CHIEF COMPLAINT: Diabetic Ketoacidosis

PRESENT ILLNESS: The patient is a 42-year-old man with history of T1DM, HCV,
polysubstance abuse (alcohol, cocaine, heroin), and bipolar
disorder who initially presented with nausea, lethargy, and
increased thirst/polyuria x 3 days.  He was apparently kicked
out of his sober house and did not have access to his
medications.  He reports then going on an EtOH and drug binge,
whereby he consumed "a couple bottles" of vodka and a "gram or
two" of cocaine each day.  He also takes suboxone for prior
heroin abuse, but did not take it during this time given
inability to access home medications. On day 3 of this binge he
presented to the [**Hospital1 18**] ED with glucose levels >700s.
.
In the ED, initial VS afebrile HR 91, BP 112/72  RR 14  SaO2
100% RA.  He was a/ox2 to person and place but not date.  Labs
notable for an anion gap of 23, as well as hyperkalemia to 6.4
with peaked T-waves on EKG, normal QRS.  He received calcium
gluconate, IVF, kayexalate, albuterol, an bicarbonate with
improvement of K to 4.2.  He was transferred to the MICU where
he was placed on an insulin gtt with improvement of his serum
glucose and lowering of anion gap to 5.  He was initially
lethargic in the MICU but gradually became more interactive; he
was able to tolerate po intake without nausea/vomiting and was
transitioned to subcutaneous insulin.
.
Upon transfer to the floor, the patient continues to feel "worn
out" but denies headache, n/v/d, abdominal pain, fevers, chills,
vision changes, chest pain, dyspnea, polyuria.
.

MEDICAL HISTORY: # Type 1 diabetes (followed at [**Last Name (un) **])
# Chronic Hepatitis C (referred to Liver Center)
# Polysubstance abuse
-- heroin overdose in [**2177**], [**2181**], has been on suboxone provided
by [**Hospital 1680**] Hospital, Dr. [**Last Name (STitle) 93335**]; last used a few months ago
-- alcohol abuse (drinks vodka), does not report history of DTs
-- active cocaine use (last use prior to this admission)
-- percocet/painkillers (last use a few months ago)
# Bipolar disorder
-- History of suicide attempts (cutting, drug OD)
# Cardiac cath in [**2189**] with non-obstructive coronary disease
-- (thought to be cocaine-induced)
# Depression
# Dyslipidemia
# s/p appendectomy

MEDICATION ON ADMISSION: buprenorphine-naloxone 8 mg-2 mg 1 tablet sublingual TID
buproprion hcl 100 mg tablet po qhs
insulin glargine - 100 unit/mL - 26 units qHS
insulin lispro - 100 unit/mL - sliding scale
quetiapine 100 mg po qhs
simvastatin 20 mg po qPM
aspirin 81 mg daily
multivitamin daily

ALLERGIES: Penicillins

PHYSICAL EXAM: PHYSICAL EXAM AT ADMISSION:
VS - Temp 98.2 F, BP 108/60, HR 67, R 18, O2-sat 97% RA
GENERAL - Lethargic man in NAD, appropriate, eyes closed while
talking, falls asleep mid-sentence
HEENT - NC/AT, PERRLA 3-->2 mm bilaterally, EOMI, sclerae
anicteric, MM dry, OP clear
NECK - supple, no thyromegaly, no carotid bruits
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - no rashes or lesions, two tattoos on each upper arm
LYMPH - no cervical LAD
NEURO - A&Ox3, CNs II-XII grossly intact, muscle strength 5/5
throughout, sensation grossly intact throughout

FAMILY HISTORY: Both parents were alcoholics.
Brother is recovering alcoholic.
Father died of liver cancer.

