CHIEF COMPLAINT: 

PRESENT ILLNESS: This is a 57-year-old woman
with history of metastatic colon cancer, diabetes mellitus,
end-stage renal disease, and hemodialysis.  She was admitted
to the Medical Intensive Care Unit for increasing confusion.
She was found to be in a hypo-osmolar, nonketotic state.  The
patient was treated with IV Insulin and carefully monitored
for serum glucose and electrolytes.  Over the course of her
Medical Intensive Care Unit stay she was followed by the
[**Last Name (un) **] Staff and her mental status improved slowly with
better control of her blood glucose and decreasing gap.
Given her recent history of falls at home and weakness, head
CT was performed, which was negative.  Antihypertensives were
held given low systolic blood pressure.  The patient
continued to receive hemodialysis during the course of her
stay in the Medical Intensive Care Unit.  She was
subsequently transferred to the [**Hospital1 139**] Firm for further care.
On the floor, the patient's mental status cleared over the
course of time.  The patient was unclear regarding time,
course of her symptoms that lead to MICU admission.  The
patient does report fluctuating blood glucoses in the past
few months.  She reports poor appetite and some nausea.  She
denies cough, fevers, chills, or chest pain.

MEDICAL HISTORY: 1.  Colon cancer diagnosed in [**2194**] with metastasis to liver,
lymph node, and bone, status post chemotherapy.  The patient
has a Port-A-Cath.  Status post RFA to liver.
2.  End-stage renal disease on hemodialysis on Tuesday,
Thursday, and Saturdays.
3.  Diabetes mellitus.

MEDICATION ON ADMISSION: 

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is on disability, previously a
business manager.  The patient lives alone.  The patient has
friends who help her out with activities of daily living.
Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Hyperpotassemia,Pulmonary collapse,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of colon, unspecified site
DMII hprosmlr uncontrold,Hyperpotassemia,Pulmonary collapse,Second malig neo liver,Secondary malig neo bone,Malignant neo colon NOS
Admission Date:  [**2200-4-19**]       Discharge Date:  [**2200-4-24**]

Date of Birth:   [**2143-4-16**]       Sex:  F

Service:

HISTORY OF THE PRESENT ILLNESS:  This is a 57-year-old woman
with history of metastatic colon cancer, diabetes mellitus,
end-stage renal disease, and hemodialysis.  She was admitted
to the Medical Intensive Care Unit for increasing confusion.
She was found to be in a hypo-osmolar, nonketotic state.  The
patient was treated with IV Insulin and carefully monitored
for serum glucose and electrolytes.  Over the course of her
Medical Intensive Care Unit stay she was followed by the
[**Last Name (un) **] Staff and her mental status improved slowly with
better control of her blood glucose and decreasing gap.
Given her recent history of falls at home and weakness, head
CT was performed, which was negative.  Antihypertensives were
held given low systolic blood pressure.  The patient
continued to receive hemodialysis during the course of her
stay in the Medical Intensive Care Unit.  She was
subsequently transferred to the [**Hospital1 139**] Firm for further care.
On the floor, the patient's mental status cleared over the
course of time.  The patient was unclear regarding time,
course of her symptoms that lead to MICU admission.  The
patient does report fluctuating blood glucoses in the past
few months.  She reports poor appetite and some nausea.  She
denies cough, fevers, chills, or chest pain.

PAST MEDICAL HISTORY:
1.  Colon cancer diagnosed in [**2194**] with metastasis to liver,
lymph node, and bone, status post chemotherapy.  The patient
has a Port-A-Cath.  Status post RFA to liver.
2.  End-stage renal disease on hemodialysis on Tuesday,
Thursday, and Saturdays.
3.  Diabetes mellitus.

MEDICATIONS ON TRANSFER TO THE FLOOR:
1.  NPH insulin.
2.  Regular insulin sliding scale.
3.  Renagel.
4.  Calcium acetate.
5.  Sertraline.
6.  Docusate.
7.  Oxycodone.
8.  Phenergan.
9.  Reglan.

SOCIAL HISTORY:  The patient is on disability, previously a
business manager.  The patient lives alone.  The patient has
friends who help her out with activities of daily living.

