CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 46 year old type 1
diabetic diagnosed 34 years ago with a past medical history
of coronary artery disease, end-stage renal disease status
post transplant in [**2117-9-17**], who presents with
mental status changes on the 20th.  The patient was well
until 02:30 a.m. on the morning of the 20th when her insulin
pump alarmed her for cartridge replacement.  She replaced the
cartridge and went to sleep.  The husband left for work at
03:30 a.m.; when he returned home at 02:00 p.m. he found her
walking around confused, disoriented, and incoherently
speaking.  Her insulin pump was lying on the floor.

MEDICAL HISTORY: 1.  Type 1 diabetes mellitus.
2.  Gastroparesis.
3.  Severe peripheral vascular disease with a left below the
knee amputation and a chronic non-healing right heel ulcer
and right elbow ulcers.
4.  Coronary artery disease status post myocardial
infarction, status post coronary artery bypass graft.
5.  Cerebrovascular accidents times two.
6.  End-stage renal disease status post renal transplant.
7.  Hypercholesterolemia.
8.  Hypertension.
9.  Anemia.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to Augmentin, Demerol,
which gives her a rash; intravenous contrast gives her nausea
and vomiting; and tape allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY: 
Mechanical complication due to other implant and internal device, not elsewhere classified,Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Ulcer of heel and midfoot,Polyneuropathy in diabetes,Nonspecific abnormal results of function study of liver,Other nonspecific abnormal serum enzyme levels,Tobacco use disorder
Malfunc oth device/graft,DMI keto nt st uncntrld,Ulcer of heel & midfoot,Neuropathy in diabetes,Abn liver function study,Abn serum enzy level NEC,Tobacco use disorder
Admission Date:  [**2120-7-5**]     Discharge Date:  [**2120-7-9**]

Date of Birth:   [**2074-6-22**]     Sex:  F

Service:  ACOVE

ADMITTING DIAGNOSIS:  Diabetic ketoacidosis.

HISTORY OF PRESENT ILLNESS:   This is a 46 year old type 1
diabetic diagnosed 34 years ago with a past medical history
of coronary artery disease, end-stage renal disease status
post transplant in [**2117-9-17**], who presents with
mental status changes on the 20th.  The patient was well
until 02:30 a.m. on the morning of the 20th when her insulin
pump alarmed her for cartridge replacement.  She replaced the
cartridge and went to sleep.  The husband left for work at
03:30 a.m.; when he returned home at 02:00 p.m. he found her
walking around confused, disoriented, and incoherently
speaking.  Her insulin pump was lying on the floor.

PAST MEDICAL HISTORY:
1.  Type 1 diabetes mellitus.
2.  Gastroparesis.
3.  Severe peripheral vascular disease with a left below the
knee amputation and a chronic non-healing right heel ulcer
and right elbow ulcers.
4.  Coronary artery disease status post myocardial
infarction, status post coronary artery bypass graft.
5.  Cerebrovascular accidents times two.
6.  End-stage renal disease status post renal transplant.
7.  Hypercholesterolemia.
8.  Hypertension.
9.  Anemia.

MEDICATIONS ON TRANSFER FROM INTENSIVE CARE UNIT:
[**Unit Number **].  Aspirin 325 mg p.o. q. day.
2.  Famotidine 20 mg p.o. twice a day.
3.  Colace 100 mg p.o. twice a day.
4.  Senna.
5.  Paroxetine 20 mg p.o. q. day.
6.  Alprazolam 1 mg p.o. twice a day.
7.  Metoprolol 50 mg p.o. twice a day.
8.  Nitroglycerin p.r.n.
9.  Bactrim one tablet q. day.
10. Tacrolimus 2 mg q. 12 hours.
11. Prednisone 5 mg q. day.
12. CellCept [**Pager number **] mg twice a day.
13. Morphine SR 30 mg twice a day.
14. MSIR q. four to six p.r.n.
15. Gabapentin 400 mg q. four.
16. Levofloxacin 500 mg p.o. q. day.
17. Lactulose 30 mg q. eight p.r.n.
18. Subcutaneous heparin.
19. Insulin sliding scale.
20. NPH 20 units q. a.m. and 10 units q. h.s.

ALLERGIES:   The patient is allergic to Augmentin, Demerol,
which gives her a rash; intravenous contrast gives her nausea
and vomiting; and tape allergies.

PHYSICAL EXAMINATION:  On admission:  Temperature 99.6 F.;
respiratory rate 15; blood pressure 91/52; heart rate 80.  On
examination on admission, she was drowsy, unarousable.  Her
skin was anicteric, warm.  HEENT:  Normocephalic.  Her
oropharynx was clear.  Mucous membranes were dry.  Neck with
no lymphadenopathy.  Lungs clear to auscultation bilaterally.
Cardiovascular with regular S1, S2.  Systolic ejection murmur
at apex, Grade III/VI.  Abdomen is soft, nontender, mass in
the right lower quadrant from the transplant.  Extremities
with left below the knee amputation, prosthetic in place.
Right foot dressed.  Neurologically, cranial nerves II
through XII intact.  Oriented to place and self, not to time.

LABORATORY:   EKG findings as above.  Chest x-ray showed no
infiltrates.

HOSPITAL COURSE:  She was brought to the Emergency Room
initially where her fingersticks ran in the 500s, serum
glucose was 585.  Her anion gap was 88 with a bicarbonate of
15.  Her venous blood gas was a pH of 7.21.  Her urinalysis
had ketones and she had positive serum acetone.

