CHIEF COMPLAINT: DKA

PRESENT ILLNESS: Pt was transferred from [**Hospital 16843**] Hospital, where she presented
after not having taken her insulin since Friday, 4 days PTA. Pt
ran out and did not refill her presciption. States that she lost
her insurance. Reports having felt malaise, polyuria, and
polydipsia, as well as "fruity breath." Denies blurry vision.
States that these are typical symptoms of hyperglycemia. Left
work early and went to [**Location (un) 16843**]. States that she was
recovering from a URI; no abdominal pain, no dysuria. Mild cough
possibly productive of sputum. + pleuritic chest pain today. No
SOB.
.
Pt diagnosed with DM 1 at 13y/o, presented in DKA. Has had one
other episode, at 18y/o. Pt states that she does not check her
glucose regularly, usually runs in the high 200s when she does
check it. She was last seen by an endocrinologist in [**3-27**] at [**Hospital **] [**Hospital1 1559**], in the pediatric unit. Had an appt with [**Last Name (un) **]
[**6-27**], but did not keep it and was unable to make another appt
before she lost her insurance. Has not had an eye exam in a few
years. Pt not clear about her insulin regimen, says that she
takes it "whenever," but is on 56 units lantus and a humalog
sliding scale.
.
In ED, glc 274 and 422. Bicarb was 6, VBG was 6.94/26/32.
Lactate 1.7. Pt was given 2L NS at OSH, here was given 3L IVF,
now with D5NS with KCl 40mEq/L. Placed on insulin gtt - arrived
to ED with 2U/hr, increased to 6U/hr. Initial VS were 120/70,
100s, 32, 100% RA.

MEDICAL HISTORY: diabetes mellitus type 1 - diagnosed at 13y/o, not followed by
endocrinologist currently

MEDICATION ON ADMISSION: Insulin: Glargine 56U qD
Sliding scale regular insulin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.1 133/59 124 23 100% RA
Gen: appears tired, thin, pale
HEENT: EOMI, PERRL
Neck: JVP flat
CV: RRR, nl S1/S2, no m/r/g
Pulm: CTAB
Abd: soft, NT/ND, +BS, no masses
Ext: no edema
Neuro: nonfocal

FAMILY HISTORY: no DM1; DM2 in MGM and MGF; no MI or CVA

SOCIAL HISTORY: Lives alone, has a cat. Denies tobacco (past or present). Seldom
EtOH, no IVDU. Provides medical rides for pts with Mass Health.
Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Anemia, unspecified
DMI keto nt st uncntrld,Anemia NOS
Admission Date:  [**2118-3-9**]              Discharge Date:   [**2118-3-11**]

Date of Birth:  [**2094-7-19**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 613**]
Chief Complaint:
DKA

Major Surgical or Invasive Procedure:
None

History of Present Illness:
Pt was transferred from [**Hospital 16843**] Hospital, where she presented
after not having taken her insulin since Friday, 4 days PTA. Pt
ran out and did not refill her presciption. States that she lost
her insurance. Reports having felt malaise, polyuria, and
polydipsia, as well as "fruity breath." Denies blurry vision.
States that these are typical symptoms of hyperglycemia. Left
work early and went to [**Location (un) 16843**]. States that she was
recovering from a URI; no abdominal pain, no dysuria. Mild cough
possibly productive of sputum. + pleuritic chest pain today. No
SOB.
.
Pt diagnosed with DM 1 at 13y/o, presented in DKA. Has had one
other episode, at 18y/o. Pt states that she does not check her
glucose regularly, usually runs in the high 200s when she does
check it. She was last seen by an endocrinologist in [**3-27**] at [**Hospital **] [**Hospital1 1559**], in the pediatric unit. Had an appt with [**Last Name (un) **]
[**6-27**], but did not keep it and was unable to make another appt
before she lost her insurance. Has not had an eye exam in a few
years. Pt not clear about her insulin regimen, says that she
takes it "whenever," but is on 56 units lantus and a humalog
sliding scale.
.
In ED, glc 274 and 422. Bicarb was 6, VBG was 6.94/26/32.
Lactate 1.7. Pt was given 2L NS at OSH, here was given 3L IVF,
now with D5NS with KCl 40mEq/L. Placed on insulin gtt - arrived
to ED with 2U/hr, increased to 6U/hr. Initial VS were 120/70,
100s, 32, 100% RA.


