CHIEF COMPLAINT: Nausea and fatigue

PRESENT ILLNESS: 21 year old female with type I DM diagnosed age 14, presented
with nausea and hyperglycemia. She had discontinued her insulin
pump this summer because the pump was disconnecting with
activity. She transitioned herself to basal bolus regimen, but
has been having trouble staying with her schedule since college
began a few weeks ago. She has been having epigastric pressure
the past two weeks, and this morning had nausea, headache, and
fatigue with decreased appetite and increased abd pressure. She
noticed her BS 400's at home and went to the ED. Had nonbloody
emesis en route to ED. She denies fever, cough, sore throat. She
denies chest pain, SOB, or chest pressure. Denies diarrhea.
Denies dysuria, frequency, or urgency. No vaginal dc, LMP two
months ago, no oral contraceptive in past year, irregular menses
since then.

MEDICAL HISTORY: Type I DM, diagnosed age 14, only prior episode DKA at 18
secondary to EtOH use

MEDICATION ON ADMISSION: Lantus 27 units at 6PM
NovaLog SS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T:98.9 BP: 128/109 P: 115 R: 33 O2:97% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, pupils
round/reactive
Neck: supple, no LAD
CV: Tachycardic, regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Lungs: No accessory muscle use, good air movement, bibasilar
crackles, no wheezes, rales, ronchi
Abdomen: Soft, some epigastric tenderness to deep palpation,
non-distended, hypoactive bowel sounds, no organomegaly.
Ext: warm, well perfused, 2+ pulses bilaterally, no clubbing,
cyanosis or edema
Neuro: 5/5 strength upper/lower extremities, grossly normal
sensation

FAMILY HISTORY: Family History:
Cousin and grandfather with [**Name (NI) 17095**], father had gallbladder removed

SOCIAL HISTORY: Social History: College student, not currently sexually active,
no history of STD's, uses protection.
- Tobacco: Never
- Alcohol: 3-4 beers per weekend, no binging
- Illicits: Denies, including denies IVDU
Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Personal history of noncompliance with medical treatment, presenting hazards to health,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Other specified diseases of blood and blood-forming organs,Insulin pump status
DMI ketoacd uncontrold,Hx of past noncompliance,Elev transaminase/ldh,Blood diseases NEC,Insulin pump status
Admission Date:  [**2104-8-26**]              Discharge Date:   [**2104-8-28**]

Date of Birth:  [**2083-5-7**]             Sex:   F

Service: MEDICINE

Allergies:
No Known Allergies / Adverse Drug Reactions

Attending:[**First Name3 (LF) 594**]
Chief Complaint:
Nausea and fatigue

Major Surgical or Invasive Procedure:
None

History of Present Illness:
21 year old female with type I DM diagnosed age 14, presented
with nausea and hyperglycemia. She had discontinued her insulin
pump this summer because the pump was disconnecting with
activity. She transitioned herself to basal bolus regimen, but
has been having trouble staying with her schedule since college
began a few weeks ago. She has been having epigastric pressure
the past two weeks, and this morning had nausea, headache, and
fatigue with decreased appetite and increased abd pressure. She
noticed her BS 400's at home and went to the ED. Had nonbloody
emesis en route to ED. She denies fever, cough, sore throat. She
denies chest pain, SOB, or chest pressure. Denies diarrhea.
Denies dysuria, frequency, or urgency. No vaginal dc, LMP two
months ago, no oral contraceptive in past year, irregular menses
since then.

In the ED initial VS were: 98.9 122 112/78 30 97%
Remained afebrile, remained tachycardic, abdomen soft.
Initial K 4.6, AG 32, HCO3 12, BG 444.
ALT 103, AST 99, Alk Ph 200, T Bili 0.2, Alb 4.4, Lipase 28.
UA with glucose 1000, ketones 150, 8WBC, few bact, trace LE, 2
epi UCG -ve
WBC 6.4, H/H 15.3/46.7, MCV 101, platelets 444
RUQ US-> hepatomeg, no gallstone, no acute process
Given 40 IV K, 10U insulin, started on insulin gtt, given 2.5L
NS before transfer and 1gm cefriaxone.
Repeat K Glucose fell to 161 on insulin gtt, D5W started,
insulin gtt stopped.
On arrival to the MICU, she feels like her normal self, except
with some epigastric discomfort. She does not feel short of
breath.
Review of systems:
(+) Per HPI
(-) Denies fever, chills, night sweats, recent weight loss or
gain. Denies sinus tenderness, rhinorrhea or congestion. Denies
cough, shortness of breath, or wheezing. Denies chest pain,
chest pressure, palpitations, or weakness. Denies diarrhea,
constipation, or changes in bowel habits. Denies dysuria,
frequency, or urgency. Denies arthralgias or myalgias. Denies
rashes or skin changes.


