CHIEF COMPLAINT: DKA/Uremia

PRESENT ILLNESS: 52 yo man with DM 1 and triopathy as well as PVD and CRI
(followed by transplant) p/w 3 days of hyperglycemia, and N/V of
coffee-ground emesis this am. Patient denies infectious symptoms
or cardiac symptoms. Of note, had a stress test 3 days ago read
as normal. EKG in ED with lateral ST depressions and + troponin
(trending down).

MEDICAL HISTORY: 1. Diabetes mellitus type 2 x 35 years.
2. Triopathy.
3. Chronic renal insufficiency.
4. Chronic anemia.
5. Hypertension.
6. Hypercholesterolemia.
7. Depression

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: non-contributory

SOCIAL HISTORY: 
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Ulcer of other part of foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Depressive disorder, not elsewhere classified,Background diabetic retinopathy,Polyneuropathy in diabetes,Anemia in chronic kidney disease,Secondary hyperparathyroidism (of renal origin)
DMI ketoacd uncontrold,Acute kidney failure NOS,Gastrointest hemorr NOS,Ulcer other part of foot,Hyp kid NOS w cr kid V,Depressive disorder NEC,Diabetic retinopathy NOS,Neuropathy in diabetes,Anemia in chr kidney dis,Sec hyperparathyrd-renal
Admission Date:  [**2158-1-5**]              Discharge Date:   [**2158-1-9**]

Date of Birth:  [**2105-1-12**]             Sex:   M

Service: MEDICINE

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 3814**]
Chief Complaint:
DKA/Uremia

Major Surgical or Invasive Procedure:
EGD

History of Present Illness:
52 yo man with DM 1 and triopathy as well as PVD and CRI
(followed by transplant) p/w 3 days of hyperglycemia, and N/V of
coffee-ground emesis this am. Patient denies infectious symptoms
or cardiac symptoms. Of note, had a stress test 3 days ago read
as normal. EKG in ED with lateral ST depressions and + troponin
(trending down).

Past Medical History:
1. Diabetes mellitus type 2 x 35 years.
2. Triopathy.
3. Chronic renal insufficiency.
4. Chronic anemia.
5. Hypertension.
6. Hypercholesterolemia.
7. Depression


Family History:
non-contributory

Brief Hospital Course:
A/P: 52 yo male w/ DM 1, depression admitted for DKA, developed
ARF, gastritis, r/o for MI, now stable.
.
DKA - The pt was placed in an insulin dip and was transferred to
MICU.  In the MICU his sugars came under control and the patient
was eventually transitioned to fixed doses of insulin with a
Humalog SS with [**Last Name (un) **] consult input. His sugars were well
controlled. It remained unclear as to what caused the pt's DKA;
it was felt that he may not have been compliant with his home
regimen [**1-11**] to depression.
.
Acute on CRI - The patient was found to have an acute increase
in his baseline creatinine thought to arise from dehydration.
His serum creatinine began to decrease with aggressive fluid
hydration.  Nephrology followed the patient. The pt stayed in
the hospital for venous mapping, to help initiate the process of
moving towards HD. He was set up for an appointment with renal
transplant on discharge.
.
CAD/HTN - The pt was found to have EKG changes in the ED with
elevated serum troponin but in the setting of renal failure.  He
ruled out for MI with negative cardiac enzymes x 3. He had an
echo that shows a depressed EF from prior echo, but this was in
the setting of an acidosis. Metoprolol was increased to 50mg [**Hospital1 **]
for better BP control.
.
Depression - Pt appears obviously depressed and expressed little
confidence in medical and psychotherapy. This may have
contributed to his current presentation.  He has tried
medication in the past but did not find them to be helpful. A
psychiatry consult was called who urged the pt to seek o/p
psychiatric help.
.
Coffee Ground Emesis - The pt was found to have gastritis on EGD
but no source of active large bleed.  He was started on a high
dose PPI. He was transfused one unit PRBCs in MICU.
.
Anemia - Per renal, will start procrit [**Numeric Identifier 961**] units 3x/week
.
Proph - Hep SC, PPI
.
FEN - con't to replete Mg and K.  Diabetic diet.
.
Code - Full.   HCP is wife.
.

Discharge Medications:
1. Calcitriol 0.25 mcg Capsule Sig: Three (3) Capsule PO DAILY
(Daily).
2. Calcium Acetate 667 mg Tablet Sig: One (1) Tablet PO TID
W/MEALS (3 TIMES A DAY WITH MEALS).
3. Epoetin Alfa 10,000 unit/mL Solution Sig: 10,000 units
Injection QMOWEFR (Monday -Wednesday-Friday).
Disp:*qs units* Refills:*2*
4. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO TID
(3 times a day).
Disp:*90 Tablet(s)* Refills:*2*
5. Pantoprazole Sodium 40 mg Tablet, Delayed Release (E.C.) Sig:
One (1) Tablet, Delayed Release (E.C.) PO twice a day.
Disp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*
6. Atorvastatin Calcium 40 mg Tablet Sig: One (1) Tablet PO
DAILY (Daily).
Disp:*30 Tablet(s)* Refills:*2*
7. Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: Ten (10)
units Subcutaneous twice a day: QAM and QHS.
Humalog sliding scale as attached.