SOCIAL HISTORY: Recently kicked out of sober house for relapses.  Previously
lived with girlfriend of 6 years, [**Doctor Last Name 1060**], but had period of
homelessness s/p an altercation with her.  Has a 9 year old
daughter. Previously worked in construction, currently
unemployed.  Active cocaine use ([**2-12**] grams per day prior to
admission).  On suboxone for heroin abuse history.  EtOH abuse.
Smokes cigarettes only when drinking.
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Cocaine dependence, continuous,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Other and unspecified alcohol dependence, continuous,Bipolar disorder, unspecified,Other and unspecified hyperlipidemia
DMI ketoacd uncontrold,Cocaine depend-contin,Long-term use of insulin,Hx of past noncompliance,Alcoh dep NEC/NOS-contin,Bipolar disorder NOS,Hyperlipidemia NEC/NOS
Admission Date:  [**2192-4-4**]              Discharge Date:   [**2192-4-7**]

Date of Birth:  [**2149-8-30**]             Sex:   M

Service: MEDICINE

Allergies:
Penicillins

Attending:[**First Name3 (LF) 2195**]
Chief Complaint:
Diabetic Ketoacidosis


Major Surgical or Invasive Procedure:
None


History of Present Illness:
The patient is a 42-year-old man with history of T1DM, HCV,
polysubstance abuse (alcohol, cocaine, heroin), and bipolar
disorder who initially presented with nausea, lethargy, and
increased thirst/polyuria x 3 days.  He was apparently kicked
out of his sober house and did not have access to his
medications.  He reports then going on an EtOH and drug binge,
whereby he consumed "a couple bottles" of vodka and a "gram or
two" of cocaine each day.  He also takes suboxone for prior
heroin abuse, but did not take it during this time given
inability to access home medications. On day 3 of this binge he
presented to the [**Hospital1 18**] ED with glucose levels >700s.
.
In the ED, initial VS afebrile HR 91, BP 112/72  RR 14  SaO2
100% RA.  He was a/ox2 to person and place but not date.  Labs
notable for an anion gap of 23, as well as hyperkalemia to 6.4
with peaked T-waves on EKG, normal QRS.  He received calcium
gluconate, IVF, kayexalate, albuterol, an bicarbonate with
improvement of K to 4.2.  He was transferred to the MICU where
he was placed on an insulin gtt with improvement of his serum
glucose and lowering of anion gap to 5.  He was initially
lethargic in the MICU but gradually became more interactive; he
was able to tolerate po intake without nausea/vomiting and was
transitioned to subcutaneous insulin.
.
Upon transfer to the floor, the patient continues to feel "worn
out" but denies headache, n/v/d, abdominal pain, fevers, chills,
vision changes, chest pain, dyspnea, polyuria.
.


Past Medical History:
# Type 1 diabetes (followed at [**Last Name (un) **])
# Chronic Hepatitis C (referred to Liver Center)
# Polysubstance abuse
-- heroin overdose in [**2177**], [**2181**], has been on suboxone provided
by [**Hospital 1680**] Hospital, Dr. [**Last Name (STitle) 93335**]; last used a few months ago
-- alcohol abuse (drinks vodka), does not report history of DTs
-- active cocaine use (last use prior to this admission)
-- percocet/painkillers (last use a few months ago)
# Bipolar disorder
-- History of suicide attempts (cutting, drug OD)
# Cardiac cath in [**2189**] with non-obstructive coronary disease
-- (thought to be cocaine-induced)
# Depression
# Dyslipidemia
# s/p appendectomy


Social History:
Recently kicked out of sober house for relapses.  Previously
lived with girlfriend of 6 years, [**Doctor Last Name 1060**], but had period of
homelessness s/p an altercation with her.  Has a 9 year old
daughter. Previously worked in construction, currently
unemployed.  Active cocaine use ([**2-12**] grams per day prior to
admission).  On suboxone for heroin abuse history.  EtOH abuse.
Smokes cigarettes only when drinking.


Family History:
Both parents were alcoholics.
Brother is recovering alcoholic.
Father died of liver cancer.


