CHIEF COMPLAINT: Hyperglycemia

PRESENT ILLNESS: 34M HIV (?CD4 100, VL 115K), DM here with hyperglycemia after
episode of cough and abdominal pain. USOH until ~5d prior to
admission, began to have nausea, vomiting, diarrhea, mild
abdominal discomfort in lower quadrants bilat, unable to
tolerate POs. In addition, noted muscle and back pains (thought
[**1-31**] work), non productive cough. Noted fever of 100-101 at home,
chills on arrival to ED. Denies sick contacts, never had
opportunistic infections. Stopped taking Lantus (50U HS) at that
time as he had been unable to take PO. Endorses polydipsia, but
no polyuria, no vision changes. States that he last took FS
regularly 5 days ago, and may have taken FS once two days ago
(?170s). Otherwise, denies chest pain, SOB, wheeze, joint pain,
rashes, dysuria.
.
In ED, given 3L NS, started on insulin gtt, given CTX/Flagyl for
presumed PNA (although CXR negative).

MEDICAL HISTORY: - HIV (sexually transmitted, not on [**Month/Day (2) 2775**], no opportunistic
infections)
- DM, dx 8 yrs ago, previously on orals. On 70/30 for ~4 years,
then recently changed to Lantus ~one month ago per pt.
- Corneal ulcer
- Asymmetric Pupils, L>R

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: (on transfer to floor)
VS - Tm 98.1, Tc 97.5, BP 118/68, HR 82, RR 20, sats 100% on RA

FAMILY HISTORY: DM on father's side. CA on mother's side. No kidney disease

SOCIAL HISTORY: Works intermittently as caterer. On disability now, had been a
school bus driver for disabled kids previously. Denies alcohol,
tobacco, drug or IV drug use. Sexually active with male partners
too numerous to count w/o condom use.
Septicemia due to escherichia coli [E. coli],Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hypovolemia,Thrombocytopenia, unspecified,Severe sepsis,Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Asymptomatic human immunodeficiency virus [HIV] infection status,Anemia, unspecified
E coli septicemia,Ac kidny fail, tubr necr,Urin tract infection NOS,Hypovolemia,Thrombocytopenia NOS,Severe sepsis,DMII keto nt st uncntrld,Long-term use of insulin,Asymp hiv infectn status,Anemia NOS
Admission Date:  [**2188-6-9**]              Discharge Date:   [**2188-6-14**]

Date of Birth:  [**2154-1-4**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 562**]
Chief Complaint:
Hyperglycemia

Major Surgical or Invasive Procedure:
None


History of Present Illness:
34M HIV (?CD4 100, VL 115K), DM here with hyperglycemia after
episode of cough and abdominal pain. USOH until ~5d prior to
admission, began to have nausea, vomiting, diarrhea, mild
abdominal discomfort in lower quadrants bilat, unable to
tolerate POs. In addition, noted muscle and back pains (thought
[**1-31**] work), non productive cough. Noted fever of 100-101 at home,
chills on arrival to ED. Denies sick contacts, never had
opportunistic infections. Stopped taking Lantus (50U HS) at that
time as he had been unable to take PO. Endorses polydipsia, but
no polyuria, no vision changes. States that he last took FS
regularly 5 days ago, and may have taken FS once two days ago
(?170s). Otherwise, denies chest pain, SOB, wheeze, joint pain,
rashes, dysuria.
.
In ED, given 3L NS, started on insulin gtt, given CTX/Flagyl for
presumed PNA (although CXR negative).


Past Medical History:
- HIV (sexually transmitted, not on [**Month/Day (2) 2775**], no opportunistic
infections)
- DM, dx 8 yrs ago, previously on orals. On 70/30 for ~4 years,
then recently changed to Lantus ~one month ago per pt.
- Corneal ulcer
- Asymmetric Pupils, L>R


Social History:
Works intermittently as caterer. On disability now, had been a
school bus driver for disabled kids previously. Denies alcohol,
tobacco, drug or IV drug use. Sexually active with male partners
too numerous to count w/o condom use.

Family History:
DM on father's side. CA on mother's side. No kidney disease

Physical Exam:
(on transfer to floor)
VS - Tm 98.1, Tc 97.5, BP 118/68, HR 82, RR 20, sats 100% on RA

FS 111
Gen: WDWN young male in NAD.
HEENT: Sclera anicteric. Irises different color (contact on R).
L pupil > R, both reactive to light. OP clear, no thrush. No
cervical LAD. MMM.
CV: RR, normal S1, S2. No m/r/g.
Lungs: CTAB, no crackles/wheezes/rhonchi.
Abd: Soft, NTND. No HSM appreciated. + BS. + costal margin
tenderness bilaterally.
Ext: 2+ radial, PT pulses bilaterally. No c/c/e.
Skin: No rashes.


