{"patient_id":"P16","encounter_id":"KE-P16","note_id":"KN-P16-1","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":"hypoglycaemia"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00016","replay_hash":"8a72ad4b8c268c971aeb3fac1fe8446daac0a123ef772121d06b5aa7e4784180","measurement_replay_hash":"d5f215bda06c68dce1eea300320a125f58a08fc06ecdae1a046d6821b1190eb8","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-00016","encounter_id":"KE-P16","note_id":"KN-P16-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"df3873637fe81bb6c979d8f34803e2dbea15efccc5393f5d5c426cc7ed548e9d","measurement_replay_hash":"43a12bb6d840ee2353691d06b7acd8022a2bed173d5e9f09400976951726b9d3","surfaced":[{"family":"hypoglycaemia","topic":"Low glucose values","direction":"UNDER","status":"needs_look","label":"Needs a look","icon":"●","lead":"","quote":null,"text":"Glucose 62 mg/dL on 2026-11-12 06:00 meets the published definition's criteria for the category “level 1 (glucose 54 to below 70 mg/dL)” (ada2026_hypoglycaemia@1.0). The note doesn't mention this.","sentence":"Glucose 62 mg/dL on 2026-11-12 06:00 meets the published definition's criteria for the category “level 1 (glucose 54 to below 70 mg/dL)” (ada2026_hypoglycaemia@1.0). The note doesn't mention this.","threshold":"Threshold for this category (ada2026_hypoglycaemia@1.0): glucose ≥ 54 mg/dL and glucose < 70 mg/dL.","span":null,"note_mentions":false,"lab_ids":["LM-P16-04"],"definition":"ada2026_hypoglycaemia@1.0","version":"1.0","tier":"measured","values":"glucose 62 mg/dL on 2026-11-12 06:00","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://pmc.ncbi.nlm.nih.gov/articles/PMC12690178/","optional_set":null,"cite":{"id":"ada2026_hypoglycaemia@1.0","title":"6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes—2026","body":"American Diabetes Association Professional Practice Committee","edition":"2026 (Diabetes Care 2026;49 Suppl 1)","year":2026,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690178/","locator":"Table 6.4 Classification of hypoglycemia","quote":"Level 1: Glucose <70 mg/dL (<3.9 mmol/L) and ≥54 mg/dL (≥3.0 mmol/L). Level 2: Glucose <54 mg/dL (<3.0 mmol/L). Level 3: A severe event characterized by altered mental and/or physical status requiring assistance for treatment of hypoglycemia","accessed":"2026-11-14"}}],"more":[{"family":"diabetes","topic":"Glucose and HbA1c","direction":"CONSISTENT","status":"agrees","label":"Agrees","icon":"✓","lead":"The note says ","quote":"diabetes","text":", and HbA1c 8.2 % on 2026-09-12 09:00 meets the published definition's criteria for the category “two results at or above the diagnostic thresholds” (ada2026_diabetes@1.0).","sentence":"The note says “diabetes”, and HbA1c 8.2 % on 2026-09-12 09:00 meets the published definition's criteria for the category “two results at or above the diagnostic thresholds” (ada2026_diabetes@1.0).","threshold":"Threshold for this category (ada2026_diabetes@1.0): number of qualifying results ≥ 2.","span":[257,265],"note_mentions":true,"lab_ids":["LM-P16-02"],"definition":"ada2026_diabetes@1.0","version":"1.0","tier":"measured","values":"HbA1c 8.2 % on 2026-09-12 09:00","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/PMC12690183/","optional_set":null,"cite":{"id":"ada2026_diabetes@1.0","title":"2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026","body":"American Diabetes Association Professional Practice Committee","edition":"2026 (Diabetes Care 2026;49 Suppl 1:S27-S49, doi:10.2337/dc26-S002)","year":2026,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","locator":"Table 2.1 Criteria for the diagnosis of diabetes in nonpregnant individuals","quote":"Table 2.1: A1C ≥6.5% (≥48 