Physical Exam:
PHYSICAL EXAM AT ADMISSION:
VS - Temp 98.2 F, BP 108/60, HR 67, R 18, O2-sat 97% RA
GENERAL - Lethargic man in NAD, appropriate, eyes closed while
talking, falls asleep mid-sentence
HEENT - NC/AT, PERRLA 3-->2 mm bilaterally, EOMI, sclerae
anicteric, MM dry, OP clear
NECK - supple, no thyromegaly, no carotid bruits
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - no rashes or lesions, two tattoos on each upper arm
LYMPH - no cervical LAD
NEURO - A&Ox3, CNs II-XII grossly intact, muscle strength 5/5
throughout, sensation grossly intact throughout

PHYSICAL EXAM AT DISCHARGE:
VS: 97.1, 114/64, 65, 16, 97% RA
GENERAL - NAD, comfortable, appropriate
HEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear
NECK - supple, no JVD, no carotid bruits
LUNGS - CTAB, no r/rh/wh, good air movement, resp unlabored
HEART - RRR, no MRG, nl S1-S2
ABDOMEN - soft/NT/ND, no masses or HSM, no rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses
SKIN  +tattoos. no rashes or lesions
NEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength
[**6-14**] throughout, sensation grossly intact throughout, steady gait


Pertinent Results:
Labs On Admission:
[**2192-4-4**] 02:35PM BLOOD WBC-5.5# RBC-4.89 Hgb-14.4 Hct-44.7
MCV-91 MCH-29.4 MCHC-32.2 RDW-13.9 Plt Ct-173
[**2192-4-4**] 02:35PM BLOOD Neuts-84.3* Lymphs-10.8* Monos-4.0
Eos-0.6 Baso-0.4
[**2192-4-4**] 02:35PM BLOOD PT-12.7 PTT-23.6 INR(PT)-1.1
[**2192-4-4**] 02:35PM BLOOD Glucose-748* UreaN-22* Creat-1.4* Na-125*
K-6.4* Cl-85* HCO3-17* AnGap-29*
[**2192-4-4**] 02:35PM BLOOD ALT-43* AST-32 AlkPhos-99 TotBili-0.7
[**2192-4-4**] 02:35PM BLOOD Lipase-13
[**2192-4-4**] 02:35PM BLOOD cTropnT-<0.01
[**2192-4-4**] 02:35PM BLOOD Albumin-4.5 Calcium-9.4 Phos-4.6* Mg-2.5
[**2192-4-4**] 09:14PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG
Bnzodzp-NEG Barbitr-NEG Tricycl-NEG
[**2192-4-4**] 02:37PM BLOOD Glucose-GREATER TH Lactate-1.6 Na-127*
K-6.4* Cl-85* calHCO3-17*
.
Other Relevant Labs:
[**2192-4-5**] 10:03AM URINE Color-Yellow Appear-Clear Sp [**Last Name (un) **]-1.033
[**2192-4-5**] 10:03AM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-1000 Ketone-50 Bilirub-NEG Urobiln-1 pH-6.0 Leuks-NEG
.
Labs On Discharge:
[**2192-4-7**] 07:05AM BLOOD WBC-3.3* RBC-3.96* Hgb-11.5* Hct-34.4*
MCV-87 MCH-29.0 MCHC-33.4 RDW-14.1 Plt Ct-131*
[**2192-4-7**] 07:05AM BLOOD Glucose-131* UreaN-12 Creat-0.7 Na-134
K-4.0 Cl-103 HCO3-28 AnGap-7*
[**2192-4-7**] 07:05AM BLOOD Calcium-8.1* Phos-3.7 Mg-2.0
.
.
Imaging / Studies:
# CHEST (PORTABLE AP) ([**2192-4-4**] at 3:54 PM):
FINDINGS: Single frontal view of the chest was obtained. Lungs
are clear without focal consolidation. No pleural effusion or
pneumothorax is seen. Cardiac and mediastinal silhouettes are
unremarkable.
IMPRESSION: No acute cardiopulmonary process.
.
# ECG ([**2192-4-4**] at 2:17:34 PM):
Sinus rhythm. Normal tracing. Compared to the previous tracing
of [**2191-8-24**] no diagnostic interim change.
  Intervals Axes
Rate PR QRS QT/QTc P QRS T
73 164 86 [**Telephone/Fax (2) 93338**] 67
.