Past Medical History:
diabetes mellitus type 1 - diagnosed at 13y/o, not followed by
endocrinologist currently


Social History:
Lives alone, has a cat. Denies tobacco (past or present). Seldom
EtOH, no IVDU. Provides medical rides for pts with Mass Health.

Family History:
no DM1; DM2 in MGM and MGF; no MI or CVA

Physical Exam:
VS: 98.1 133/59 124 23 100% RA
Gen: appears tired, thin, pale
HEENT: EOMI, PERRL
Neck: JVP flat
CV: RRR, nl S1/S2, no m/r/g
Pulm: CTAB
Abd: soft, NT/ND, +BS, no masses
Ext: no edema
Neuro: nonfocal


Pertinent Results:
[**2118-3-9**] 01:00AM BLOOD WBC-26.4* RBC-4.66 Hgb-15.1 Hct-41.6
MCV-89 MCH-32.4* MCHC-36.2* RDW-12.8 Plt Ct-488*
[**2118-3-9**] 01:00AM BLOOD Neuts-65 Bands-0 Lymphs-11* Monos-7 Eos-1
Baso-0 Atyps-6* Metas-7* Myelos-3*
[**2118-3-10**] 07:19AM BLOOD Neuts-58.0 Lymphs-33.7 Monos-4.5 Eos-3.4
Baso-0.5
[**2118-3-10**] 07:19AM BLOOD WBC-7.9 RBC-3.63* Hgb-11.6* Hct-31.0*
MCV-85 MCH-32.1* MCHC-37.6* RDW-13.1 Plt Ct-296
[**2118-3-10**] 04:10AM BLOOD PT-11.9 PTT-32.8 INR(PT)-1.0
[**2118-3-9**] 01:00AM BLOOD Glucose-206* UreaN-9 Creat-0.9 Na-142
K-4.1 Cl-112* HCO3-<5*
[**2118-3-9**] 05:15AM BLOOD Glucose-167* UreaN-5* Creat-0.6 Na-139
K-3.3 Cl-119* HCO3-6* AnGap-17
[**2118-3-9**] 08:41AM BLOOD Glucose-90 UreaN-5* Creat-0.6 Na-140
K-3.2* Cl-116* HCO3-10* AnGap-17
[**2118-3-9**] 01:00PM BLOOD Glucose-261* UreaN-4* Creat-0.7 Na-137
K-3.4 Cl-115* HCO3-12* AnGap-13
[**2118-3-9**] 06:22PM BLOOD Glucose-164* UreaN-4* Creat-0.5 Na-137
K-3.4 Cl-112* HCO3-12* AnGap-16
[**2118-3-9**] 05:15AM BLOOD CK(CPK)-28
[**2118-3-9**] 05:15AM BLOOD CK-MB-2 cTropnT-<0.01
[**2118-3-9**] 01:00AM BLOOD Calcium-7.2* Phos-2.2* Mg-1.3*
[**2118-3-9**] 05:15AM BLOOD Calcium-6.5* Phos-0.7* Mg-1.0*
Cholest-178
[**2118-3-9**] 08:41AM BLOOD Calcium-7.4* Phos-0.9* Mg-2.2
[**2118-3-9**] 01:00PM BLOOD Calcium-6.4* Phos-2.2* Mg-1.7
[**2118-3-10**] 03:48PM BLOOD Albumin-3.3* Calcium-7.7* Phos-2.0*
Mg-2.2 Iron-141
[**2118-3-10**] 03:48PM BLOOD calTIBC-209* VitB12-1344* Folate-14.5
Ferritn-153* TRF-161*
[**2118-3-9**] 05:15AM BLOOD %HbA1c-14.3* [Hgb]-DONE [A1c]-DONE
[**2118-3-9**] 05:15AM BLOOD Triglyc-251* HDL-38 CHOL/HD-4.7
LDLcalc-90
[**2118-3-10**] 03:48PM BLOOD TSH-9.2*
[**2118-3-9**] 01:28AM BLOOD Type-[**Last Name (un) **] pO2-32* pCO2-26* pH-6.94*
calHCO3-6* Base XS--29 Comment-GREEN TOP
[**2118-3-9**] 05:24AM BLOOD Type-ART pO2-168* pCO2-18* pH-7.13*
calHCO3-6* Base XS--21
[**2118-3-9**] 03:57PM BLOOD Type-ART Temp-37.0 pO2-87 pCO2-25*
pH-7.29* calHCO3-13* Base XS--12 Intubat-NOT INTUBA
[**2118-3-9**] 08:55PM BLOOD Type-ART Temp-37.0 pO2-165* pCO2-22*
pH-7.33* calHCO3-12* Base XS--12 Intubat-NOT INTUBA
[**2118-3-10**] 08:03AM BLOOD Type-ART pO2-97 pCO2-28* pH-7.38
calHCO3-17* Base XS--6
[**2118-3-9**] 01:28AM BLOOD Glucose-204* Lactate-1.7 Na-143 K-4.3
Cl-112 calHCO3-6*
[**2118-3-9**] 12:35AM URINE RBC-0 WBC-0 Bacteri-NONE Yeast-NONE
Epi-0-2
[**2118-3-9**] 12:35AM URINE Blood-TR Nitrite-NEG Protein-TR
Glucose-1000 Ketone-150 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2118-3-9**] 12:35AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.014
[**2118-3-10**] 07:19AM URINE RBC-22* WBC-54* Bacteri-OCC Yeast-NONE
Epi-1
[**2118-3-10**] 07:19AM URINE Blood-MOD Nitrite-NEG Protein-NEG
Glucose-1000 Ketone-50 Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-MOD
[**2118-3-10**] 07:19AM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.020
[**3-9**] Urine Culture: No Growth
[**3-10**] Urine Culture: No Growth
[**3-9**] Blood Cultures: No Growth

