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Metabolic Acidosis Icd 10

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What is DIABETIC KETOACIDOSIS? What does DIABETIC KETOACIDOSIS mean? DIABETIC KETOACIDOSIS meaning - DIABETIC KETOACIDOSIS definition - DIABETIC KETOACIDOSIS explanation. Source: Wikipedia.org article, adapted under https://creativecommons.org/licenses/... license. SUBSCRIBE to our Google Earth flights channel - https://www.youtube.com/channel/UC6Uu... Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion, and occasionally loss of consciousness. A person's breath may develop a specific smell. Onset of symptoms is usually rapid. In some cases people may not realize they previously had diabetes. DKA happens most often in those with type 1 diabetes, but can also occur in those with other types of diabetes under certain circumstances. Triggers may include infection, not taking insulin correctly, stroke, and certain medications such as steroids. DKA results from a shortage of insulin; in response the body switches to burning fatty acids which produces acidic ketone bodies. DKA is typically diagnosed when testing finds high blood sugar, low blood pH, and ketoacids in either the blood or urine. The primary treatment of DKA is with intravenous fluids and insulin. Depending on the severity, insulin may be given intravenously or by injection under the skin. Usually potassium is also needed to prevent the development of low blood potassium. Throughout treatment blood sugar and potassium levels should be regularly checked. Antibiotics may be required in those with an underlying infection. In those with severely low blood pH, sodium bicarbonate may be given; however, its use is of unclear benefit and typically not recommended. Rates of DKA vary around the world. About 4% of people with type 1 diabetes in United Kingdom develop DKA a year, while in Malaysia the condition affects about 25% a year. DKA was first described in 1886 and, until the introduction of insulin therapy in the 1920s, it was almost universally fatal. The risk of death with adequate and timely treatment is currently around 1–4%. Up to 1% of children with DKA develop a complication known as cerebral edema. The symptoms of an episode of diabetic ketoacidosis usually evolve over a period of about 24 hours. Predominant symptoms are nausea and vomiting, pronounced thirst, excessive urine production and abdominal pain that may be severe. Those who measure their glucose levels themselves may notice hyperglycemia (high blood sugar levels). In severe DKA, breathing becomes labored and of a deep, gasping character (a state referred to as "Kussmaul respiration"). The abdomen may be tender to the point that an acute abdomen may be suspected, such as acute pancreatitis, appendicitis or gastrointestinal perforation. Coffee ground vomiting (vomiting of altered blood) occurs in a minority of people; this tends to originate from erosion of the esophagus. In severe DKA, there may be confusion, lethargy, stupor or even coma (a marked decrease in the level of consciousness). On physical examination there is usually clinical evidence of dehydration, such as a dry mouth and decreased skin turgor. If the dehydration is profound enough to cause a decrease in the circulating blood volume, tachycardia (a fast heart rate) and low blood pressure may be observed. Often, a "ketotic" odor is present, which is often described as "fruity", often compared to the smell of pear drops whose scent is a ketone. If Kussmaul respiration is present, this is reflected in an increased respiratory rate.....

Alcoholic Ketoacidosis

Increased production of ketone bodies due to: Dehydration (nausea/vomiting, ADH inhibition) leads to increased stress hormone production leading to ketone formation Depleted glycogen stores in the liver (malnutrition/decrease carbohydrate intake) Elevated ratio of NADH/NAD due to ethanol metabolism Increased free fatty acid production Elevated NADH/NAD ratio leads to the predominate production of β–hydroxybutyrate (BHB) over acetoacetate (AcAc) Dehydration Fever absent unless there is an underlying infection Tachycardia (common) due to: Dehydration with associated orthostatic changes Concurrent alcohol withdrawal Tachypnea: Common Deep, rapid, Kussmaul respirations frequently present Nausea and vomiting Abdominal pain (nausea, vomiting, and abdominal pain are the most common symptoms): Usually diffuse with nonspecific tenderness Epigastric pain common Rebound tenderness, abdominal distension, hypoactive bowel sounds uncommon Mandates a search for an alternative, coexistent illness Decreased urinary output from hypovolemia Mental status: Minimally altered as a result of hypovolemia and possibly intoxication Altered mental status mandates a search for other associated conditions s Continue reading >>