Brief Hospital Course:
The patient is a 42 year old man with a history of Type 1 DM,
polysubstance abuse, chronic HCV, and bipolar disorder who
presented with DKA after being without insulin x 3 days.

# DIABETES/DKA: The patient initially presented with serum
glucose levels >700s and AG=23 metabolic acidosis with urine
ketones, consistent with DKA. Etiology was likely secondary to
poor adherence to insulin, with contribution from active
polysubstance abuse.  Infectious etiologies were ruled out. In
the MICU the patient was started on insulin gtt at 0.1 units/kg
[**First Name8 (NamePattern2) **] [**Last Name (un) **] protocol, given IVF, and electrolytes were checked
every 3 hours.  By the morning after admission, the patient's
anion gap had closed.  He was transferred onto the medicine
floor on subcutaneous insulin. On the floor his glucose levels
came down from the mid-200s and remained stable in the mid-100s.
 His electrolytes were checked [**Hospital1 **] with repletion as needed.  He
was continued on IV fluids and tolerated a regular diabetic
diet. At discharge the patient appeared euvolemic on exam with
stable electrolytes (K 4.0, Ca 8.1, Mg 2.0, P: 3.7).
.
# LETHARGY: The patient was initially lethargic in the MICU,
thought to be secondary to toxic ingestion although Utox
negative. Infectious etiologies for lethargy were ruled out
given lack of fever/leukocytosis, and a nonfocal neuro exam.  On
transfer he was alert and oriented x 3 with mental status much
improved. Lethargy resolved on the floor.
.
# HYPERKALEMIA: Hyperkalemia 6.2 resolved with kayexalate,
calcium gluconate and insulin. On transfer K was 4.1, no peaked
T waves seen on EKG. His potassium was repleted on the floor,
along with other electrolytes, to good effect.  On discharge K
was 4.0.
.
# POLYSUBSTANCE ABUSE: The patient has a history of
polysubstance abuse including cocaine, narcotics and EtOH but
has no known history of DTs or withdrawal seizures. He endorsed
active cocaine and EtOH use prior to this admission, although
urine tox was negative in the ED.  He was placed on CIWA and
closely monitored.  Although he endorsed some anxiety and
tremulousness, he did not trigger the CIWA scale during his
stay.  He received 0.5 mg lorazepam once for anxiety.  Both the
medicine and MICU teams attempted to reach his prescribing
psychiatrist, Dr. [**Last Name (STitle) 14611**] at [**Hospital 1680**] Hospital for confirmation of
home dose of suboxone. These efforts were met without success
and the patient received suboxone 8mg/2mg during this
hospitalization.

# HOMELESSNESS: Social work was consulted to assess the
patient's living situations in the context of his recent
homelessness.  He refused social work help for placement at a
sober house and was discharged on his own [**Location (un) **] to a friend's
house in [**Hospital3 **].
.
# DEPRESSION: His home Buproprion was initially held in the MICU
due to concern for seizure risk in the setting of possible
withdrawal.  On the floor this medication was restarted
successfully.  He denied any active suicidal or homicidal
ideation.
.
# BIPOLAR DISORDER: He was kept on his home dose of Quetapine
throughout his stay with no active bipolar symptoms.
.
# CHRONIC HEPATITIS C: The patient's LFTs were stable during
this hospitalization.  He is seen by his PCP for chronic
hepatitis C and was also referred to the Liver Center where he
will receive outpatient follow-up.
.
# HYPERLIPIDEMIA: He was kept on his home statin during this
hospitalization.
.
LABS/STUDIES PENDING AT DISCHARGE:
-- Blood cultures x 2 ([**2192-4-4**])
-- MRSA screen ([**2192-4-4**])
.
TRANSITIONAL CARE ISSUES:
-- None


