Understanding pseudohyponatremia, its causes, and proper management is crucial for accurate clinical documentation and medical coding. This resource provides information on pseudohyponatremia diagnosis, laboratory testing including serum sodium and osmolality, symptoms, and treatment. Learn about the difference between true hyponatremia and pseudohyponatremia, and how to avoid coding and documentation errors related to hyperglycemia, hyperlipidemia, and hyperproteinemia, common causes of falsely low sodium levels. Find guidance on appropriate ICD-10 codes and clinical documentation improvement strategies for pseudohyponatremia.
Also known as
Other specified abnormal findings
This code captures other abnormal findings not elsewhere classified.
Hypo-osmolality and hyponatremia
Used for true hyponatremia with low serum osmolality.
Abnormal serum electrolyte levels
A broader category encompassing abnormal electrolyte findings.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is pseudohyponatremia due to hyperglycemia?
Yes
Code E87.1, Hyposmolality and hyponatremia
No
Is it due to hyperproteinemia?
When to use each related code
| Description |
|---|
| False low sodium due to high lipids/protein |
| True low sodium with low serum osmolality |
| SIADH: Excess ADH despite normal volume status |
Miscoding pseudohyponatremia as dilutional hyponatremia (276.1) due to similar lab findings, impacting DRG assignment and reimbursement.
Failure to code the underlying cause of pseudohyponatremia (e.g., hyperglycemia, hyperproteinemia) leading to inaccurate clinical documentation and data analysis.
Insufficient documentation of corrected sodium levels or other relevant lab data required for accurate pseudohyponatremia diagnosis validation, impacting audit integrity.
Q: How can I differentiate between true hyponatremia and pseudohyponatremia in a patient with hyperglycemia?
A: Differentiating between true and pseudohyponatremia in hyperglycemic patients requires considering the effect of glucose on serum sodium concentration. Pseudohyponatremia occurs because hyperglycemia causes water to shift from the intracellular to the extracellular space, diluting the sodium concentration. A simple formula can correct for this: Corrected Sodium = Measured Sodium + (0.016 x (Serum Glucose - 100)). If the corrected sodium is within the normal range, the patient has pseudohyponatremia. If the corrected sodium remains low, the patient likely has concomitant true hyponatremia requiring further investigation into its underlying cause. Consider implementing this correction formula in your clinical practice for accurate assessment. Learn more about the different types of hyponatremia and their specific management strategies.
Q: What are the common lab findings, besides low serum sodium, that might suggest pseudohyponatremia due to hyperproteinemia or hyperlipidemia?
A: In pseudohyponatremia caused by hyperproteinemia or hyperlipidemia, the measured serum sodium is low, but the effective osmolality is normal. Lab findings indicative of these conditions include an elevated total protein level (hyperproteinemia) or significantly increased triglyceride and/or cholesterol levels (hyperlipidemia). These conditions increase the solid phase of plasma, leading to a falsely low sodium measurement by certain laboratory methods (indirect ion-selective electrodes). Direct potentiometry, however, measures the sodium concentration in the aqueous phase and is unaffected. Suspect pseudohyponatremia in patients with low sodium but no symptoms of hyponatremia and explore alternative measurement methods to confirm true sodium levels. Consider reviewing the limitations of indirect ion-selective electrodes in your lab practices.
Patient presents with pseudohyponatremia, a laboratory artifact characterized by a falsely low serum sodium concentration. Differential diagnosis includes true hyponatremia, hyperglycemia, hyperlipidemia, and hyperproteinemia. Initial laboratory evaluation revealed a low serum sodium (Na) level below 135 mEqL, with elevated serum osmolality indicating an isotonic or hypertonic state. The patient's medical history is significant for [Insert relevant medical history, e.g., uncontrolled diabetes mellitus, multiple myeloma]. Physical examination findings include [Insert relevant physical exam findings, e.g., dehydration, edema]. Assessment suggests pseudohyponatremia secondary to [Insert cause, e.g., hyperglycemia, hyperlipidemia]. Plan includes further laboratory testing to confirm the underlying cause of the elevated osmolality, including lipid panel, serum protein electrophoresis, and blood glucose. Treatment will focus on managing the underlying condition contributing to the pseudohyponatremia. Patient education provided on the importance of medication adherence and lifestyle modifications as indicated. Follow-up scheduled to monitor sodium levels and overall clinical status. ICD-10 code R74.4 (abnormal findings on examination of blood chemistry) is considered, with additional codes to reflect the underlying cause. CPT codes for laboratory tests performed will be included for billing purposes. Continue to monitor for any development of true hyponatremia and adjust treatment accordingly.