Pertinent Results:
LABS on admission:
WBC 13.0, Hct 29.4, MCV 83, Plt 95
88%N, 7.0%L, 3.1%M, many smudge cells

MICRO:
[**2188-6-9**] blood cx - 4/4 bottles + for E.coli
_________________________________________________________
ESCHERICHIA COLI
|
AMPICILLIN------------ =>32 R
AMPICILLIN/SULBACTAM-- =>32 R
CEFAZOLIN------------- <=4 S
CEFEPIME-------------- <=1 S
CEFTAZIDIME----------- <=1 S
CEFTRIAXONE----------- <=1 S
CEFUROXIME------------ 4 S
CIPROFLOXACIN--------- 0.5 S
GENTAMICIN------------ <=1 S
IMIPENEM-------------- <=1 S
LEVOFLOXACIN---------- 1 S
MEROPENEM-------------<=0.25 S
PIPERACILLIN---------- 32 I
PIPERACILLIN/TAZO----- <=4 S
TOBRAMYCIN------------ <=1 S
TRIMETHOPRIM/SULFA---- =>16 R
.
[**2188-6-9**] urine cx - 10-100,000 E.coli
_________________________________________________________
ESCHERICHIA COLI
|
AMPICILLIN------------ =>32 R
AMPICILLIN/SULBACTAM-- 16 I
CEFAZOLIN------------- <=4 S
CEFEPIME-------------- <=1 S
CEFTAZIDIME----------- <=1 S
CEFTRIAXONE----------- <=1 S
CEFUROXIME------------ 4 S
CIPROFLOXACIN---------<=0.25 S
GENTAMICIN------------ <=1 S
IMIPENEM-------------- <=1 S
LEVOFLOXACIN---------- 1 S
MEROPENEM-------------<=0.25 S
NITROFURANTOIN-------- <=16 S
PIPERACILLIN---------- 32 I
PIPERACILLIN/TAZO----- <=4 S
TOBRAMYCIN------------ <=1 S
TRIMETHOPRIM/SULFA---- =>16 R
.
[**2188-6-9**] mycolytic blood cx - pending
[**2188-6-9**] blood cx - pending
[**2188-6-10**] blood cx - pending
[**2188-6-11**] urine cx - no growth
.
IMAGING:
[**2188-6-9**] CXR: The cardiac, mediastinal, and hilar contours are
within normal limits. Pulmonary vasculature is unremarkable. The
lungs appear clear. No pleural effusions or pneumothoraces are
identified. Surrounding osseous and soft tissue structures
appear unremarkable.
.
[**2188-6-9**] CXR: Increased left retrocardiac opacity with time
course favoring atelectasis, though pneumonia cannot be
excluded.
.
[**2188-6-9**] CXR:
1. Right subclavian central venous catheter tip in the mid SVC
without pneumothorax.
2. Patchy bibasilar opacities, which may represent atelectasis
or aspiration with new tiny bilateral pleural effusions.
.
[**2188-6-10**] ABD U/S:
1. No evidence of nephrolithiasis or cholelithiasis. Mild
gallbladder distention with a small amount of surrounding fluid.
If symptoms worsen, follow up is recommended.
2. Simple-appearing cyst in the left kidney.
3. Splenomegaly
.
[**2188-6-10**] CXR: Improved pulmonary edema. Increased small left
pleural effusion.
.
[**2188-6-12**] LIVER U/S: The liver is normal in contour and
echotexture without focal lesions. No evidence of intra- or
extra-hepatic ductal dilatation. The portal vein demonstrates
appropriate forward flow. The gallbladder again is slightly
distended with no evidence of wall thickening, no gallstones
present, and no demonstrable surrounding fluid. The right kidney
measures approximately 12 cm.
IMPRESSION: Unchanged slightly distended gallbladder. No
additional son[**Name (NI) 493**] evidence of cholecystitis.