Medications on Admission:
buprenorphine-naloxone 8 mg-2 mg 1 tablet sublingual TID
buproprion hcl 100 mg tablet po qhs
insulin glargine - 100 unit/mL - 26 units qHS
insulin lispro - 100 unit/mL - sliding scale
quetiapine 100 mg po qhs
simvastatin 20 mg po qPM
aspirin 81 mg daily
multivitamin daily

Discharge Medications:
1. buprenorphine-naloxone 8-2 mg Tablet, Sublingual Sig: One (1)
Tablet Sublingual TID (3 times a day).
2. bupropion HCl 100 mg Tablet Extended Release Sig: One (1)
Tablet Extended Release PO at bedtime.
3. quetiapine 100 mg Tablet Sig: One (1) Tablet PO HS (at
bedtime).
4. simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.
5. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable
PO DAILY (Daily).
6. multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).

7. Lantus 100 unit/mL Solution Sig: Thirty (30) units
Subcutaneous at bedtime.
Disp:*qs * Refills:*2*
8. Humalog 100 unit/mL Solution Sig: One (1) injection
Subcutaneous four times a day: Before meals and at bedtime
according to sliding scale.
Disp:*qs * Refills:*2*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary Diagnoses:
Diabetic Ketoacidosis
Diabetes Mellitus Type 1
Polysubstance Abuse

Secondary Diagnoses:
Chronic Hepatitis C
Bipolar Disorder
Hyperlipidemia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
Dear Mr. [**Known lastname **],

You were admitted to the hospital after presenting with
dangerously high glucose levels in your blood (diabetic
ketoacidosis).  This was most likely due to your missed insulin
doses.  You were admitted to the medical intensive care unit
where you received IV fluids and insulin.  We also corrected the
levels of potassium, magnesium, and phosphate in your blood.
You improved with these treatments and were transferred to the
medical floor.  Your glucose levels came down and were stable
for the remainder of your stay. Your mental status also improved
and you became more alert and awake during the course of your
hospitalization.

While in the hospital, you received your home suboxone dose.  We
did not make any changes to your home medications.  Please
continue to take them as previously prescribed.

You will need a follow-up appointment with your PCP soon after
discharge.  The details are below.


Followup Instructions:
You will need a followup appointment with your PCP, [**Name10 (NameIs) **] [**Known firstname 449**]
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], [**First Name3 (LF) **] after discharge.  You should call on Monday
to schedule this appointment.  His office can be reached at
[**Telephone/Fax (1) 250**].

You also have the following appointments at [**Hospital1 18**] in the near
future.

Department: ORTHOPEDICS
When: FRIDAY [**2192-4-20**] at 10:45 AM
With: [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], MD [**Telephone/Fax (1) 1228**]
Building: SC [**Hospital Ward Name 23**] Clinical Ctr [**Location (un) 551**]
Campus: EAST     Best Parking: [**Hospital Ward Name 23**] Garage
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Cocaine dependence, continuous,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Other and unspecified alcohol dependence, continuous,Bipolar disorder, unspecified,Other and unspecified hyperlipidemia'}