Past Medical History:
Type I DM, diagnosed age 14, only prior episode DKA at 18
secondary to EtOH use

Social History:
Social History: College student, not currently sexually active,
no history of STD's, uses protection.
- Tobacco: Never
- Alcohol: 3-4 beers per weekend, no binging
- Illicits: Denies, including denies IVDU



Family History:
Family History:
Cousin and grandfather with [**Name (NI) 17095**], father had gallbladder removed


Physical Exam:
Vitals: T:98.9 BP: 128/109 P: 115 R: 33 O2:97% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, pupils
round/reactive
Neck: supple, no LAD
CV: Tachycardic, regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Lungs: No accessory muscle use, good air movement, bibasilar
crackles, no wheezes, rales, ronchi
Abdomen: Soft, some epigastric tenderness to deep palpation,
non-distended, hypoactive bowel sounds, no organomegaly.
Ext: warm, well perfused, 2+ pulses bilaterally, no clubbing,
cyanosis or edema
Neuro: 5/5 strength upper/lower extremities, grossly normal
sensation


Pertinent Results:
[**2104-8-26**] 05:27PM BLOOD WBC-6.4 RBC-4.64 Hgb-15.3 Hct-46.7
MCV-101* MCH-33.0* MCHC-32.9 RDW-13.0 Plt Ct-444*
[**2104-8-26**] 05:27PM BLOOD Neuts-51.8 Lymphs-43.3* Monos-3.1 Eos-0.7
Baso-1.0
[**2104-8-26**] 08:22PM BLOOD PT-9.2* PTT-27.3 INR(PT)-0.8*
[**2104-8-26**] 05:27PM BLOOD Glucose-520* UreaN-12 Creat-0.9 Na-135
K-4.6 Cl-91* HCO3-12* AnGap-37*
[**2104-8-26**] 05:27PM BLOOD ALT-103* AST-99* AlkPhos-200* TotBili-0.2
[**2104-8-26**] 05:27PM BLOOD Lipase-28
[**2104-8-26**] 05:27PM BLOOD Albumin-4.4
[**2104-8-26**] 10:43PM BLOOD Type-[**Last Name (un) **] Temp-36.9 pO2-34* pCO2-33*
pH-7.17* calTCO2-13* Base XS--16
[**2104-8-26**] 07:49PM BLOOD Lactate-2.3* K-3.6
[**2104-8-26**] 05:50PM URINE Color-Straw Appear-Clear Sp [**Last Name (un) **]-1.020
[**2104-8-26**] 05:50PM URINE Blood-NEG Nitrite-NEG Protein-NEG
Glucose-1000 Ketone-150 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-TR
[**2104-8-26**] 05:50PM URINE RBC-<1 WBC-8* Bacteri-FEW Yeast-NONE
Epi-2
[**2104-8-26**] 05:50PM URINE UCG-NEGATIVE

Brief Hospital Course:
21 yo F type I DM presenting with DKA.

MICU Course:
# DKA: Secondary to noncompliance. Not pregnant with neg HCG,
CXR clear for PNA, EKG unconcerning for MI, denies drug use. K
not sig elevated, anion gap closed with insulin bolus and gtt.
Sugars dropped swiftly prior to transfer to MICU, 444->141, gtt
was paused, sugars returned to 300's after gtt was restarted,
remained on ICU insulin protocol thereafter, pH 7.17.
Transitioned to SQ insulin with overlap 2hrs on gtt. Maintained
on D5 1/2NS with 40mEq K at 125/hr. [**Last Name (un) **] consulted and
recommended Lantus 27, HISS 5 units breakfast, 4 before lunch, 7
before dinner, correct 1:40 above 120, self reported carb
consumption 40g with breakfast, 30 with lunch, 60 with dinner.
Following transition to diabetic PO diet the patient's anion gap
was noted to remain closed and the patient was without
complaints.

