Extended criteria (experimental). This is the broader ten-condition engine, kept as a secondary area. It shows ICD-10-CM codes and illustrative grouping effects for CDI staff. The primary surface is Before you sign (kidney, measurement only). All extended pages.

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Jun Galloway: Hyponatraemia

ENC-00067 · 73M · Hospital Medicine · admitted Sun Nov 08, 2026 06:57 PM · in hospital · attending Dr. Cyrus Ellingham

Specificity gap Criteria met Open In hospital: concurrent review

Criteria support Hyponatraemia (profound) (E87.1); no corresponding diagnosis is documented.

Documented vs supported

Documented: not documented
Criteria support: Hyponatraemia (profound) · E87.1 Hypo-osmolality and hyponatremia
Outcome: Sodium below 135 on 6 values (lowest 122, profound) with treatment ordered
Rule: Hyponatraemia v2026.11-1
Published source: Clinical practice guideline on diagnosis and treatment of hyponatraemia (Spasovski et al., Eur J Endocrinol 2014;170:G1-G47) (2014), Classification by biochemical severity: mild 130-135, moderate 125-129, profound <125 mmol/L · source (checked 2026-11-14)

Effect if the clinician agrees (illustrative)

Change: add E87.1
Secondary-diagnosis level: — → CC
MS-DRG (illustrative): 193 Simple pneumonia and pleurisy with MCC → 193 Simple pneumonia and pleurisy with MCC
Relative weight: 1.3144 → 1.3144 (+0.0000)
Codes before: J18.9, E66.9, N18.32, I50.9, L89.154
Codes after: J18.9, E66.9, N18.32, I50.9, L89.154, E87.1

All open gaps on this encounter together: MS-DRG 193 → 193 (RW +0.0000). The grouping does not change; the record becomes accurate.

CC/MCC status, CC exclusions (subset) and relative weights from the public CMS FY2026 IPPS final rule tables (5, 6I, 6J, 6K). This is not a grouper and not a payment estimate. Queries never mention any of this.

Severity documentation index change SIMULATED

0.5 points

SIMULATED: Illustrative severity weights (MCC = 1.0, CC = 0.5, non-CC = 0) summed over secondary diagnoses; not a validated risk-adjustment model and not a measured effect.

Evidence

Structured values are read by code from the cited rows. Note facts are shown only when the model's quote was found verbatim in the note.

Evidence (each item cited to a source row or a quoted span)
Input	Value	Source
Lowest serum sodium this stay (mmol/L)	122.0	sodium 122 mmol/L · lab LAB-002270 · 2026-11-09 05:00
Number of sodium values below 135	6	sodium 124 · lab LAB-002269 · 2026-11-08 19:57 sodium 122 · lab LAB-002270 · 2026-11-09 05:00 sodium 123 · lab LAB-002271 · 2026-11-10 05:00 sodium 126 · lab LAB-002272 · 2026-11-11 05:00 sodium 128 · lab LAB-002273 · 2026-11-12 05:00 sodium 134 · lab LAB-002274 · 2026-11-13 05:00
Fluid restriction, salt tablets, hypertonic saline or a vaptan ordered	True	fluid restriction 1.2 L/day · order ORD-000058 · 2026-11-08 21:57 sodium chloride 3% 100 mL IV · med MED-000266 · 2026-11-08 22:57

Rule trace (inputs, thresholds, outcome)

Rule trace (rule hyponatremia v2026.11-1; evaluated in order, first true outcome wins; "unknown" = missing input)
Step	Expression	Inputs and thresholds read	Result
derived: severity	`case(na_min < t.profound, 'profound', na_min < t.moderate, 'moderate', na_min < t.low, 'mild', 'none')`	na_min=122.0, t.low=135, t.moderate=130, t.profound=125	profound
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_low_count=6, na_min=122.0, na_treated=True, t.low=135, t.repeat=2	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2099); clinical indicators and answer options assembled by code from the rule and the record.

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DOCUMENTATION QUERY (draft)
Title: Clarification request: electrolyte documentation
Encounter: ENC-00067   Patient: Jun Galloway   To: Dr. Cyrus Ellingham

Clinical indicators from the health record:
- sodium 122 mmol/L (2026-11-09 05:00) [lab LAB-002270]
- sodium 124 (2026-11-08 19:57) [lab LAB-002269]
- sodium 123 (2026-11-10 05:00) [lab LAB-002271]
- sodium 126 (2026-11-11 05:00) [lab LAB-002272]
- sodium 128 (2026-11-12 05:00) [lab LAB-002273]
- sodium 134 (2026-11-13 05:00) [lab LAB-002274]
- fluid restriction 1.2 L/day (2026-11-08 21:57) [order ORD-000058]
- sodium chloride 3% 100 mL IV (2026-11-08 22:57) [med MED-000266]

Question:
Based on your clinical judgement and the indicators above, can a related diagnosis be documented?

Response options (select one or write your own):
( ) Hyponatremia (please specify cause, if known)
( ) Other (please specify): ____________
( ) Unable to determine

Please respond based on your independent clinical judgement. Any response, including "unable to determine", is acceptable. This query and your response are kept as part of the health record.

Other findings on this encounter

Heart failure · Specificity gap Documented “heart failure” (I50.9); criteria support the more specific Acute on chronic diastolic (HFpEF) heart failure (I50.33).
Obesity · Specificity gap Documented “obesity” (E66.9); criteria support the more specific Obesity, class 3 (E66.813).
Pressure injury · Clinical validation gap Documented “stage 4 sacral pressure ulcer” (L89.154) conflicts with what the criteria support (Pressure injury of sacral region, stage 2, L89.152).

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2099	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00067, ENC-00067.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 300e15d9f73a output 1529a3e2b70e entry 90cef2a2d314
1273	2026-11-14T19:24:29	system:llm system	`llm.call`	ENC-00067, ENC-00067.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 300e15d9f73a output 1529a3e2b70e entry cb7492bee8b5
531	2026-11-14T18:29:04	system:llm system	`llm.call`	ENC-00067, ENC-00067.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 300e15d9f73a output 1529a3e2b70e entry 3c9087b555a7