PHYSICAL EXAMINATION:  Examination on transfer revealed
temperature of 98; pulse of 68; blood pressure 129/52;
respiratory rate 13; saturation 98% on room air.  GENERAL:
The patient was alert and oriented times three.  The patient
is tired.  HEENT:  Pupils were equal and reactive to light.
Extraocular muscles are intact.  No lymphadenopathy.
PULMONARY:  Bibasilar crackles.  CARDIOVASCULAR:  S1 and S2,
regular rate and rhythm.  ABDOMEN: Soft and nontender,
nondistended, positive bowel sounds.  EXTREMITIES:  There was
no cyanosis, erythema, edema.  NEUROLOGICAL:  Cranial nerves
II through XII intact.

LABORATORY DATA:  Upon transfer, the white blood cell count
was 7, hematocrit 40, platelet count 219,000, sodium 138,
4.1, chloride 104, bicarbonate 22, BUN 30, creatinine 4.8,
glucose 82.

HOSPITAL COURSE:

#1.  ENDOCRINE:  The [**Hospital 228**] Medical Intensive Care Unit
course was outlined in the history of present illness portion
of this discharge summary.  On the floor, the patient's
mental status remained clear.  The patient's blood sugars
were well controlled on her NPH and sliding scale regimen.
The patient will continued to be followed by the [**Last Name (un) **]
Staff.  The patient's appetite increased over the course of
her stay in the hospital.

#2.  RENAL:  The patient continued to receive hemodialysis.

#3.  CARDIOVASCULAR:  The patient remained normotensive and,
therefore, her antihypertensives were not continued on the
floor.

#4.  ONCOLOGY:  The patient was seen by the Oncology Staff
and no intervention was recommended at this time.

DISCHARGE DIAGNOSES:  Hyperosmolar nonketotic state leading
to mental status changes in the setting of uncontrolled blood
sugars.

DISCHARGE MEDICATIONS:
1.  Megace 400 mg p.o.b.i.d.
2.  Reglan 5 mg p.o.q.4h. to 6h.p.r.n.
3.  Colace 100 mg p.o.b.i.d.
4.  Oxycodone 5 mg p.o.q.4h. to 6h.p.r.n.
5.  Sertraline 50 mg p.o.q.d.
6.  Sevelamer 1600 mg p.o.t.i.d.
7.  Prochlorperazine 10 mg p.o.q6h.p.r.n.nausea.
8.  Calcium acetate two tablets p.o.t.i.d.
9.  Senna one tablet p.o. b.i.d.
10. Regular insulin sliding scale.
11. NPH insulin 5 units subcutaneously at bedtime and 9 units
subcutaneously at breakfast.

CONDITION ON DISCHARGE:  Stable.  The patient was discharged
to [**Location (un) 2716**] Point Rehabilitation.  The patient is to followup
in [**Last Name (un) **] upon discharge from [**Location (un) 2716**] Point Rehabilitation.




                            [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **], M.D.  [**MD Number(1) 3851**]

Dictated By:[**Name8 (MD) 5753**]
MEDQUIST36

D:  [**2200-4-24**]  12:23
T:  [**2200-4-24**]  12:42
JOB#:  [**Job Number 21305**]


Admission Date:  [**2200-4-19**]     Discharge Date:  [**2200-4-24**]

Date of Birth:   [**2143-4-16**]     Sex:  F

Service:  [**Hospital Unit Name 16129**] OF PRESENT ILLNESS:  This is a 58 year-old female
with colon cancer with metastases to the liver, bone and
lymph nodes, diabetes mellitus and end stage renal disease
who presented to the Emergency Room, because of an episode of
atrial fibrillation that occurred during hemodialysis.  She
chest pain and shortness of breath.  She was given 5 mg
intravenous times three of Lopressor, nitroglycerin times
three and morphine times one to relieve the pain.  She is
sent to the Emergency Room where she is DC cardioverted with
three shocks 300, 360, 360 and converted into normal sinus
rhythm.  Since on the floor she described some chest pain,
which resolved spontaneously with no event on telemetry.  She
Emergency Room and it is unclear if this is prior or after
receiving her medications.

PAST MEDICAL HISTORY:  Significant for colon cancer with
metastases to liver, bone and lymph nodes.  She is status
post chemotherapy with a Port-A-Cath and status post RFA to
the liver.  She has diabetes mellitus and has a tendency to
go into hyperosmotic nonketotic coma.  She has end stage
renal disease for which she takes hemodialysis three times a
week.

ALLERGIES:  She has no known drug allergies.

MEDICATIONS:  NPH insulin 14 units in the a.m. and 7 units
subQ in the p.m., regular insulin sliding scale, Renagel,
calcium acetate 100 mg b.i.d., Sertraline 50 mg q day,
Decussate, Oxycodone, Phenergan, Reglan 5 mg q 4 to 6 prn,
Phos-Lo, Megace 400 b.i.d.