Brief Hospital Course:
Ms. [**Known lastname **] was admitted to the [**Hospital Unit Name 153**] in DKA, most likely [**2-24**]
nonadherence to her insulin regimen. She had no evidence of
infiltrate on CXR. Initial UA was negative for urinary tract
infection. She did complain on pleuritic CP, but had one set of
negative cardiac enzymes, and had no changes on her ECG, and the
pain disappeared soon after admission.

On arrival to the [**Hospital Unit Name 153**], Ms. [**Known lastname **] anion gap was mostly closed
(14), with glucose 167. Her ABG had improved to 7.13/18/168. She
was continued on D5NS with KCl. Electrolytes were aggressively
repleted, as she was hypokalemic, hypophosphatemic, and
hypomagnesemic by the time of arrival to the [**Hospital Unit Name 153**]. Fingersticks
were continued q1h. She did require additional glucose
administration (D10NS and 1 amp D50) due to falling BS while on
insulin gtt. Approximately 12h after arrival at the ED, her ABG
had improved to 7.29/25/87, and her AG remained closed. She was
given her home dose of glargine 20U and placed on a sliding
scale insulin regimen. She was taking good PO, and two hours
later, her insulin gtt was d/c'ed. She was called out of the ICU
several hours prior to discharge from the hospital.

While in-house, Ms. [**Known lastname **] was followed closely by [**Last Name (un) **], who
provided recommendations regarding the appropriate timing and
dosages of starting subcutaneous insulin. They also assisted in
ensuring a steady supply of insulin until her insurance resumed
within the next few weeks. Her A1C was found to be very
elevated, at 14.3%. She was set up with follow up at the [**Last Name (un) **]
satellite location near her home. Social work was also consulted
regarding coping with diabetes and problems adhering to her
regimen. She received her Pneumovax vaccine before discharge.

.


