/2117**], pheochromocytoma [**2110**]

MEDICATION ON ADMISSION: HCTZ 25', metformin 1000', lisinopril 40', remeron 45'qhs,
simvastatin 40', mertazipine 30'qhs, celexa 40', [**Last Name (LF) **], [**First Name3 (LF) 130**]

ALLERGIES: Penicillins / E-Mycin

PHYSICAL EXAM: Vitals: T:97.1 BP:91/40 P:140 R:25 O2:97 on 5L NC
General: somnolent but arousable, answers questions
appropriately but falls asleep mid-interview
HEENT: Sclera anicteric, very dry MM, oropharynx clear
Neck: supple, JVP not elevated, no LAD
Lungs: Upper airway snoring sounds but otherwise Clear to
auscultation bilaterally, no wheezes, rales, ronchi anteriorly
CV: tachycardic but regular
Abdomen: Obese, soft, non-tender, non-distended, bowel sounds
present, no rebound tenderness or guarding
GU: foley
Ext: warm, well perfused, no edema, bandage on right foot with
marker line on leg and inside marker line no erythema

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: (per OMR)
Smoking: Nonsmoker. ETOH: Social drinking.
Physical Exercise: Patient has been moderately physically
active. 

### Response:
{"Other specified septicemias,Acute kidney failure, unspecified,Septic shock,Acute osteomyelitis, ankle and foot,Atrial flutter,Cellulitis and abscess of foot, except toes,Ulcer of calf,Mixed acid-base balance disorder,Vascular dementia, with delirium,Severe sepsis,Diabetes with other specified manifestations, type II or unspecified type, not stated as uncontrolled,Cellulitis and abscess of toe, unspecified,Long-term (current) use of insulin,Cerebral atherosclerosis,Unspecified intellectual disabilities,Asthma, unspecified type, unspecified,Barrett's esophagus,Anemia of other chronic disease,Abnormal coagulation profile,Conjunctivitis, unspecified,Rosacea,Personal history of traumatic fracture"}