Discharge Disposition:
Home

Discharge Diagnosis:
DKA
GIB
Acute on chronic renal failure
NSTEMI in setting of likely demand ischemia
Depression


Discharge Condition:
Stable and improved

Discharge Instructions:
Please call your doctor or return to the ER if you have any
fevers or chills, any difficulty breathing, any chest pain,
abdominal pain, or if your depression worsens in any way. Please
maintain good foot care.
.
Please take all your medications as directed. Bring your
medication list to your appointments.
.
MEDICATION CHANGES:
1. Stop taking: Zestril.
2. New med: Protonix 40mg twice a day.
3. New med: Metoprolol 50mg twice a day.
4. Increase in med dose: Procrit 10,000U three times a week
5. Increase in med dose: Lipitor 40mg once a day
6. Change in insulin schedule:
a. Take 10mg NPH every morning and every night before bed
b. Follow a new Novalog insulin sliding scale, attached. Bring
this sliding scale to your [**Last Name (un) **] follow up appointment.
.
Do not take aspirin or NSAIDS for now, given your GI bleed. You
can discuss this, as well as when to stop taking Pantoprazole,
with Dr. [**Last Name (STitle) 3815**] (GI doctor).

Followup Instructions:
1. PCP [**Name Initial (PRE) **] [**Name10 (NameIs) 3816**], [**1-17**] at 11:20 with [**First Name8 (NamePattern2) 2048**] [**Last Name (NamePattern1) 3817**] at
Dr.[**Name (NI) 2989**] office, [**Company 191**], Atrium Suite, [**Location (un) 453**]. [**Telephone/Fax (1) 250**]

.

2. [**Last Name (un) **] - Dr. [**Last Name (STitle) 3818**] - [**Last Name (STitle) 3816**], [**1-24**] at 12pm. [**Hospital **]
Clinic [**Location (un) **]. [**Telephone/Fax (1) 2384**]

.

3. Dr. [**Last Name (STitle) **] - Thursday, [**1-26**] at 9:30am with Dr.
[**Last Name (STitle) **], [**Hospital Ward Name 121**] Building, [**Location (un) 470**]. [**Telephone/Fax (1) 543**]

.

4. GI - [**Telephone/Fax (1) 3816**], [**1-24**] at 2:20pm with Dr. [**Last Name (STitle) 3815**].
[**Hospital Ward Name 23**] Building, [**Location (un) 436**]. [**Telephone/Fax (1) 1954**]

.

5. Transplant: [**Name6 (MD) 1344**] [**Last Name (NamePattern4) 3125**], MD. Where: LM [**Hospital Unit Name 3126**] CENTER Phone:[**Telephone/Fax (1) 673**] Date/Time:[**2158-1-12**] 2:00


                             [**First Name11 (Name Pattern1) 674**] [**Last Name (NamePattern4) 3819**] MD, [**MD Number(3) 3820**]
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Ulcer of other part of foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Depressive disorder, not elsewhere classified,Background diabetic retinopathy,Polyneuropathy in diabetes,Anemia in chronic kidney disease,Secondary hyperparathyroidism (of renal origin)'}


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: DKA/Uremia

PRESENT ILLNESS: 52 yo man with DM 1 and triopathy as well as PVD and CRI
(followed by transplant) p/w 3 days of hyperglycemia, and N/V of
coffee-ground emesis this am. Patient denies infectious symptoms
or cardiac symptoms. Of note, had a stress test 3 days ago read
as normal. EKG in ED with lateral ST depressions and + troponin
(trending down).

MEDICAL HISTORY: 1. Diabetes mellitus type 2 x 35 years.
2. Triopathy.
3. Chronic renal insufficiency.
4. Chronic anemia.
5. Hypertension.
6. Hypercholesterolemia.
7. Depression

MEDICATION ON ADMISSION: 

ALLERGIES: Patient recorded as having No Known Allergies to Drugs

PHYSICAL EXAM: 

FAMILY HISTORY: non-contributory

SOCIAL HISTORY:  

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Acute kidney failure, unspecified,Hemorrhage of gastrointestinal tract, unspecified,Ulcer of other part of foot,Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease,Depressive disorder, not elsewhere classified,Background diabetic retinopathy,Polyneuropathy in diabetes,Anemia in chronic kidney disease,Secondary hyperparathyroidism (of renal origin)'}