Brief Hospital Course:
34yo M w/ HIV and DM type I, presents w/ DKA, ARF, and elevated
LFTs in setting of Ecoli urosepsis/bacteremia.
.
# GASTROENTERITIS: Diarrhea and nausea appear to have resolved
at this time.
-check stool studies if pt continues to have diarrhea

# DKA: Pt was seen by [**Last Name (un) **] consult who thinks he has type I DM
and DKA. His insulin gtt was stopped last night and he was
started on standing lantus. His gap is closing and his BS are
currently in the 200s and being treated with humalog.
-serum betahydroxybutyrate pending
-pt taking in POs
-appreciate Josline recs
- q 8 hour electrolyte checks, and more frequently if BS cont to
rise
- cont q hr FS while in unit and cover with humalog SS
(tightened this Am)
Resolved now. Likely due to the combination of no insulin and
urosepsis. Now on SC insulin. [**Last Name (un) **] following. Needs DM
education as pt did not know how to modify insulin w/ his
illness.
- cont lantus + HISS
- f/[**Initials (NamePattern4) **] [**Last Name (NamePattern4) **] recs
- ? how to enroll pt in diabetes education
.
# ARF: Slowly resolving. Cr down to 5.0, still w/ good UOP. FeNa
suggestive of ATN, and per renal, feel that Cr will likely
improve w/ time. Most likely combination of ATN and severe
prerenal state in setting of n/v/d + DKA. Urine eos pending.
Renal had been following, signed off today.
- d/c Tums
- f/u urine eos
- f/u BUN/Cr in 1 week
- avoid nephrotoxic agents
- renally dose meds
- supportive care
.
# BACTEREMIA: Mr. [**Known lastname 32713**] likely had urosepsis, as he grew Ecoli
in [**4-1**] blood cx from [**2188-6-9**], as well as his urine cx from
[**2188-6-9**]. Blood cx since are no growth, urine is no growth. He
had originally been started on ceftriaxone and flagyl, but once
his cultures returned w/ sensistivities to CTX, his flagyl was
discontinued. Has been on ceftriaxone since [**2188-6-9**]. ? if can
switch to PO levofloxacin tomorrow.
- f/u cultures
- monitor WBC and fever curve
- switch to PO abx when able
.
# TRANSAMINITIS: LFTs are trending up. Pt c/o right sided pain
that was intially thought to be RUQ pain, but today he is c/o
rib pain. An abdominal ultrasound was done two days ago that
showed slightly edematous GB but no cholelithiasis or
choledocholithiasis.
-trend LFTs, if cont to rise could get repeat RUQ or abd CT (to
also evaluate for pyelo-but would have to be non-contrast)
Unclear etiology to his transaminitis/abnormal LFTs. ALT, alk
phos, GGT elevated, but liver U/S without evidence of
cholecystitis. ? ceftriaxone induced as abnormalities began
[**2188-6-11**], after start of abx (but no evidence of ductal
dilatation). Hep panel pending, as are hemolysis labs.
- f/u hepatitis panel
- f/u hemolysis labs
- monitor LFTs daily
.
# METABOLIC ACIDOSIS: Non-gap acidosis, secondary to etihter
renal failure, RTA, or resolving diarrhea.
- f/u urine lytes
.
# HIV: Per his PCP, [**Name10 (NameIs) 2775**] was not initiated while the patient
was hospitalized. This discussion will be deferred to the
outpatient setting.
.
# SMUDGE CELLS/SPLENOMEGALY: Concerning for a heme malignancy,
but could also be due to his acute illness. These findings
should be followed up as outpatient. Will convey this to his
PCP, [**Last Name (NamePattern4) **]. [**Last Name (STitle) **].
.
# THROMBOCYTOPENIA: Likely secondary to HIV/splenomegaly. Will
check platelets daily. No concern for DIC or TTP at present.
- monitor plts daily
.
# FEN: Regular [**Doctor First Name **] diet. No IVF. Check lytes daily, replete prn.

- nutrition consult given his low albumin
- sugar free shakes as supplement
.
# ACCESS: 2 peripheral IV and triple lumen SC on R
- ? can d/c R SC line today (was placed on [**6-9**])
.
# PPX: Hep SC, PPI, no bowel regimen given recent diarrhea
.
# CODE: FULL
.
# DISPO: To home, possibly tomorrow. ? outpt SW or other
services.


