Diagnosis: Alcohol Dependence, Rhabdomyolysis.
Treatment: Inpatient admission.
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a female with a history including HIV (human immunodeficiency virus) on HAART (highly active antiretroviral therapy), heart failure, MDD (major depressive disorder), HTN (hypertension), and CAD (coronary artery disease). She presented to the ED requesting alcohol detox. She had begun drinking one year prior. She drinks 3-40 oz beers daily. Her last drink was the morning PTA (prior to admission).

The patient's VS (vital signs) were as follows: T (temperature) 97.7, P (pulse) 94, RR (respiratory rate) 16, BP (blood pressure) 207/117. Her exam was unremarkable. Her labs were as follows: WBC (white blood count) 2.42, H/H (hemoglobin/hematocrit) 14.7/43.8, Na (sodium) 146, K (potassium) 3.8, BUN/Cr (blood urea nitrogen/creatinine) 13/.8. CXR (chest x-ray) revealed left middling nodule. EKG (electrocardiogram) revealed NSR (normal sinus rhythm), Q waves in V1-3, depression 3 F V4-6.

The patient was admitted. Plan of care included Ativan prn and CIWA (clinical institute withdrawal assessment) protocol, transfuse one-unit platelet for thrombocytopenia and start Decadron, check hepatitis B and C, monitor CBC (complete blood count) and LFTs (liver function tests).

No, the inpatient admission was not medically necessary.

This patient was admitted after presenting for alcohol detox. The patient was hemodynamically stable and afebrile. BP was elevated. She did not have tachycardia or arrhythmia. She did not have vomiting, delirium, seizures, or gross tremor. Labs were remarkable for thrombocytopenia. The patient was admitted with plan for platelet transfusion and CIWA protocol. The patient did not have signs of alcohol withdrawal during hospital stay. Hospital stay was primarily remarkable for workup of thrombocytopenia. The patient was clinically stable and did not have findings of severe alcohol withdrawal. She did not have symptoms that required an acute inpatient level of care. She had not failed management in a lesser level of care. The requested inpatient admission was not medically necessary.