# ?UTI: Patient with 7WBC on initial UA, received dose of
Ceftriaxone. Patient was asymptomatic and urine culture was
negative. No plan for further antibiotics.

Transition Issues:
# Transaminitis: Could be secondary to EtOH or critical illness
in setting of DKA alcohol. Elevated GGT, Fe studies normal, Hep
B Ab positive, Hep B SAg neg, HepC Ab neg, acetaminophen neg.
Transaminases trended down during stay.  Would recommend
re-evaluation of liver function tests in [**12-17**] months.

# Macrocytosis: Etiology unclear, not anemic. Considering
possible liver disease in context of transaminitis and DM. Would
recommend re-evaluation in [**12-17**] months.

Transitional Issues:
Follow up with PCP

Medications on Admission:
Lantus 27 units at 6PM
NovaLog SS

Discharge Medications:
Lantus 27 units at 6PM
NovaLog SS

Discharge Disposition:
Home

Discharge Diagnosis:
Diabetic Ketoacidosis.


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


Discharge Instructions:
Please continue to take your insulin as perscribed with pre-meal
insulin doses of 5units before breakfast, 4 before lunch and 7
before dinner. Please continue to carefully monitor your blood
glucose level.  Call your doctor or return to the hospital if
you have any of the warning signs listed below or any
new/concerning complaints.

Followup Instructions:
[**Last Name (un) **] Diabetes Center, within 1 week
Primary Care Physician, [**Name Initial (NameIs) 176**] 1-2 months
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Personal history of noncompliance with medical treatment, presenting hazards to health,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Other specified diseases of blood and blood-forming organs,Insulin pump status'}


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: Nausea and fatigue

PRESENT ILLNESS: 21 year old female with type I DM diagnosed age 14, presented
with nausea and hyperglycemia. She had discontinued her insulin
pump this summer because the pump was disconnecting with
activity. She transitioned herself to basal bolus regimen, but
has been having trouble staying with her schedule since college
began a few weeks ago. She has been having epigastric pressure
the past two weeks, and this morning had nausea, headache, and
fatigue with decreased appetite and increased abd pressure. She
noticed her BS 400's at home and went to the ED. Had nonbloody
emesis en route to ED. She denies fever, cough, sore throat. She
denies chest pain, SOB, or chest pressure. Denies diarrhea.
Denies dysuria, frequency, or urgency. No vaginal dc, LMP two
months ago, no oral contraceptive in past year, irregular menses
since then.

MEDICAL HISTORY: Type I DM, diagnosed age 14, only prior episode DKA at 18
secondary to EtOH use

MEDICATION ON ADMISSION: Lantus 27 units at 6PM
NovaLog SS

ALLERGIES: No Known Allergies / Adverse Drug Reactions

PHYSICAL EXAM: Vitals: T:98.9 BP: 128/109 P: 115 R: 33 O2:97% RA
General: Alert, oriented, no acute distress
HEENT: Sclera anicteric, MMM, oropharynx clear, pupils
round/reactive
Neck: supple, no LAD
CV: Tachycardic, regular rhythm, normal S1 + S2, no murmurs,
rubs, gallops
Lungs: No accessory muscle use, good air movement, bibasilar
crackles, no wheezes, rales, ronchi
Abdomen: Soft, some epigastric tenderness to deep palpation,
non-distended, hypoactive bowel sounds, no organomegaly.
Ext: warm, well perfused, 2+ pulses bilaterally, no clubbing,
cyanosis or edema
Neuro: 5/5 strength upper/lower extremities, grossly normal
sensation

FAMILY HISTORY: Family History:
Cousin and grandfather with [**Name (NI) 17095**], father had gallbladder removed

SOCIAL HISTORY: Social History: College student, not currently sexually active,
no history of STD's, uses protection.
- Tobacco: Never
- Alcohol: 3-4 beers per weekend, no binging
- Illicits: Denies, including denies IVDU 

### Response:
{'Diabetes with ketoacidosis, type I [juvenile type], uncontrolled,Personal history of noncompliance with medical treatment, presenting hazards to health,Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH],Other specified diseases of blood and blood-forming organs,Insulin pump status'}
