CHIEF COMPLAINT: Transfer from [**Hospital3 **] with DKA

PRESENT ILLNESS: 23 yo female with DM1 transferred from [**Hospital3 **] with DKA, on
insulin gtt @ 5 u/hour. Patient reports worsened glycemic
control x3 days, then awoke with FS>assay this am, down to 357
after Humalog 15 units. Reports dizziness, weakness, n/v this
a.m. Of note, exposed to child at home with recent URI and she
developed same Sx. AG of 26 at OSH, glucose 442. She received 10
units insulin and was started insulin gtt prior to transfer.
.
In the ED, AFVSS. Her gap rapidly closed and insulin gtt was
discontinued after receiving lantus 44 units. Urine Hcg neg.
Admitted for floor.
.
Review of Systems:  Negative except as above.

MEDICAL HISTORY: PNC:
(1)Dating: EDC [**2123-3-4**] by LMP and c/w 8.6 wk US
(2)Labs: O-,Ab-,RI,RPRnr,HbsAg-, nl FFS
(3)Class C DM:
   -diagnosed at age 5
   -mild proliferative retinopathy
   -s/p 2 episodes of DKA
   -last HbA1c 7.5 ([**10-16**])
(4)US: nl FFS, post placenta,, EFW 917g(52%) on [**12-25**]
(5)s/p open appendectomy [**2122-12-12**] (at 24 wks) for ruptured
appendicitis complicated by post-op ileus, pulmonary edema,
difficulty with pain management, and preterm contractions
(admitted [**Date range (3) 42340**])
(6)multiple triage visits for preterm contractions
(7)Rh- (s/p rhogam at 23+6wks at time of amnio, also at 28wks)

MEDICATION ON ADMISSION: insulin glargine
- lisinopril 2.5mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission
T 97.8 HR 77 BP 98/62 RR 16 SaO2 99% RA
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD

FAMILY HISTORY: significant for Type II DM

SOCIAL HISTORY: denies tobacco, alcohol, illicit drug use
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Esophageal reflux
DMI ketoacd uncontrold,Dehydration,Diabetic retinopathy NOS,Nephritis NOS in oth dis,Esophageal reflux
Admission Date:  [**2124-6-19**]              Discharge Date:   [**2124-6-21**]

Date of Birth:  [**2101-4-17**]             Sex:   F

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3705**]
Chief Complaint:
Transfer from [**Hospital3 **] with DKA

Major Surgical or Invasive Procedure:
none.


History of Present Illness:
23 yo female with DM1 transferred from [**Hospital3 **] with DKA, on
insulin gtt @ 5 u/hour. Patient reports worsened glycemic
control x3 days, then awoke with FS>assay this am, down to 357
after Humalog 15 units. Reports dizziness, weakness, n/v this
a.m. Of note, exposed to child at home with recent URI and she
developed same Sx. AG of 26 at OSH, glucose 442. She received 10
units insulin and was started insulin gtt prior to transfer.
.
In the ED, AFVSS. Her gap rapidly closed and insulin gtt was
discontinued after receiving lantus 44 units. Urine Hcg neg.
Admitted for floor.
.
Review of Systems:  Negative except as above.


Past Medical History:
PNC:
(1)Dating: EDC [**2123-3-4**] by LMP and c/w 8.6 wk US
(2)Labs: O-,Ab-,RI,RPRnr,HbsAg-, nl FFS
(3)Class C DM:
   -diagnosed at age 5
   -mild proliferative retinopathy
   -s/p 2 episodes of DKA
   -last HbA1c 7.5 ([**10-16**])
(4)US: nl FFS, post placenta,, EFW 917g(52%) on [**12-25**]
(5)s/p open appendectomy [**2122-12-12**] (at 24 wks) for ruptured
appendicitis complicated by post-op ileus, pulmonary edema,
difficulty with pain management, and preterm contractions
(admitted [**Date range (3) 42340**])
(6)multiple triage visits for preterm contractions
(7)Rh- (s/p rhogam at 23+6wks at time of amnio, also at 28wks)

PAST OBSTETRIC HISTORY
-SAB requiring D&C in [**7-/2121**]: complicated by pneumonia/DKA

PAST GYNECOLOGIC HISTORY
-no abnormal paps
-no STDs

PAST MEDICAL HISTORY
-Type I Diabetes Mellitis (Class C)

PAST SURGICAL HISTORY
-D&C
-open appendectomy [**2122-12-12**] (Dr [**Last Name (STitle) **]

