Diagnosis: Polyuria, polydisia, muscle cramps, and blurry vision
Treatment: Inpatient admission
The insurer denied the inpatient admission.
The denial is upheld.

The patient is a male with insulin-dependent diabetes, hypertension, and COPD (chronic obstructive pulmonary disease). He presented with polyuria, polydisia, muscle cramps, and blurry vision after not having taken insulin for two days.

The patient's glucose was 803 mg/dL (milligrams per deciliter), sodium 127, BUN (blood urea nitrogen) 34, creatinine 2.0, and venous pH (potential of hydrogen) 7.3. He was alert and oriented. His BP (blood pressure) was 102/57, and his heart rate was 65.

The patient was treated with intravenous fluids, potassium, and insulin. His creatinine improved to 1.3, CO2 (carbon dioxide) to 25, and glucose to 269 mg/dL (milligrams per deciliter).

The inpatient stay is the topic of this review.

No, the Inpatient admission was not medically necessary.

Patients with diabetic ketoacidosis can be safely managed in observation units unless they present with severe alteration of mental status or with critical illness such as sepsis [1], which is not documented in this case. This patient presented with hyperglycemia with known insulin-dependent diabetes. He had missed insulin therapy for two days. He presented with mild diabetic ketoacidosis with an initial pH (potential of hydrogen) of 7.3. His hyperglycemia quickly improved with intravenous hydration and insulin. He was hemodynamically stable. He had acute renal failure that quickly improved with hydration. This patient did not have alteration in his mental status, and the documentation does not support a diagnosis of hyperglycemic hyperosmolar syndrome. He was discharged the day after admission. Therefore, no, the proposed inpatient admission was not medically necessary.