An ED patient with fever, WBC 14,000, ketones in urine, fatigue, and altered mental status is diagnosed with cystitis, and hyperglycemia (glucose 325) leads to diabetes being documented at discharge. Which condition should the CDS query for?

• A. Diabetes with ketoacidosis
• B. Diabetes without complications
• C. Hyperglycemia without diabetes
• D. Urinary tract infection with dehydration

Answer: (A)

Recognize diabetic ketoacidosis when hyperglycemia is present with ketosis and neurologic symptoms, especially in the context of an infection that can trigger it. In this patient, the high glucose level and ketones in the urine, along with fatigue and altered mental status, point to an acute metabolic complication of diabetes—diabetic ketoacidosis. The fever and urinary tract infection can precipitate DKA, but the correct documentation should reflect the diabetes with ketoacidosis, not just diabetes or hyperglycemia alone.

Why the other options aren’t the best fit: coding for diabetes without complications would miss the ketosis and mental status changes that define the acute DKA event. Coding hyperglycemia without diabetes would be inappropriate since diabetes is documented at discharge. Writing urinary tract infection with dehydration would focus on the infectious/dehydration aspect rather than the primary metabolic crisis driven by diabetes.