EKG showed new ST depressions in V3 through V6.  She was
treated with ten units of insulin intravenous and insulin
drip at 7 units an hour and also aggressive intravenous fluid
hydration.  She was sent to the Surgical Intensive Care Unit
for admission.  In the Surgical Intensive Care Unit her anion
gap was closed at 2 a.m. the night of admission.  Her
fingerstick decreased and intravenous fluids were changed to
D5 [**1-18**] normal saline.  The insulin drip was titrated down and
discontinued on the [**10-6**].  Low urine output responded
to increased intravenous fluids.  EKG changes had resolved by
the 21st.  She ruled out for an myocardial infarction
however, her CKs had been elevated with negative MB so there
was a question of rhabdomyolysis.  Her urinalysis also had
positive blood and red blood cells.  Both Renal and [**Last Name (un) **]
were consulted.

Her liver function tests on admission had been elevated for
unknown etiology.  The patient was asymptomatic.  Podiatry
was consulted on the 21st for a left heel ulcer, chronic
ulcer, and they recommended starting empiric Levaquin.

The mental status changes had resolved by the 21st.  On the
22nd, the patient was admitted to the Medicine Floor on
5-South, feeling much better.  She was noted to have some
knee pain which worsened with ambulation otherwise while on
admission to the Medicine Floor.

When she was admitted to the Floor, her mental status
improved.  On the 23rd, her insulin pump was restarted.  Her
blood sugars had stabilized and on the 24th she was sent home
in stable condition.

CONDITION ON DISCHARGE:   Stable.

DISCHARGE DIAGNOSES:  Diabetic ketoacidosis.

DISCHARGE MEDICATIONS:   The patient was told to continue all
of her home medicines and using her insulin pump as
previously instructed as well as to continue the Levofloxacin
500 mg p.o. q. day for the next seven days; those medications
were:
1.  Aspirin 325 mg p.o. q. day.
2.  Famotidine 20 mg p.o. twice a day.
3.  Colace 100 mg p.o. twice a day.
4.  Senna.
5.  Paroxetine 20 mg p.o. q. day.
6.  Alprazolam 1 mg p.o. twice a day.
7.  Metoprolol 50 mg p.o. twice a day.
8.  Nitroglycerin p.r.n.
9.  Bactrim one tablet q. day.
10. Tacrolimus 2 mg q. 12 hours.
11. Prednisone 5 mg q. day.
12. CellCept [**Pager number **] mg twice a day.
13. Morphine SR 30 mg twice a day.
14. MSIR q. four to six p.r.n.
15. Gabapentin 400 mg q. four.
16. Levofloxacin 500 mg p.o. q. day.
17. Lactulose 30 mg q. eight p.r.n.
18. Subcutaneous heparin.
19. Insulin sliding scale.
20. NPH 20 units q. a.m. and 10 units q. h.s.

DISCHARGE INSTRUCTIONS:   The patient was discharged with the
following instructions:
1.  Continue regular diabetes care.
2.  Use Adaptic dressing on ulcers on heel and wrap dressings
around over those dressings.  Change the dressings every day
until you return the 29th for admission for angiogram.
3.  Continue using yellow multi...... while lying in bed.
4.  Recommended follow-up with primary care physician.
5.  She is to follow-up with Dr. [**Last Name (STitle) 17887**] in one week and
call for an appointment.
6.  For [**Hospital **] Clinic she is to keep her regular appointment
and continue with her regular pump use.
7.  For Podiatry, she is to follow-up with her podiatrist per
her weekly appointment and use the Adaptic dressings on her
ulcer on heel.
8.  Renal to follow-up at her next regular appointment.



                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M. D.  [**MD Number(1) 10038**]

Dictated By:[**Name8 (MD) 8736**]

MEDQUIST36

D:  [**2120-7-9**]  16:32
T:  [**2120-7-16**]  20:04
JOB#:  [**Job Number 26044**]

cc:[**Last Name (NamePattern1) 26638**]
{'Mechanical complication due to other implant and internal device, not elsewhere classified,Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Ulcer of heel and midfoot,Polyneuropathy in diabetes,Nonspecific abnormal results of function study of liver,Other nonspecific abnormal serum enzyme levels,Tobacco use disorder'}


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: 

PRESENT ILLNESS: This is a 46 year old type 1
diabetic diagnosed 34 years ago with a past medical history
of coronary artery disease, end-stage renal disease status
post transplant in [**2117-9-17**], who presents with
mental status changes on the 20th.  The patient was well
until 02:30 a.m. on the morning of the 20th when her insulin
pump alarmed her for cartridge replacement.  She replaced the
cartridge and went to sleep.  The husband left for work at
03:30 a.m.; when he returned home at 02:00 p.m. he found her
walking around confused, disoriented, and incoherently
speaking.  Her insulin pump was lying on the floor.

MEDICAL HISTORY: 1.  Type 1 diabetes mellitus.
2.  Gastroparesis.
3.  Severe peripheral vascular disease with a left below the
knee amputation and a chronic non-healing right heel ulcer
and right elbow ulcers.
4.  Coronary artery disease status post myocardial
infarction, status post coronary artery bypass graft.
5.  Cerebrovascular accidents times two.
6.  End-stage renal disease status post renal transplant.
7.  Hypercholesterolemia.
8.  Hypertension.
9.  Anemia.

MEDICATION ON ADMISSION: 

ALLERGIES: The patient is allergic to Augmentin, Demerol,
which gives her a rash; intravenous contrast gives her nausea
and vomiting; and tape allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: 

SOCIAL HISTORY:  

### Response:
{'Mechanical complication due to other implant and internal device, not elsewhere classified,Diabetes with ketoacidosis, type I [juvenile type], not stated as uncontrolled,Ulcer of heel and midfoot,Polyneuropathy in diabetes,Nonspecific abnormal results of function study of liver,Other nonspecific abnormal serum enzyme levels,Tobacco use disorder'}