Discharge Medications:
1. Codeine-Guaifenesin 10-100 mg/5 mL Syrup Sig: 5-10 MLs PO Q6H
(every 6 hours) as needed for cough.
Disp:*75 ML(s)* Refills:*0*
2. Insulin Glargine 100 unit/mL Solution Sig: Thirty Five (35)
units Subcutaneous at bedtime.
3. Insulin Lispro (Human) 100 unit/mL Solution Sig: Varied units
Subcutaneous four times a day: As per sliding scale.
Disp:*qs 1 month units* Refills:*2*
4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2
times a day) as needed for constipation.
Disp:*60 Capsule(s)* Refills:*2*
5. Levofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q24H (every
24 hours) for 9 days.
Disp:*9 Tablet(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
Primary diagnosis:
E.coli bacteremia
E.coli UTI
DKA
ARF
Transaminitis
.
Secondary diagnosis:
HIV
DM type I


Discharge Condition:
Good. Afebrile, VSS.


Discharge Instructions:
Please call your PCP or go to the nearest ER if you develop any
of the following symptoms: fever >101, chills, shortness of
breath, difficulty breathing, chest pain, shortness of breath,
inability to urinate, back pain, nausea, vomiting, diarrhea, or
any other worrisome symptoms.
.
Please complete the full course of your antibiotic - last dose
is [**2188-6-23**]
.
Please keep all your follow-up appointments as outlined below.
It is very important that you see Dr. [**Last Name (STitle) **] on [**Last Name (STitle) 2974**] of next
week to have your labs drawn to make sure your Creatinine and
Liver function tests are stable.

Followup Instructions:
Please follow up with Dr. [**Last Name (STitle) **] on [**Last Name (STitle) 2974**] [**6-20**] at
10:40am.
You need to have BUN/Cr and LFTs checked in 1 week to make sure
that they have all returned to baseline. Please call
[**Telephone/Fax (1) 2776**] if you have any questions or concerns.
.
Please follow-up with [**First Name9 (NamePattern2) 32887**] [**Doctor Last Name 1726**] (Diabetes Educator) at
[**Last Name (un) **] on [**Last Name (LF) 2974**], [**6-20**], at 1pm. Please call her office at
[**Telephone/Fax (1) 2384**] if you have any questions or concerns.
{'Septicemia due to escherichia coli [E. coli],Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hypovolemia,Thrombocytopenia, unspecified,Severe sepsis,Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Asymptomatic human immunodeficiency virus [HIV] infection status,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: Hyperglycemia

PRESENT ILLNESS: 34M HIV (?CD4 100, VL 115K), DM here with hyperglycemia after
episode of cough and abdominal pain. USOH until ~5d prior to
admission, began to have nausea, vomiting, diarrhea, mild
abdominal discomfort in lower quadrants bilat, unable to
tolerate POs. In addition, noted muscle and back pains (thought
[**1-31**] work), non productive cough. Noted fever of 100-101 at home,
chills on arrival to ED. Denies sick contacts, never had
opportunistic infections. Stopped taking Lantus (50U HS) at that
time as he had been unable to take PO. Endorses polydipsia, but
no polyuria, no vision changes. States that he last took FS
regularly 5 days ago, and may have taken FS once two days ago
(?170s). Otherwise, denies chest pain, SOB, wheeze, joint pain,
rashes, dysuria.
.
In ED, given 3L NS, started on insulin gtt, given CTX/Flagyl for
presumed PNA (although CXR negative).

MEDICAL HISTORY: - HIV (sexually transmitted, not on [**Month/Day (2) 2775**], no opportunistic
infections)
- DM, dx 8 yrs ago, previously on orals. On 70/30 for ~4 years,
then recently changed to Lantus ~one month ago per pt.
- Corneal ulcer
- Asymmetric Pupils, L>R

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: (on transfer to floor)
VS - Tm 98.1, Tc 97.5, BP 118/68, HR 82, RR 20, sats 100% on RA

FAMILY HISTORY: DM on father's side. CA on mother's side. No kidney disease

SOCIAL HISTORY: Works intermittently as caterer. On disability now, had been a
school bus driver for disabled kids previously. Denies alcohol,
tobacco, drug or IV drug use. Sexually active with male partners
too numerous to count w/o condom use. 

### Response:
{'Septicemia due to escherichia coli [E. coli],Acute kidney failure with lesion of tubular necrosis,Urinary tract infection, site not specified,Hypovolemia,Thrombocytopenia, unspecified,Severe sepsis,Diabetes with ketoacidosis, type II or unspecified type, not stated as uncontrolled,Long-term (current) use of insulin,Asymptomatic human immunodeficiency virus [HIV] infection status,Anemia, unspecified'}
