CHIEF COMPLAINT: Lethargy.

PRESENT ILLNESS: This is a 64 year-old Vietnamese
male with a history of anoxic brain injury from a V
fibrillation arrest that occurred five years prior and
diabetes mellitus brought by ambulance after family noticed
increases in lethargy, decrease in po intake and increasing
generalized weakness over the past one week.  The patient was
also noted to have some urinary incontinence times two to
three days.  The family denied nausea, vomiting, cough,
diarrhea, new rash, fevers or chills.  The patient is very
difficulty to communicate with at baseline.

MEDICAL HISTORY: 1.  Anoxic brain injury five years ago
secondary to a V fibrillation arrest secondary to myocardial
infarction.  2.  Diabetes mellitus.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient with his family and is cared for
by his wife and sons.
Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled,Acute kidney failure with lesion of tubular necrosis,Hyperosmolality and/or hypernatremia,Other disorders of muscle, ligament, and fascia
DMII hprsm nt st uncntrl,Ac kidny fail, tubr necr,Hyperosmolality,Muscle/ligament dis NEC
Admission Date:  [**2154-11-15**]       Discharge Date:  [**2154-11-22**]

Date of Birth:   [**2090-3-4**]       Sex:  M

Service:  [**Hospital1 **]/MEDICAL INTENSIVE CARE UNIT

CHIEF COMPLAINT:  Lethargy.

HISTORY OF PRESENT ILLNESS:  This is a 64 year-old Vietnamese
male with a history of anoxic brain injury from a V
fibrillation arrest that occurred five years prior and
diabetes mellitus brought by ambulance after family noticed
increases in lethargy, decrease in po intake and increasing
generalized weakness over the past one week.  The patient was
also noted to have some urinary incontinence times two to
three days.  The family denied nausea, vomiting, cough,
diarrhea, new rash, fevers or chills.  The patient is very
difficulty to communicate with at baseline.

PAST MEDICAL HISTORY:  1.  Anoxic brain injury five years ago
secondary to a V fibrillation arrest secondary to myocardial
infarction.  2.  Diabetes mellitus.

MEDICATIONS:  Klonopin 1 mg po b.i.d., Avandia the dose is
unknown apparent the patient's primary care physician [**Last Name (NamePattern4) **].
[**Last Name (STitle) 10145**] prescribed Avandia some time ago and it was
discontinued by the family for an unknown reason.

ALLERGIES:  No known drug allergies.

SOCIAL HISTORY:  The patient with his family and is cared for
by his wife and sons.

REVIEW OF SYSTEMS:  Please see history of present illness.

EMERGENCY DEPARTMENT COURSE:  In the Emergency Department the
patient's finger stick blood glucose was 900.  It was
measured at 624 in the serum.  The patient's sodium was 173
corrected for hyperglycemia his sodium was 181.  The patient
was minimally responsive with a temperature of 101.2.  Workup
for the source of infection and mental status changes
resulted in the negative head CT, negative lumbar puncture,
negative urinalysis, negative chest x-ray.  The patient was
given Ceftriaxone and 8 units of regular insulin in the
Emergency Room as well as hydrated.

PHYSICAL EXAMINATION:  Temperature 101.8.  Blood pressure
121/62.  Respirations 24.  Pulse ox 98% on room air.
General, the patient is somnolent, but opens eyes to sternal
rub.  HEENT mucous membranes dry.  No icterus.  No pallor.
Supple neck.  No bruits.  Cardiovascular regular rate and
rhythm.  No murmurs, rubs or gallops.  No jugulovenous
distention.  No peripheral edema.  Pulmonary lungs clear to
auscultation.  Abdomen soft, nontender, nondistended.  No
palpable masses.  Extremities warm, dry, 2+ dorsalis pedis
pulses, symmetric.

LABORATORIES ON ADMISSION:  Sodium 172 corrected sodium 181,
potassium 3.4, chloride 130, bicarb 29, BUN 38, creatinine
2.2.  The patient's baseline creatinine is apparently 1.0.
Serum blood glucose 624.  Blood gas revealed pH of 7.34, PCO2
56 and PO2 of 85.  Creatine kinase was 18, 100, 69, small
amount of acetone noted in the serum.  Electrocardiogram
demonstrated normal sinus rhythm at 105 beats per minute,
normal axis.

HOSPITAL COURSE:  1.  Diabetes mellitus:  The patient
presented in nonketonic hyperosmolar coma, which resolved
with hydration with one quarter normal saline, because of the
hypernatremia and insulin drip.  The patient was subsequently
switched to a regular insulin sliding scale, which was
subsequently advanced to Avandia 4 mg po q day and NPH 20
units q.a.m. with regular insulin sliding scale coverage.
Prior to being switched to the NPH and Avandia the patient
had several blood sugars in the 400s.

2.  Hypernatremia:  As stated above the patient's corrected
sodium on presentation was 181.  His fluid deficit was found
to be 11 liters.  His sodium was corrected at a rate of
approximately 1 milliequivalent an hour with hydration with
one quarter normal saline.  The patient's sodium resolved to
normal levels within three days.  After stopping intravenous
fluid after transfer to the floor the patient was found to
have a slowly rising sodium again.  Renal Service who was
following the patient expressed concerned that this may be
due to diabetes insipidus as opposed to polyuria secondary to
ATN.  Please see hospital course for acute renal failure
below.  At the request of the Renal Service the patient's
intravenous fluids were stopped and urine and serum
osmolalities and sodiums were drawn at 0, 2 and 4 hours.  The
results of this test appeared that the patient was able to
concentrate his urine and thus his polyuria and slowly
elevating hypernatremia with no supplemental fluids was
attributed to resolving polyuria from resolving ATN.

