Diagnosis: vomiting
treatment: inpatient stay
The insurer denied an inpatient stay. The health plan's determination is overturned.

The patient is a girl with mild persistent asthma who presented with emesis, diarrhea, and upper respiratory symptoms.
She had presented to the emergency department (ED) the day prior to presentation and was diagnosed with viral gastroenteritis. She was discharged from the ED after receiving intravenous fluids, Zofran, and an oral challenge. Her electrolytes were within normal limits at that time. However, that evening, she had additional emesis and diarrhea. She subsequently had a near syncopal episode in the bathroom. Emergency services were called and her fingerstick glucose was 68. She was given some juice and then brought to the emergency department for evaluation.

Inpatient Hospital Stay was medically necessary for this patient, in order to provide treatment with intravenous fluids, assessment and evaluation for failure to thrive, and specialist consultation. According to the Milliman Care Guidelines (MCG) Health, Inpatient and Surgical Care Guidelines 26th edition, Syncope; hospital admission is indicated for patients with dehydration that is severe or persistent, which was the case for this patient.
This is a young girl who presented with near syncope, in the setting of multiple days of vomiting, diarrhea, and decreased oral intake. She was found to have low blood glucose at the time of presentation and was felt to be dehydrated and ill-appearing. She therefore required hospital admission for ongoing treatment with intravenous fluids, as well as assessment and evaluation for failure to thrive. She required consultation from a nutritionist, and ongoing intravenous fluids until she could fully support her hydration with oral intake.