Endocrine
Inpatient hospital

Diagnosis: Hyponatremia
Treatment; Inpatient stay
The insurer denied the inpatient stay. The health plan's determination is overturned.

The patient is a woman with history of diabetes who was admitted to the hospital. She was referred from urgent care for a sodium level of 118. She reported having nausea and vomiting for several days. She also reported having diarrhea and said she had been drinking substantial amounts of water. Review of systems was negative for fevers and chills. Vital signs showed temperature 98.4 Fahrenheit, heart rate 104, and blood pressure 116/74. On physical exam, heart was regular, breath sounds were normal and there was no cranial nerve deficit. Abdomen was soft and nontender. The patient was admitted for hyponatremia.

The Emergent Hospital Admission was medically necessary for this patient.

The reason is that the patient had a sodium level less than 120 mEq (milliequivalents) per liter, and therefore had severe hyponatremia. Patients with severe hyponatremia can develop life-threatening complications such as cerebral edema and neurologic disability from osmotic demyelination during the process of correction. These patients require the inpatient level of care for close monitoring and frequent checks of sodium levels.

Severe hyponatremia is treated at the inpatient level of care and requires careful correction to ensure that the sodium level does not change by more than approximately 8 mEq per liter per day. Patients with rapid correction may develop osmotic demyelination, mental status changes, and neurologic disability. When sodium levels are below 120 mEq, patients are typically managed at the inpatient level of care and are sometimes managed in the intensive care unit with hypertonic saline.