Social History:
denies tobacco, alcohol, illicit drug use


Family History:
significant for Type II DM

Physical Exam:
On Admission
T 97.8 HR 77 BP 98/62 RR 16 SaO2 99% RA
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD

Cardiac: RRR, s1s2 normal, soft systolic murm, no r/g, no JVD
Pulmonary: CTAB
Abdomen: +BS, soft, nontender, nondistended, no HSM
Extremities: warm, 2+ DP pulses, no edema
Neuro: A&Ox3, speech clear and logical, CNII-XII intact, moves
all extremities
------------


Pertinent Results:
[**2124-6-19**] 08:45PM BLOOD WBC-10.3 RBC-4.53 Hgb-13.0 Hct-38.4#
MCV-85 MCH-28.7 MCHC-33.8 RDW-13.2 Plt Ct-295
[**2124-6-20**] 06:55AM BLOOD WBC-9.2 RBC-3.97* Hgb-11.5* Hct-33.6*
MCV-85 MCH-28.9 MCHC-34.1 RDW-13.6 Plt Ct-272
[**2124-6-19**] 08:45PM BLOOD Neuts-66.4 Lymphs-29.4 Monos-3.4 Eos-0.2
Baso-0.6
[**2124-6-19**] 08:45PM BLOOD Plt Ct-295
[**2124-6-20**] 06:55AM BLOOD Plt Ct-272
[**2124-6-19**] 08:45PM BLOOD Glucose-128* UreaN-15 Creat-0.9 Na-136
K-4.8 Cl-109* HCO3-12* AnGap-20
[**2124-6-19**] 11:04PM BLOOD Glucose-GREATER TH UreaN-8 Creat-0.7
Na-110* K-2.7* Cl-99 HCO3-7* AnGap-7*
[**2124-6-19**] 11:30PM BLOOD Glucose-200* UreaN-13 Creat-0.8 Na-135
K-4.4 Cl-112* HCO3-14* AnGap-13
[**2124-6-20**] 06:55AM BLOOD Glucose-164* UreaN-12 Creat-0.7 Na-136
K-3.8 Cl-112* HCO3-17* AnGap-11
[**2124-6-21**] 07:05AM BLOOD Glucose-62* UreaN-8 Creat-0.6 Na-142
K-3.5 Cl-111* HCO3-26 AnGap-9
[**2124-6-19**] 11:30PM BLOOD ALT-9 AST-13 LD(LDH)-93* AlkPhos-63
TotBili-0.3
[**2124-6-19**] 08:45PM BLOOD Calcium-8.6 Phos-3.0 Mg-1.9
[**2124-6-19**] 11:04PM BLOOD Calcium-4.1* Phos-1.5* Mg-0.9*
[**2124-6-20**] 06:55AM BLOOD Mg-2.2
[**2124-6-21**] 07:05AM BLOOD Calcium-8.4 Phos-2.2* Mg-1.5*
[**2124-6-19**] 09:22PM BLOOD Type-ART pO2-137* pCO2-25* pH-7.27*
calTCO2-12* Base XS--13
[**2124-6-19**] 08:48PM BLOOD Glucose-121* Na-138 K-4.6 Cl-112
[**2124-6-19**] 11:05PM BLOOD Glucose-GREATER TH
[**2124-6-19**] 08:48PM BLOOD Hgb-13.4 calcHCT-40
--------------

[**2124-6-19**] 08:45PM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.021
[**2124-6-19**] 08:45PM URINE Blood-LG Nitrite-NEG Protein-NEG
Glucose-1000 Ketone-150 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG
[**2124-6-19**] 08:45PM URINE RBC-0-2 WBC-0-2 Bacteri-OCC Yeast-NONE
Epi-0-2
--------------
CXR: IMPRESSION: No acute intrathoracic process.
ECG: Sinus rhythm. Compared to the previous tracing of [**2123-2-2**] T
wave in
lead III is now flat. QRS changes in leads V2-V4 could be
positional.
ECG: Sinus rhythm
Delayed R wave progression - may be in part positional/normal
variant
Since previous tracing of [**2124-6-19**], delayed R wave progression
now present
.
--------------


Brief Hospital Course:
Patient was admitted to the medicine service for management of
DKA.
.
# DKA secondly to DM type 1: Prior to arrival on the floor
patient's gap had closed.  She had been transitioned off her
insulin gtt and restarted on her home lantus regimen.  Patient
was monitored closely with q4-6 FSG's and had no recurrence of
her DKA.  She was restarted on her full home regimen when she
began taking PO's and continued to have good glucose control.
She was discharged home with plan for follow-up with her PCP for
further evaluation.
.
# Infectious Work-up: Unrevealing.  Blood/Urine/CXR negative.
No evidence f MI.  Impression was for viral syndrome
precipitating DKA.  Patient to follow-up with PCP/[**Last Name (un) **] on
discharge.

