No.
New patient admit for a heart attack and non-ketotic hyperosmolar state.
So, the heart attack was secondary to the non-ketotic hyperosmolar state, which was secondary to a urinary tract infection, which was secondary to a kidney stone, which was secondary to dehydration, which was secondary to nausea/vomiting, which was secondary to using ipecac recreationally, which was secondary to a sexual fetish for vomiting.
...you really needed to see the face of the medical team when we discussed this. Priceless.