Why Is There Acidosis In Dka?

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A Physicochemical Acid-base Approach For Managing Diabetic Ketoacidosis

LETTER TO THE EDITOR Alexandre Toledo Maciel; Marcelo Park Medical Emergencies, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo/SP, Brazil. Email: [email protected] Tel: 55 11 3069.6336 INTRODUCTION Diabetic ketoacidosis (DKA) is one of the most serious acute metabolic complications of diabetes. It is characterized by the biochemical triad of hyperglycemia, ketonemia/ketonuria, and an increased anion gap (AG) metabolic acidosis. Unless it is relatively mild, DKA is usually managed in the intensive care unit (ICU), and treatment involves a continuous infusion of intravenous (IV) insulin, correction of water and electrolytes deficits, and treatment of the underlying precipitating factors. Patients are commonly discharged from the ICU when criteria of DKA resolution are met (glucose < 200 mg/dl, serum bicarbonate > 18 mEq/l, venous pH > 7.3 and calculated AG < 12 mEq/l)1 and an IV insulin infusion is no longer necessary. However, serum bicarbonate levels have serious limitations as a surrogate of underlying metabolic disturbances (due to an interdependence with pCO2 and it does not reveal, per se, the main acid responsible for the Continue reading >>

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  1. Dm 2 with ketoacidosis

    I had a case to code a couple of days ago; patient had "diabetic ketoacidosis." There was no description as to the type of diabetes, so I went with type 2. At this point, I noticed there are combination codes for DM 1, DM due to drug or chemical, due to underlying condition and specified type NEC, but there is no combination code for DM 2 with ketoacidosis. I coded it as DM 2 with complication NEC E11.69 and Ketoacidosis E87.2. The doctor gave an additional diagnosis of lactic acidosis, which is also coded as E87.2. Does anyone have any insights on a better way to code this, or the rationale of not having a combination code for DM type 2 with ketoacidosis? (Incidentally, the patient also had urogenital warts, severe sepsis present on admission, and there was no mention of any kind kidney malfunction.)

  2. I found an answer on another thread that indicated to go with "DM specified type NEC with ketoacidosis (without coma) E13.10" instead of DM 2 with complication NEC E11.69 and ketoacidosis E87.2 (even though the type of diabetes is not specified); seems strange, but I guess that's what I'll do if it ever comes up again.

  3. rbandaru

    As per coding Clinic Diabetic with ketoacidosis code is E13.10 below is reference from coding Clinic.
    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
    Dr.Ramnath Bandaru, CCS, CPC
    American Medical Services LLC
    Twitter: @HospitalCoders

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