Medications on Admission:
 insulin glargine
- lisinopril 2.5mg daily


Discharge Medications:
1. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).
2. Acetaminophen 325 mg Tablet Sig: 1-2 Tablets PO Q6H (every 6
hours) as needed.
3. Aluminum-Magnesium Hydroxide 225-200 mg/5 mL Suspension Sig:
15-30 MLs PO QID (4 times a day) as needed for indigestion.
Disp:*360 ML(s)* Refills:*0*
4. Insulin Glargine 100 unit/mL Solution Sig: Forty Four (44)
units Subcutaneous once a day.
5. Humalog 100 unit/mL Cartridge Sig: Fifteen (15) units
Subcutaneous qMeals.
6. Humalog 100 unit/mL Cartridge Sig: as per sliding scale units
Subcutaneous qACHS: as directed by your primary doctor.


Discharge Disposition:
Home

Discharge Diagnosis:
Diabetic Ketoacidosis
Upper Respiratory Infection
Dehydration secondary to DKA


Discharge Condition:
Good, tolerating PO's


Discharge Instructions:
You were admitted to the hospital for evaluation of diabetic
ketoacidosis (DKA).  This is a condition that occurs with high
blood sugars in patients with diabetes.  Please monitor your
blood sugar closely upon leaving the hospital, and be sure to
take your insulin as directed.  This condition likely occurred
because of your recent viral infection.
.
Please call your doctor with any high blood sugars, if you are
unable to take food or fluids, or if you develop any severe
shortness of breath, chest pain or any other symptom concerning
to you.

Followup Instructions:
Please follow-up with Dr. [**Last Name (STitle) 42341**] [**Name (STitle) **] this [**Last Name (LF) 766**], [**6-26**] at
11:00AM.  Please call ([**Telephone/Fax (1) 42342**] with any questions or
concerns.
.
Please follow-up with your regular physician, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **] in the
next 2-3 weeks.  Please call for an appointment.
.
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Esophageal reflux'}


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: Transfer from [**Hospital3 **] with DKA

PRESENT ILLNESS: 23 yo female with DM1 transferred from [**Hospital3 **] with DKA, on
insulin gtt @ 5 u/hour. Patient reports worsened glycemic
control x3 days, then awoke with FS>assay this am, down to 357
after Humalog 15 units. Reports dizziness, weakness, n/v this
a.m. Of note, exposed to child at home with recent URI and she
developed same Sx. AG of 26 at OSH, glucose 442. She received 10
units insulin and was started insulin gtt prior to transfer.
.
In the ED, AFVSS. Her gap rapidly closed and insulin gtt was
discontinued after receiving lantus 44 units. Urine Hcg neg.
Admitted for floor.
.
Review of Systems:  Negative except as above.

MEDICAL HISTORY: PNC:
(1)Dating: EDC [**2123-3-4**] by LMP and c/w 8.6 wk US
(2)Labs: O-,Ab-,RI,RPRnr,HbsAg-, nl FFS
(3)Class C DM:
   -diagnosed at age 5
   -mild proliferative retinopathy
   -s/p 2 episodes of DKA
   -last HbA1c 7.5 ([**10-16**])
(4)US: nl FFS, post placenta,, EFW 917g(52%) on [**12-25**]
(5)s/p open appendectomy [**2122-12-12**] (at 24 wks) for ruptured
appendicitis complicated by post-op ileus, pulmonary edema,
difficulty with pain management, and preterm contractions
(admitted [**Date range (3) 42340**])
(6)multiple triage visits for preterm contractions
(7)Rh- (s/p rhogam at 23+6wks at time of amnio, also at 28wks)

MEDICATION ON ADMISSION: insulin glargine
- lisinopril 2.5mg daily

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: On Admission
T 97.8 HR 77 BP 98/62 RR 16 SaO2 99% RA
General: WDWN, NAD, breathing comfortably on RA
HEENT: PERRL, EOMi, anicteric sclera, conjunctivae pink
Neck: supple, trachea midline, no thyromegaly or masses, no LAD

FAMILY HISTORY: significant for Type II DM

SOCIAL HISTORY: denies tobacco, alcohol, illicit drug use 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Dehydration,Background diabetic retinopathy,Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere,Esophageal reflux'}
