Diagnosis: Vomiting
Treatment: Inpatient Admission
The insurer denied the Inpatient Admission.
The denial is overturned.

The patient is a female child with medical history significant for reactive airways disease presented to her pediatrician with ongoing vomiting and was seen in the ED. She was given Zofran and discharged. She continued to have vomiting multiple times daily. On the day of admission, she was again seen in the office. She had not had a wet diaper since the day prior and vomited immediately upon challenge. The patient was directly admitted to the pediatric floor for continued management of gastritis with dehydration. She was afebrile with no diarrhea. Vital signs included temperature 98, heart rate 130, respiratory rate 27, and blood pressure 100/70. Examination was significant for dry lips, crying without tears, coughing with post-tussive gagging, mild congestion, brisk capillary refill, tachycardia, non-tender abdomen with positive bowel sounds, and non-focal neurologic exam. She was given an additional diagnosis of acute upper respiratory infection.

This young child was admitted after a prolonged course of vomiting, having been to the pediatrician's office and ED multiple times, treated with Zofran with transient improvement. By the time of admission, she was unable to tolerate food or fluids, with significant decrease in urine output, moderately dehydrated on physical exam. She failed outpatient management and ED management, requiring acute inpatient admission for evaluation and hydration. She could not have been safely managed at a lower level of care. The entirety of the hospital stay was medically necessary and appropriate.