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

This is a male patient with a past medical history (PMH) of diabetes insipidus who was admitted with complaints of (c/o) syncope while having a bowel movement (BM) associated with nausea, vomiting, dizziness, and decreased by mouth (PO) intake. His vital signs were unremarkable. The physical exam was unremarkable. Lab work was notable for a sodium of 117. Imaging studies included a chest x-ray (CXR) which showed no acute pathology. An electrocardiogram (EKG) showed normal sinus rhythm (NSR) without acute ischemia. The patient was diagnosed with symptomatic hyponatremia and syncope and treated with intravenous fluids (IVF) and desmopressin, every six hour (q6h) basic metabolic panel (BMP), and expert consultations. The patient was discharged in stable condition. At issue is the medical necessity of an inpatient level of care.

Yes, the hospital stay was medically necessary at an acute inpatient level of care. This patient presented to the emergency department (ED) with c/o syncope while having a BM associated with nausea, vomiting, dizziness, and decreased PO intake. The patient was found to have a sodium level of 117, and thus, the patient presented with severe and symptomatic hyponatremia. In addition, the patient was at risk of seizures, obtundation, coma, and respiratory arrest, as well as the severe complication of osmotic demyelination and/or cerebral edema. Overall, this patient presented with symptomatic hyponatremia, which required close monitoring to ensure there was no over-correction, neurological checks, and expert consultation, and could not have been safely accomplished at a lower level of care while the patient was receiving treatment.