Diagnosis: Cyclic vomiting and diabetic ketoacidosis
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is overturned.
The Acute Inpatient Admission was medically necessary.

This patient is a male with hypertension, type-1 diabetes, and history of cyclic vomiting, who presented with multiple episodes of vomiting, diarrhea, and abdominal pain after heavy marijuana use.

The patient's blood pressure was 204/91, heart rate 64, temp 97.9, pH 7.31. He was unable to tolerate oral intake in the emergency room. He was treated with intravenous fluids and insulin, potassium, Procardia, Zofran, and Pepcid.

This patient was admitted with cyclical vomiting and diabetic ketoacidosis. This patient was medically unstable due to ongoing vomiting and diabetic ketoacidosis, which required an inpatient stay. This patient had ongoing vomiting until the day before discharge and was unable to tolerate oral intake. In addition, he had ongoing acidosis with a CO2 level of 17. Therefore, the inpatient stay was medically necessary due to ongoing vomiting and diabetic ketoacidosis. If the patient had been discharged earlier, he would have been at high risk of readmission for worsening diabetic ketoacidosis in the setting of ongoing acidosis. Therefore, yes, the proposed inpatient stay was medically necessary.