{"patient_id":"P15","encounter_id":"KE-P15","note_id":"KN-P15-1","signed":false,"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":2,"needs_look_kidney":1,"surfaced":[{"source":"kidney","family":"aki"},{"source":"kidney","family":"kidney"},{"source":"library","family":"potassium"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00015","replay_hash":"8f35978ee48431945b7216c52e6074cb8bc84623f683ae610db23438b907c588","measurement_replay_hash":"e845f978a01abc2bfafe23417cd94af52b8a66ab5883e3458b625301b5690a4f","engine":"kidney-engine 2.0","rules":[{"rule":"ckd_epi_2009@1.0","source":"Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)","url":"https://www.acpjournals.org/doi/10.7326/0003-4819-150-9-200905050-00006"},{"rule":"ckd_epi_2021@1.0","source":"Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)","url":"https://www.kidney.org/ckd-epi-creatinine-equation-2021"},{"rule":"kdigo_aki_2012@1.1","source":"KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)","url":"https://kdigo.org/guidelines/acute-kidney-injury/"},{"rule":"kdigo_ckd_2024@1.1","source":"KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"kidney_compare@1.1","source":"Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update","url":"https://www.cms.gov/medicare/coding-billing/icd-10-codes"},{"rule":"kidney_exclusions@1.0","source":"KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"lab_units@1.1","source":"KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"}],"last_replay":null,"library":{"run_id":"LRUN-00015","encounter_id":"KE-P15","note_id":"KN-P15-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"7ec5fd4e26dc2335f0611de06df1a6a736b9715c47b7517905d5bb11adfbba19","measurement_replay_hash":"daa49e0bba824e02db22e6b083f44c7d0733c1565456e2db9c4b2decf0a2138e","surfaced":[{"family":"potassium","topic":"Potassium","direction":"UNDER","status":"needs_look","label":"Needs a look","icon":"●","lead":"","quote":null,"text":"Potassium 5.8 mmol/L on 2026-11-12 15:00 meets the published definition's criteria for the category “'mild' band (5.5 to 5.9 mmol/L)” (ukka2026_hyperkalaemia@1.0). The note doesn't mention this.","sentence":"Potassium 5.8 mmol/L on 2026-11-12 15:00 meets the published definition's criteria for the category “'mild' band (5.5 to 5.9 mmol/L)” (ukka2026_hyperkalaemia@1.0). The note doesn't mention this.","threshold":"Threshold for this category (ukka2026_hyperkalaemia@1.0): potassium ≥ 5.5 mmol/L and potassium < 6 mmol/L.","span":null,"note_mentions":false,"lab_ids":["LM-P15-02"],"definition":"ukka2026_hyperkalaemia@1.0","version":"1.0","tier":"measured","values":"potassium 5.8 mmol/L on 2026-11-12 15:00","alternatives":[],"contested":true,"contested_text":"Published bodies disagree on these thresholds; another definition may give a different answer.","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://www.ukkidney.org/sites/default/files/documents/FINAL%20VERSION%20-%20UKKA%20CLINICAL%20PRACTICE%20GUIDELINE%20-%20MANAGEMENT%20OF%20HYPERKALAEMIA%20IN%20ADULTS%20-%20UPDATED%20JULY%202026_0.pdf","optional_set":null,"cite":{"id":"ukka2026_hyperkalaemia@1.0","title":"Clinical Practice Guidelines: Treatment of Acute Hyperkalaemia in Adults","body":"UK Kidney Association","edition":"updated July 2026","year":2026,"url":"https://www.ukkidney.org/sites/default/files/documents/FINAL%20VERSION%20-%20UKKA%20CLINICAL%20PRACTICE%20GUIDELINE%20-%20MANAGEMENT%20OF%20HYPERKALAEMIA%20IN%20ADULTS%20-%20UPDATED%20JULY%202026_0.pdf","locator":"Introduction, document page 9 (PDF page 10)","quote":"It is further classified by severity into mild (5.5-5.9 mmol/l), moderate (6.0-6.4 mmol/l) or severe (≥ 6.5 mmol/l).","accessed":"2026-11-14"}}],"more":[{"family":"lactate","topic":"Lactate","direction":"JUDGEMENT","status":"neutral","label":"Needs your clinical judgement","icon":"◆","lead":"","quote":null,"text":"Lactate 2.6 mmol/L on 2026-11-11 15:10: the record shows these values; this needs your clinical judgement (sepsis3_septic_shock_lactate@1.0 uses them as one part of a wider clinical picture, category “lactate above 2 mmol/L”).","sentence":"Lactate 2.6 mmol/L on 2026-11-11 15:10: the record shows these values; this needs your clinical judgement (sepsis3_septic_shock_lactate@1.0 uses them as one part of a wider clinical picture, category “lactate above 2 mmol/L”).","threshold":"Threshold for this category (sepsis3_septic_shock_lactate@1.0): lactate > 2 mmol/L.","span":null,"note_mentions":false,"lab_ids":["LM-P15-03"],"definition":"sepsis3_septic_shock_lactate@1.0","version":"1.0","tier":"judgement","values":"lactate 2.6 mmol/L on 2026-11-11 15:10","alternatives":[],"contested":false,"contested_text":"","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC4968574/","optional_set":null,"cite":{"id":"sepsis3_septic_shock_lactate@1.0","title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","body":"Society of Critical Care Medicine and European Society of Intensive Care Medicine task force (JAMA 2016;315:801-810)","edition":"2016","year":2016,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC4968574/","locator":"Box 3 'New Terms and Definitions'","quote":"persisting hypotension requiring vasopressors to maintain MAP ≥65 mm Hg and having a serum lactate level >2 mmol/L (18mg/dL) despite adequate volume resuscitation","accessed":"2026-11-14"}}],"n_needs":1,"limit":2,"dismissed":0,"ctcae_on":false,"draft_label":"Draft definition: pending clinical and coding review","dismiss_reasons":{"addressed_elsewhere":"Already addressed elsewhere in the record","not_representative":"Values not representative (for example acute illness or a lab error)","not_relevant":"Not relevant to this visit","definition_not_applicable":"The definition does not apply to this patient","other":"Other (explain)"}},"findings":[{"family":"aki","topic":"Creatinine change during this stay","status":"needs_look","label":"Needs a look","sentence":"Creatinine rose by 0.4 mg/dL within 24 hours during this stay (peak 1.6 mg/dL); the note doesn't mention a change in kidney function.","quote":null,"threshold":"Threshold: creatinine up by 0.3 mg/dL within 48 hours, or to 1.5 times an earlier value. Urine output is not checked.","span":null,"note_mentions":false,"lab_ids":["L-0033","L-0034"]},{"family":"kidney","topic":"Kidney function over time","status":"not_assessable","label":"Not assessable","sentence":"Could not check kidney function: there is no usable creatinine result outside an acute change.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":null,"note_mentions":false,"lab_ids":["L-0033","L-0034"]}]}