FAMILY HISTORY:  Noncontributory.

SOCIAL HISTORY:  She lives at [**Doctor Last Name 21306**]nursing home.  She
does not drink alcohol or smoke tobacco.  Her oncologist is
[**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **].

PHYSICAL EXAMINATION:  Temperature 99.5.  [**Last Name (NamePattern1) **] pressure
90/40.  Pulse 80.  Respirations 20.  98% on 2 liters.  Her
heart she had a systolic murmur heard best on the right
sternal border.  Lungs upper lung fields clear, some
decreased breath sounds at the left lower lobe with some
rhonchi.  Abdomen soft, nontender, nondistended.  No rash.
Extremities no clubbing, cyanosis or edema.

ASSESSMENT:  This patient had new onset atrial fibrillation,
which converted spontaneously.  We kept her telemetry to
monitor.  A TSH was obtained and an echocardiogram was
obtained.

HOSPITAL COURSE:  Her CPKs and troponins were negative ruling
her out.  The chest x-ray was clear and the echocardiogram
was clear with an ejection fraction of 60%.  Her TSH is still
pending.  She did have an episode of slight hyperkalemia at
5.1, however, the OMR provides evidence that this is somewhat
of a chronic problem.  [**Name (NI) **] [**Name2 (NI) **] sugar ran high in the high
300 and low 400s at which point her insulin dose was
adjusted.

Social issues included the patient's desire to go to hospice
upon discharge.  This was arranged that she would start
hospice the Monday following discharge.  Her hemodialysis was
rescheduled for the morning of [**2200-5-17**] after which point she
was discharged.

DISCHARGE CONDITION:  Good.

DISCHARGE STATUS:  To home.

DISCHARGE DIAGNOSIS:
Atrial fibrillation converted.

DISCHARGE MEDICATIONS:  Same as admission medications.






                         DR.[**Last Name (STitle) **],[**First Name3 (LF) 1730**] 12-607

Dictated By:[**Last Name (NamePattern1) 21307**]

MEDQUIST36

D:  [**2200-5-16**]  23:49
T:  [**2200-5-19**]  07:29
JOB#:  [**Job Number 21308**]
{'Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Hyperpotassemia,Pulmonary collapse,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of colon, unspecified site'}


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 57-year-old woman
with history of metastatic colon cancer, diabetes mellitus,
end-stage renal disease, and hemodialysis.  She was admitted
to the Medical Intensive Care Unit for increasing confusion.
She was found to be in a hypo-osmolar, nonketotic state.  The
patient was treated with IV Insulin and carefully monitored
for serum glucose and electrolytes.  Over the course of her
Medical Intensive Care Unit stay she was followed by the
[**Last Name (un) **] Staff and her mental status improved slowly with
better control of her blood glucose and decreasing gap.
Given her recent history of falls at home and weakness, head
CT was performed, which was negative.  Antihypertensives were
held given low systolic blood pressure.  The patient
continued to receive hemodialysis during the course of her
stay in the Medical Intensive Care Unit.  She was
subsequently transferred to the [**Hospital1 139**] Firm for further care.
On the floor, the patient's mental status cleared over the
course of time.  The patient was unclear regarding time,
course of her symptoms that lead to MICU admission.  The
patient does report fluctuating blood glucoses in the past
few months.  She reports poor appetite and some nausea.  She
denies cough, fevers, chills, or chest pain.

MEDICAL HISTORY: 1.  Colon cancer diagnosed in [**2194**] with metastasis to liver,
lymph node, and bone, status post chemotherapy.  The patient
has a Port-A-Cath.  Status post RFA to liver.
2.  End-stage renal disease on hemodialysis on Tuesday,
Thursday, and Saturdays.
3.  Diabetes mellitus.

MEDICATION ON ADMISSION: 

ALLERGIES: She has no known drug allergies.

PHYSICAL EXAM: 

FAMILY HISTORY: Noncontributory.

SOCIAL HISTORY: The patient is on disability, previously a
business manager.  The patient lives alone.  The patient has
friends who help her out with activities of daily living. 

### Response:
{'Diabetes with hyperosmolarity, type II or unspecified type, uncontrolled,Hyperpotassemia,Pulmonary collapse,Malignant neoplasm of liver, secondary,Secondary malignant neoplasm of bone and bone marrow,Malignant neoplasm of colon, unspecified site'}