3.  Acute renal failure:  The patient's creatinine at the
time of admission was 1.8.  His baseline is reportedly 1.0
per his primary care physician.  [**Name10 (NameIs) **] creatinine subsequently
peaked in the MICU to 2.6 and resolved down to 20 after
transfer to the floor.  Muddy brown casts were found on
examination of the urine and fractional excretion of sodium
was 6% both consistent with ATN.  The patient's polyuria
gradually decreased after transfer to the floor with his
urine output down to roughly 2 liters on the day of
discharge.  The acute renal failure was attributed to both a
prerenal state secondary to hyperglycemia and subsequent
diuresis and also to rhabdomyolysis.  The patient's CK was
about [**2152**] on presentation, peaked at 11,000 and resolved
after transfer to the floor.  It is unclear if his
rhabdomyolysis is as a result of his metabolic disarray or if
the patient's seized from having such an elevated sodium.

4.  Fevers:  The fever workup initiated in the Emergency Room
(please see Emergency Room course above) was done in addition
to pan culture.  All results were negative and the patient
eventually quit spiking a fever and remained afebrile
throughout the rest of his hospitalization.  Thought was
given to his fevers being a result of his metabolic disorder
in combination with his anoxic brain injury.

5.  Neurological status:  After treatment with hydration and
insulin drip for hypernatremia, hyperglycemia the patient's
mental status improved to baseline per his family.

DISCHARGE STATUS:  The patient is stable for discharge to
either an extended care facility or to home with visiting
nurse.  After discussion with the family it was decided that
the patient would not be appropriately cared for at home and
that he would be placed in an extended care facility.  The
patient is currently on Avandia 4 mg po q day and 20 of NPH
insulin q.a.m. with a regular insulin sliding scale and has
achieved reasonable glucose control, but this will likely
need better titration as an outpatient and can be guided by
his primary care physician [**Last Name (NamePattern4) **]. [**Last Name (STitle) 10145**].  It is also
recommended that the patient have his BUN, creatinine and
sodium checked at least every other day for the first week of
his stay at this facility.

DISCHARGE MEDICATIONS:  1.  Klonopin 1 mg po b.i.d.  2.
Insulin NPH 20 units subQ q.a.m.  3.  Avandia 4 mg po q day.
4.  Regular insulin sliding scale.  5.  Metoprolol 50 mg po
b.i.d.  6.  Protonix 40 mg po q day.  7.  Tylenol 325 to 650
mg po q 4 to 6 hours prn.

DISCHARGE DIAGNOSES:
1.  Nonketotic hyperosmolar coma.
2.  Hypernatremia.
3.  Acute renal failure secondary to prerenal causes and
rhabdomyolysis.
4.  Acute tubular necrosis.
5.  Rhabdomyolysis.
6.  Anoxic brain injury secondary to V fibrillation arrest
secondary to myocardial infarction five years ago.
7.  Anxiety.
8.  Diabetes mellitus.

The patient may also benefit from long term physical therapy.






                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 10146**]

Dictated By:[**Last Name (NamePattern1) 43593**]
MEDQUIST36

D:  [**2154-11-22**]  13:16
T:  [**2154-11-22**]  13:36
JOB#:  [**Job Number 45085**]


Admission Date:  [**2154-11-15**]       Discharge Date:  [**2154-11-20**]

Date of Birth:   [**2090-3-4**]       Sex:  M

Service:

ADDENDUM:  Please add date of admission [**2154-11-15**] and date of
discharge [**2154-11-20**] to the previously dictated discharge
summary.




                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 10146**]

Dictated By:[**Last Name (NamePattern1) 43593**]
MEDQUIST36

D:  [**2154-11-22**]  13:17
T:  [**2154-11-22**]  13:34
JOB#:
{'Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled,Acute kidney failure with lesion of tubular necrosis,Hyperosmolality and/or hypernatremia,Other disorders of muscle, ligament, and fascia'}


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: Lethargy.

PRESENT ILLNESS: This is a 64 year-old Vietnamese
male with a history of anoxic brain injury from a V
fibrillation arrest that occurred five years prior and
diabetes mellitus brought by ambulance after family noticed
increases in lethargy, decrease in po intake and increasing
generalized weakness over the past one week.  The patient was
also noted to have some urinary incontinence times two to
three days.  The family denied nausea, vomiting, cough,
diarrhea, new rash, fevers or chills.  The patient is very
difficulty to communicate with at baseline.

MEDICAL HISTORY: 1.  Anoxic brain injury five years ago
secondary to a V fibrillation arrest secondary to myocardial
infarction.  2.  Diabetes mellitus.

MEDICATION ON ADMISSION: 

ALLERGIES: No known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: The patient with his family and is cared for
by his wife and sons. 

### Response:
{'Diabetes with hyperosmolarity, type II or unspecified type, not stated as uncontrolled,Acute kidney failure with lesion of tubular necrosis,Hyperosmolality and/or hypernatremia,Other disorders of muscle, ligament, and fascia'}
