Hypocalcemia, severe or symptomatic: Difference between revisions
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== Additional Info == | == Additional Info == | ||
{{ICD10 Guideline repeated events}} | |||
=== Thresholds for pts with regular albumin levels === | |||
*The parameters for coding hypocalcemia are any of the following 3 items: (This change is active as of Feb 12, 2018) | *The parameters for coding hypocalcemia are any of the following 3 items: (This change is active as of Feb 12, 2018) | ||
**Ca++ < 1.8 '''OR''' | **'''Ca++ < 1.8 '''OR''' | ||
**Any Ca++ < 2.2 AND in the presence of signs or symptoms believed to be due to hypocalcemia '''OR''' | **'''Any Ca++ < 2.2 AND in the presence of signs or symptoms believed to be due to hypocalcemia''' '''OR''' | ||
**Any Ca++ < 2.2 with active treatment for hypocalcemia | **'''Any Ca++ < 2.2 with active treatment for hypocalcemia ''' | ||
=== Thresholds for pts with hypoalbuminemia === | |||
For patients with substantial hypoalbuminemia using total calcium to define hypcalcemia is a problem. | |||
* These cutoff numbers are all for total serum calcium. But it's actually the ionized serum calcium that's relevant and causes symptoms when high or low -- AND the usual range for total calcium is altered (downwards) in patients with low serum albumin. So you can have a completely normal ionized calcium with a very low total calcium if the albumin is significantly low. Furthermore, the old "correction" of total calcium for measured albumin does not work well at all. Thus, to identify truly low circulating calcium in the presence of more than trivial hypoalbuminemia, it's necessary to measure an ionized calcium. | |||
**So to diagnose ionized hypocalcemia use these thresholds for ionized (not total) serum calcium: | |||
***'''Ca++ <0.9 regardless, OR <1.15 with symptoms or being treated for it''' | |||
=== Signs and symptoms === | |||
*Main signs and symptoms of hypocalcemia are: | *Main signs and symptoms of hypocalcemia are: | ||
**GI - nausea\vomiting, abdominal pain | **GI - nausea\vomiting, abdominal pain | ||
**Neuromuscular - paresthesias (esp. acral, perioral), muscle cramps\spasms, hyperreflexia | **Neuromuscular - paresthesias (esp. acral, perioral), muscle cramps\spasms, hyperreflexia, tetany, weakness, fatigue, seizures, extrapyramidal movement disorders, abnormal EEG | ||
**cardiovascular - long QT interval, hypotension (if acute), arrythmias | **cardiovascular - long QT interval, hypotension (if acute), arrythmias | ||
**miscellaneous - secondary hypoparathyroidism | **miscellaneous - secondary hypoparathyroidism | ||
== Alternate ICD10s to consider coding instead or in addition == | == Alternate ICD10s to consider coding instead or in addition == | ||
Latest revision as of 12:16, 2019 July 24
| ICD10 Diagnosis | |
| Dx: | Hypocalcemia, severe or symptomatic |
| ICD10 code: | E83.51 |
| Pre-ICD10 counterpart: | Hypocalcemia Ca Less Than 1.8 |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | 2019-0: Metabolic/Renal NOS, 2019-0: Renal/Metabolic NOS |
| Start Date: | |
| Stop Date: | |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
Additional Info
Repeated events
If this happens repeatedly during the same ward or unit stay, only code it the first time it happens, regardless of whether it is an Admit Diagnosis or Acquired Diagnosis, rather than each time it happens. See ICD10 codes only coded the first time for other diagnoses coded this way.
| Example: |
|
Thresholds for pts with regular albumin levels
- The parameters for coding hypocalcemia are any of the following 3 items: (This change is active as of Feb 12, 2018)
- Ca++ < 1.8 OR
- Any Ca++ < 2.2 AND in the presence of signs or symptoms believed to be due to hypocalcemia OR
- Any Ca++ < 2.2 with active treatment for hypocalcemia
Thresholds for pts with hypoalbuminemia
For patients with substantial hypoalbuminemia using total calcium to define hypcalcemia is a problem.
- These cutoff numbers are all for total serum calcium. But it's actually the ionized serum calcium that's relevant and causes symptoms when high or low -- AND the usual range for total calcium is altered (downwards) in patients with low serum albumin. So you can have a completely normal ionized calcium with a very low total calcium if the albumin is significantly low. Furthermore, the old "correction" of total calcium for measured albumin does not work well at all. Thus, to identify truly low circulating calcium in the presence of more than trivial hypoalbuminemia, it's necessary to measure an ionized calcium.
- So to diagnose ionized hypocalcemia use these thresholds for ionized (not total) serum calcium:
- Ca++ <0.9 regardless, OR <1.15 with symptoms or being treated for it
- So to diagnose ionized hypocalcemia use these thresholds for ionized (not total) serum calcium:
Signs and symptoms
- Main signs and symptoms of hypocalcemia are:
- GI - nausea\vomiting, abdominal pain
- Neuromuscular - paresthesias (esp. acral, perioral), muscle cramps\spasms, hyperreflexia, tetany, weakness, fatigue, seizures, extrapyramidal movement disorders, abnormal EEG
- cardiovascular - long QT interval, hypotension (if acute), arrythmias
- miscellaneous - secondary hypoparathyroidism
Alternate ICD10s to consider coding instead or in addition
- Tetany
- Disorder of mineral metabolism, NOS
- Electrolyte disorder, NOS
- Hyperparathyroidism
- Parathyroid disorder, NOS
- Cushing's syndrome, NOS
- Vitamin D deficiency
Candidate Combined ICD10 codes
Related CCI Codes
Data Integrity Checks (automatic list)
none found
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