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.

← Back to the worklist · Whole encounter ENC-00098

Celeste Hartwell: Hyponatraemia

ENC-00098 · 80M · Hospital Medicine · admitted Sat Nov 07, 2026 10:30 PM · in hospital · attending Dr. Kenji Stavros

Clinical validation gap Criteria not met Open In hospital: concurrent review

Documented “hyponatremia” (E87.1) but the criteria are not met: All sodium values 135 or above (lowest 136).

Documented vs supported

Documented: “hyponatremia” · E87.1 Hypo-osmolality and hyponatremia
Criteria support: criteria not met
Outcome: All sodium values 135 or above (lowest 136)
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: remove E87.1
Secondary-diagnosis level: CC → removed
MS-DRG (illustrative): 689 Kidney and urinary tract infections with MCC → 689 Kidney and urinary tract infections with MCC
Relative weight: 1.1603 → 1.1603 (+0.0000)
Codes before: N39.0, E43, J96.01, E87.1, D62, I10, E78.5
Codes after: N39.0, E43, J96.01, D62, I10, E78.5

All open gaps on this encounter together: MS-DRG 689 → 690 (RW -0.3508).

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)	136.0	sodium 136 mmol/L · lab LAB-003328 · 2026-11-07 23:30
Number of sodium values below 135	0	derived (no source row)

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=136.0, t.low=135, t.moderate=130, t.profound=125	none
outcome: met	`na_min < t.low and na_low_count >= t.repeat and na_treated`	na_low_count=0, na_min=136.0, na_treated=False, t.low=135, t.repeat=2	false
outcome: untreated	`na_min < t.low`	na_min=136.0, t.low=135	false
outcome: not_met	`na_min >= t.low`	na_min=136.0, t.low=135	true

Documentation query

Title and question drafted by model clockworks-mock (audit entry #2159); 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-00098   Patient: Celeste Hartwell   To: Dr. Kenji Stavros

Clinical indicators from the health record:
- Documented in the record: "hyponatremia" [Progress note DOC-000333]
- sodium 136 mmol/L (2026-11-07 23:30) [lab LAB-003328]

Question:
The indicators above are documented in this encounter. Could you clarify the status of the documented electrolyte diagnosis?

Response options (select one or write your own):
( ) Hyponatremia: confirmed (please document the supporting clinical information)
( ) Hyponatremia: ruled out
( ) Other explanation of the clinical findings (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

Acute kidney injury · Specificity gap Criteria support Acute kidney injury (KDIGO stage 2) (N17.9); no corresponding diagnosis is documented.
Malnutrition · Clinical validation gap Documented “severe protein-calorie malnutrition” (E43) conflicts with what the criteria support (Moderate (non-severe) protein-calorie malnutrition (acute illness context), E44.0).
Acute respiratory failure · Clinical validation gap Documented “acute respiratory failure with hypoxia” (J96.01) but the criteria are not met: No hypoxaemia on room air (lowest SpO2 93%), oxygen no more than 0 L/min, no advanced support.

History

Audit entries for this finding (newest first)
Seq	When (UTC)	Actor	Action	Entities	Decision / reason	Model / hashes
2159	2026-11-14T20:57:24	system:llm system	`llm.call`	ENC-00098, ENC-00098.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 93e8559a2fcf output b161c13a4bee entry eb214ba3b62e
1333	2026-11-14T19:24:30	system:llm system	`llm.call`	ENC-00098, ENC-00098.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 93e8559a2fcf output b161c13a4bee entry b444bcd69e17
591	2026-11-14T18:29:05	system:llm system	`llm.call`	ENC-00098, ENC-00098.hyponatremia	—	clockworks-mock mock-1/exactdx.draft_query@1 prompt 93e8559a2fcf output b161c13a4bee entry 619a08b1b53f