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  1. One of our CDI noted an elevated lactic acid and queried the physician for a diagnosis. The patient did not have Sepsis. Our physician advisor said not to do that because the next lactic acid was normal. She said we should also be looking for the underlying cause of the lactic acidosis and not querying for the diagnosis. A diagnosis of lactic acidosis will give us a CC. Other CDI's have said that if the elevated lactic acid was treated, monitored or evaluated we should be querying for the diagnosis. Does anyone have any direction on how this should be handled?
    Is lactic acidosis always inherent in other conditions and that's what we should focus on?
    What can we pick up the diagnosis by itself as a CC / when should we query to get to documented in the chart?
    Are there any other clinical parameters we should be looking at when evaluating whether we should query such as the anion gap?
    Is there a specific treatment for metabolic acidosis?
    Thank you,
    Christine Butka RN MSN
    CDI Lead
    CentraState Medical Center
    Freehold, NJ

  2. What a timely comment. Recently, our coding auditor suggested that we should always keep an eye out for the cc "acidosis". It seems to me that lactic acidosis could be inherent to the disease process of sepsis and therefore should not be captured. Any thoughts?
    Yvonne B RN CDI Salinas, CA.

  3. Hello all! I agree, I believe lactic acidosis is inherent to sepsis. It is one of the most important indicators that gives the clnician a clue that sepsis may be present. Our fluid administration policy was actually developed on the lactic acid result: the higher the number, the more fluid we bolused (in non-CHF patients, of course). In cases were Sepsis is determined not to be present, we will query the provider, providing they treated or monitored the acidosis in some manner
    Shiloh

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Anion gap usmle - anion gap metabolic acidosis normal anion gap metabolic acidosis

Search Page 1/10: Metabolic Acidosis

Arthropathy assoc w metabolic disorder; Arthropathy due to a metabolic disorder; Arthropathy due to metabolic disorder; Arthropathy with metabolic disorder; Bilateral corneal deposits in metabolic disorders; Cardiomyopathy, metabolic; Corneal deposit associated with metabolic disorder; Corneal deposits in metabolic disorders; Corneal deposits in metabolic disorders, both eyes; Enzymopathy; Inborn error of metabolism; Left corneal deposits in metabolic disorders; Metabolic cardiomyopathy; Metabolic disease; Metabolism disorder; Multiple carboxylase deficiency; Right corneal deposits in metabolic disorders 2016 2017 2018 Non-Billable/Non-Specific Code P19.0 Metabolic acidemia in newborn first noted bef... P19.1 Metabolic acidemia in newborn first noted dur... Encounter for screening for other metabolic disorders Screening for endocrine, nutritional, metabolic and immunity disorders done; Screening for endocrine, nutritional, metabolic, and immunity disorders; Screening for metabolic disease; Screening for metabolic disorder done Encounter for screening for other metabolic disorders 2016 2017 2018 Billable/Specific Code POA Exempt Drug resistance to insulin; Dysmetabolic syndrome x; Continue reading >>

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  1. One of our CDI noted an elevated lactic acid and queried the physician for a diagnosis. The patient did not have Sepsis. Our physician advisor said not to do that because the next lactic acid was normal. She said we should also be looking for the underlying cause of the lactic acidosis and not querying for the diagnosis. A diagnosis of lactic acidosis will give us a CC. Other CDI's have said that if the elevated lactic acid was treated, monitored or evaluated we should be querying for the diagnosis. Does anyone have any direction on how this should be handled?
    Is lactic acidosis always inherent in other conditions and that's what we should focus on?
    What can we pick up the diagnosis by itself as a CC / when should we query to get to documented in the chart?
    Are there any other clinical parameters we should be looking at when evaluating whether we should query such as the anion gap?
    Is there a specific treatment for metabolic acidosis?
    Thank you,
    Christine Butka RN MSN
    CDI Lead
    CentraState Medical Center
    Freehold, NJ

  2. What a timely comment. Recently, our coding auditor suggested that we should always keep an eye out for the cc "acidosis". It seems to me that lactic acidosis could be inherent to the disease process of sepsis and therefore should not be captured. Any thoughts?
    Yvonne B RN CDI Salinas, CA.

