Diagnosis: Gastroenteritis.
Treatment: Inpatient admission.
The insurer denied the inpatient admission.
The denial is overturned.

The patient is a male child with history of some feeding difficulties. He presented to the ED with one-week history of vomiting initially once daily and up to three times on the day of presentation, one-day history of diarrhea having fifteen stools with mucus but no blood, tactile fever, and irritability. His mother was also having loose stools.

The patient was treated with Zofran and two IV fluid boluses followed by 1.5 maintenance IV fluids. Repeat labs revealed improved but still abnormal CO2 (11). He was able to tolerate some milk and ginger ale in the ED, but also passed several diarrhea stools. He was admitted for ongoing management of significant dehydration, ongoing diarrhea, and inability to keep up with fluid losses. While admitted, he had several episodes of emesis (mainly post-tussive), ongoing viral upper respiratory infection symptoms including skin rash, and slowly improving diarrhea. He was deemed stable for discharge to follow-up with his pediatrician in two to three days.

Yes, the Inpatient admission was medically necessary.

This young child presented to the ED with a prolonged course of vomiting and worsening diarrhea. He was moderately to severely dehydrated upon arrival, with dry lips, tachycardia, no tears with crying. Laboratory evidence supported the diagnosis, with CO2 9 and elevated lactate. He received two fluid boluses in the ED and was able to tolerate some ginger ale, Pedialyte, and milk. However, he continued to have profuse diarrhea and was not able to keep up with his fluid losses. He required hospitalization for ongoing parenteral fluid resuscitation until his stool losses slowed sufficiently. The entirety of his hospital stay was medically necessary and appropriate.