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 Ketoacidosis

PRESENT ILLNESS: The patient is a 42-year-old man with history of T1DM, HCV,
polysubstance abuse (alcohol, cocaine, heroin), and bipolar
disorder who initially presented with nausea, lethargy, and
increased thirst/polyuria x 3 days.  He was apparently kicked
out of his sober house and did not have access to his
medications.  He reports then going on an EtOH and drug binge,
whereby he consumed "a couple bottles" of vodka and a "gram or
two" of cocaine each day.  He also takes suboxone for prior
heroin abuse, but did not take it during this time given
inability to access home medications. On day 3 of this binge he
presented to the [**Hospital1 18**] ED with glucose levels >700s.
.
In the ED, initial VS afebrile HR 91, BP 112/72  RR 14  SaO2
100% RA.  He was a/ox2 to person and place but not date.  Labs
notable for an anion gap of 23, as well as hyperkalemia to 6.4
with peaked T-waves on EKG, normal QRS.  He received calcium
gluconate, IVF, kayexalate, albuterol, an bicarbonate with
improvement of K to 4.2.  He was transferred to the MICU where
he was placed on an insulin gtt with improvement of his serum
glucose and lowering of anion gap to 5.  He was initially
lethargic in the MICU but gradually became more interactive; he
was able to tolerate po intake without nausea/vomiting and was
transitioned to subcutaneous insulin.
.
Upon transfer to the floor, the patient continues to feel "worn
out" but denies headache, n/v/d, abdominal pain, fevers, chills,
vision changes, chest pain, dyspnea, polyuria.
.

MEDICAL HISTORY: # Type 1 diabetes (followed at [**Last Name (un) **])
# Chronic Hepatitis C (referred to Liver Center)
# Polysubstance abuse
-- heroin overdose in [**2177**], [**2181**], has been on suboxone provided
by [**Hospital 1680**] Hospital, Dr. [**Last Name (STitle) 93335**]; last used a few months ago
-- alcohol abuse (drinks vodka), does not report history of DTs
-- active cocaine use (last use prior to this admission)
-- percocet/painkillers (last use a few months ago)
# Bipolar disorder
-- History of suicide attempts (cutting, drug OD)
# Cardiac cath in [**2189**] with non-obstructive coronary disease
-- (thought to be cocaine-induced)
# Depression
# Dyslipidemia
# s/p appendectomy

MEDICATION ON ADMISSION: buprenorphine-naloxone 8 mg-2 mg 1 tablet sublingual TID
buproprion hcl 100 mg tablet po qhs
insulin glargine - 100 unit/mL - 26 units qHS
insulin lispro - 100 unit/mL - sliding scale
quetiapine 100 mg po qhs
simvastatin 20 mg po qPM
aspirin 81 mg daily
multivitamin daily

ALLERGIES: Penicillins

PHYSICAL EXAM: PHYSICAL EXAM AT ADMISSION:
VS - Temp 98.2 F, BP 108/60, HR 67, R 18, O2-sat 97% RA
GENERAL - Lethargic man in NAD, appropriate, eyes closed while
talking, falls asleep mid-sentence
HEENT - NC/AT, PERRLA 3-->2 mm bilaterally, EOMI, sclerae
anicteric, MM dry, OP clear
NECK - supple, no thyromegaly, no carotid bruits
LUNGS - CTA bilat, no r/rh/wh, good air movement, resp
unlabored, no accessory muscle use
HEART - PMI non-displaced, RRR, no MRG, nl S1-S2
ABDOMEN - NABS, soft/NT/ND, no masses or HSM, no
rebound/guarding
EXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)
SKIN - no rashes or lesions, two tattoos on each upper arm
LYMPH - no cervical LAD
NEURO - A&Ox3, CNs II-XII grossly intact, muscle strength 5/5
throughout, sensation grossly intact throughout

FAMILY HISTORY: Both parents were alcoholics.
Brother is recovering alcoholic.
Father died of liver cancer.

SOCIAL HISTORY: Recently kicked out of sober house for relapses.  Previously
lived with girlfriend of 6 years, [**Doctor Last Name 1060**], but had period of
homelessness s/p an altercation with her.  Has a 9 year old
daughter. Previously worked in construction, currently
unemployed.  Active cocaine use ([**2-12**] grams per day prior to
admission).  On suboxone for heroin abuse history.  EtOH abuse.
Smokes cigarettes only when drinking. 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Cocaine dependence, continuous,Long-term (current) use of insulin,Personal history of noncompliance with medical treatment, presenting hazards to health,Other and unspecified alcohol dependence, continuous,Bipolar disorder, unspecified,Other and unspecified hyperlipidemia'}