  3. Hello all! I agree, I believe lactic acidosis is inherent to sepsis. It is one of the most important indicators that gives the clnician a clue that sepsis may be present. Our fluid administration policy was actually developed on the lactic acid result: the higher the number, the more fluid we bolused (in non-CHF patients, of course). In cases were Sepsis is determined not to be present, we will query the provider, providing they treated or monitored the acidosis in some manner
    Shiloh

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http://www.icd10forkindergarten.com http://www.pacecoding.com

Icd-10 Challenges In The Neonatal World

Association of Clinical Documentation Improvement Specialists, January 1, 2016 ICD-10-CM/PCS brought some new challenges in coding neonatal records. The term newborn has replaced the term fetus or newborn in the ICD- 10-CM code set. This change ensures that these codes will only be used on the neonates records. Gestational age is only captured in the preterm (36 weeks or less) or the post-term neonate (4042 weeks). The mapping of gestational age uses the keywords preterm, prematurity, or post-term as the term gestational is no longer recognized. The encoder mapping has changed in ICD-10-CM/ PCS, which has made locating the appropriate neonatal codes problematic. Many CDI specialists depend on their encoder, which may not lead down the appropriate pathway for code assignment. Therefore, CDI specialists should develop their knowledge of the ICD-10-CM code set and use the Tabular List of Diseases to ensure accurate code assignment. Some congenital abnormalities have been further specified in ICD-10-CM, which assists in capturing the appropriate code. Propionic acidemia, an inherited metabolic disorder, was difficult to capture in ICD-9-CM, as it mapped incorrectly to acidosis as oppo Continue reading >>

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  1. Laurie R Zawiskie, RHIT

    Has anyone tried to code DKA in a patient with DM 2? The 3M encoder takes you to the code for secondary/other diabetes and then when you try to code other diabetic manifestations you get an excludes 1 notes saying they can't be coded with other diabetes. My code book is a 2014 draft, so I don't know if this has been corrected in the 2015 version, but there is not an entry for DM 2 with DKA. I think the 3M encoder is wrong to code it as secondary/other diabetes, but I can't find another way to code it.

  2. Lynn M Farnung

    Laurie,
    There is a Coding Clinic that addresses the type of DM with DKA. I have pasted it below.
    Diabetes mellitus with diabetic ketoacidosis
    Coding Clinic, First Quarter 2013 Page: 26-27 Effective with discharges: March 27, 2013
    Related Information
    Question:
    What is the correct code assignment for type 2 diabetes mellitus with diabetic ketoacidosis?
    Answer:
    Assign code E13.10, Other specified diabetes mellitus with ketoacidosis without coma, for a patient with type 2 diabetes with ketoacidosis. Given the less than perfect limited choices, it was felt that it would be clinically important to identify the fact that the patient has ketoacidosis. The National Center for Health Statistics (NCHS), who has oversight for volumes I and II of ICD-10-CM, has agreed to consider a future ICD-10-CM Coordination and Maintenance Committee meeting proposal.
    © Copyright 1984-2015, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA. ------------------------------
    Lynn Farnung
    Inpatient/Outpatient coder, AHIMA Approved ICD-10 Trainer
    Original Message

  3. Laurie R Zawiskie, RHIT

    Thanks, Lynn. If a patient also has DM 2 w/nephropathy (E11.21), I guess we will have to ignore the Excludes 1 note that says E13.10 can't be coded with Type 2 DM (E11.-).
    ------------------------------
    Laurie Zawiskie
    Coder III
    Original Message

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