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Alcoholic Ketoacidosis Uptodate

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Ketone Body @ :: Xuite

False-negative nitroprusside testingFalse-negative results can occur by the following mechanism. Nitroprusside reacts with acetoacetateand, to a lesser degree, acetone (which is not an acid)butnot with beta-hydroxybutyrate. This is an important limitation since alcohol metabolism causes a redox shift toward NADH which drives the reaction toward beta-hydroxybutyrate. As a result, the ratio of beta-hydroxybutyrate to acetoacetate, which is normally 1:1 and increases to 3:1 in diabetic ketoacidosis, may increase to 10:1 in alcoholic ketoacidosis [ 27 ]. Thus, in most patients with alcoholic ketoacidosis, nitroprusside testsunderestimatethe degree of ketone bodies in plasma, and some patients may have negative tests [ 7,9 ]. It has been suggested that the sensitivity of the urine nitroprusside test can be improved by adding a few drops of hydrogen peroxide to a urine specimen in an attempt to nonenzymatically convert beta-hydroxybutyrate into acetoacetate. However, several studies have shown that this approach isnotclinically useful [ 33,34 ]. Continue reading >>

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  1. georgeth

    AAPC Community Wiki: ICD-10 Uncontrolled DM TYPE 2 Wih Neuropathy

    Code: E11.21
    Code Name: ICD-10 Code for Type 2 diabetes mellitus with diabetic nephropathy
    Block: Diabetes mellitus (E08-E13)
    Details: Type 2 diabetes mellitus with diabetic nephropathy
    Type 2 diabetes mellitus with intercapillary glomerulosclerosis
    Type 2 diabetes mellitus with intracapillary glomerulonephrosis
    Type 2 diabetes mellitus with Kimmelstiel-Wilson disease
    E11
    Use additional code to identify control using:insulin (Z79.4)
    oral antidiabetic drugs (Z79.84)
    oral hypoglycemic drugs (Z79.84)
    Includes: diabetes (mellitus) due to insulin secretory defect
    diabetes NOS
    insulin resistant diabetes (mellitus)
    Excludes1: diabetes mellitus due to underlying condition (E08.-)
    drug or chemical induced diabetes mellitus (E09.-)
    gestational diabetes (O24.4-)
    neonatal diabetes mellitus (P70.2)
    postpancreatectomy diabetes mellitus (E13.-)
    postprocedural diabetes mellitus (E13.-)
    secondary diabetes mellitus NEC (E13.-)
    type 1 diabetes mellitus (E10.-)
    Guidelines: Endocrine, nutritional and metabolic diseases (E00-E89)
    Excludes 1:transitory endocrine and metabolic disorders specific to newborn (P70-P74)
    Note: All neoplasms, whether functionally active or not, are classified in Chapter 2. Appropriate codes in this chapter (i.e. E05.8, E07.0, E16-E31, E34.-) may be used as additional codes to indicate either functional activity by neoplasms and ectopic endocrine tissue or hyperfunction and hypofunction of endocrine glands associated with neoplasms and other conditions classified elsewhere.
    For more details on E11.21, ICD-10 Code for Type 2 diabetes mellitus with diabetic nephropathy , visit: https://coder.aapc.com/icd-10-codes/

  2. second to none

    Hi ICD-10 Coders,
    How you will code in icd-10 DM type 2 with diabetic Neuropathy uncontrolled? I coded as E11.40 for diabetic neuropaty and E11.65 for uncontrolled Diabetes. Is this correct? or do I have to use only E11.40? I know that in ICD-10 we do not have Uncontrolled anymore but the provider documented because the patient Blood Sugar was High. He did not say anything about hypergycemia.

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