mmol/mol); FPG ≥126 mg/dL (≥7.0 mmol/L); 2-h PG ≥200 mg/dL (≥11.1 mmol/L) during OGTT; random plasma glucose ≥200 mg/dL (≥11.1 mmol/L) with classic symptoms of hyperglycemia or hyperglycemic crisis. In the absence of unequivocal hyperglycemia, diagnosis requires two abnormal results from different tests ... or the same test at two different time points.","accessed":"2026-11-14"}},{"family":"potassium","topic":"Potassium","direction":"NONE","status":"agrees","label":"Agrees","icon":"✓","lead":"","quote":null,"text":"Potassium 5.3 mmol/L on 2026-11-12 07:00: in the category “below 5.5 mmol/L” of ukka2026_hyperkalaemia@1.0; the note doesn't mention this. Nothing to review.","sentence":"Potassium 5.3 mmol/L on 2026-11-12 07:00: in the category “below 5.5 mmol/L” of ukka2026_hyperkalaemia@1.0; the note doesn't mention this. Nothing to review.","threshold":"Categories that count (ukka2026_hyperkalaemia@1.0): 'severe' band (6.5 mmol/L or more) (potassium ≥ 6.5 mmol/L); 'moderate' band (6.0 to 6.4 mmol/L) (potassium ≥ 6 mmol/L and potassium < 6.5 mmol/L); 'mild' band (5.5 to 5.9 mmol/L) (potassium ≥ 5.5 mmol/L and potassium < 6 mmol/L).","span":null,"note_mentions":false,"lab_ids":["LM-P16-05"],"definition":"ukka2026_hyperkalaemia@1.0","version":"1.0","tier":"measured","values":"potassium 5.3 mmol/L on 2026-11-12 07:00","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"}},{"family":"prediabetes","topic":"Glucose and HbA1c (intermediate range)","direction":"NONE","status":"agrees","label":"Agrees","icon":"✓","lead":"","quote":null,"text":"HbA1c 8.2 % on 2026-09-12 09:00: in the category “a result in the higher (diagnostic) range” of ada2026_prediabetes@1.0; the note doesn't mention this. Nothing to review.","sentence":"HbA1c 8.2 % on 2026-09-12 09:00: in the category “a result in the higher (diagnostic) range” of ada2026_prediabetes@1.0; the note doesn't mention this. Nothing to review.","threshold":"Categories that count (ada2026_prediabetes@1.0): intermediate range (HbA1c 5.7 to 6.4%, fasting glucose 100 to 125 mg/dL, or 2-hour glucose 140 to 199 mg/dL) (HbA1c ≥ 5.7 % and HbA1c < 6.5 % or fasting glucose ≥ 100 mg/dL and fasting glucose < 126 mg/dL or 2-hour glucose ≥ 140 mg/dL and 2-hour glucose < 200 mg/dL).","span":null,"note_mentions":false,"lab_ids":["LM-P16-02"],"definition":"ada2026_prediabetes@1.0","version":"1.0","tier":"measured","values":"HbA1c 8.2 % on 2026-09-12 09:00","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://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","optional_set":null,"cite":{"id":"ada2026_prediabetes@1.0","title":"2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026","body":"American Diabetes Association Professional Practice Committee","edition":"2026 (Diabetes Care 2026;49 Suppl 1:S27-S49)","year":2026,"url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC12690183/","locator":"Table 2.2 Criteria defining prediabetes in nonpregnant individuals","quote":"A1C 5.7–6.4% (39–47 mmol/mol); FPG 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG); 2-h PG during 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L) (IGT)","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 2.1 mg/dL within 21 hours during this stay (peak 3.9 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-0037","L-0038","L-0035"]},{"family":"kidney","topic":"Kidney function over time","status":"agrees","label":"Agrees","sentence":"The note says “CKD 3b” and two results 100 days apart agree (G3b range, filtering rate 40.6 on 2026-04-25 and 39.3 on 2026-08-03).","quote":"CKD 3b","threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":[213,219],"note_mentions":true,"lab_ids":["L-0035","L-0036"]}]}