Medications on Admission:
Insulin: Glargine 56U qD
Sliding scale regular insulin

Discharge Medications:
1. Insulin Glargine 100 unit/mL Solution Sig: Twenty (20) units
Subcutaneous QAM.
Disp:*10 ml* Refills:*2*
2. Insulin Lispro (Human) 100 unit/mL Solution Sig: per sliding
scale  Subcutaneous three times a day: please use 1 u for 10
carbs as directed by [**Hospital **] Clinic MDs.
Disp:*10 ml* Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary:
DKA
IDDM


Discharge Condition:
good - BG <200 and anion gap closed


Discharge Instructions:
Call Dr. [**First Name (STitle) 22917**] or [**Hospital **] clinic at the number below if you have
dizziness, sweating, palpitations, nausea, vomiting, fainting,
fever, chills or shortness of breath.  Check your blood sugar if
you feel these symptoms and report the [**Location (un) 1131**] to your doctor.
.
Please make sure to check your blood sugars regularly.  It is
very important to prevent future admissions to the hospital.
.
Please keep the follow up appointment with the [**Hospital **] Clinic in
[**Hospital3 **]. They will call you with an appointment time -
please call them at [**Telephone/Fax (1) 27738**] if you do not hear from them by
next week.
.
Also, call Dr. [**First Name (STitle) 22917**] for a follow-up appointment next week.

Followup Instructions:
Please keep the follow up appointment with the [**Hospital **] Clinic in
[**Hospital3 **]. They will call you with an appointment time -
please call them at [**Telephone/Fax (1) 27738**] if you do not hear from them by
next week.


                             [**First Name5 (NamePattern1) **] [**Last Name (NamePattern1) **] MD [**MD Number(2) 617**]
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Anemia, unspecified'}


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: Pt was transferred from [**Hospital 16843**] Hospital, where she presented
after not having taken her insulin since Friday, 4 days PTA. Pt
ran out and did not refill her presciption. States that she lost
her insurance. Reports having felt malaise, polyuria, and
polydipsia, as well as "fruity breath." Denies blurry vision.
States that these are typical symptoms of hyperglycemia. Left
work early and went to [**Location (un) 16843**]. States that she was
recovering from a URI; no abdominal pain, no dysuria. Mild cough
possibly productive of sputum. + pleuritic chest pain today. No
SOB.
.
Pt diagnosed with DM 1 at 13y/o, presented in DKA. Has had one
other episode, at 18y/o. Pt states that she does not check her
glucose regularly, usually runs in the high 200s when she does
check it. She was last seen by an endocrinologist in [**3-27**] at [**Hospital **] [**Hospital1 1559**], in the pediatric unit. Had an appt with [**Last Name (un) **]
[**6-27**], but did not keep it and was unable to make another appt
before she lost her insurance. Has not had an eye exam in a few
years. Pt not clear about her insulin regimen, says that she
takes it "whenever," but is on 56 units lantus and a humalog
sliding scale.
.
In ED, glc 274 and 422. Bicarb was 6, VBG was 6.94/26/32.
Lactate 1.7. Pt was given 2L NS at OSH, here was given 3L IVF,
now with D5NS with KCl 40mEq/L. Placed on insulin gtt - arrived
to ED with 2U/hr, increased to 6U/hr. Initial VS were 120/70,
100s, 32, 100% RA.

MEDICAL HISTORY: diabetes mellitus type 1 - diagnosed at 13y/o, not followed by
endocrinologist currently

MEDICATION ON ADMISSION: Insulin: Glargine 56U qD
Sliding scale regular insulin

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: VS: 98.1 133/59 124 23 100% RA
Gen: appears tired, thin, pale
HEENT: EOMI, PERRL
Neck: JVP flat
CV: RRR, nl S1/S2, no m/r/g
Pulm: CTAB
Abd: soft, NT/ND, +BS, no masses
Ext: no edema
Neuro: nonfocal

FAMILY HISTORY: no DM1; DM2 in MGM and MGF; no MI or CVA

SOCIAL HISTORY: Lives alone, has a cat. Denies tobacco (past or present). Seldom
EtOH, no IVDU. Provides medical rides for pts with Mass Health. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Anemia, unspecified'}
