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Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm, initial encounter

ICD10CM code
#### Name of the Condition
- Poisoning by Angiotensin-Converting-Enzyme (ACE) Inhibitors, Intentional Self-Harm, Initial Encounter

#### Summary
Poisoning by ACE inhibitors occurs when someone intentionally takes an overdose of these medications, often used for blood pressure control and heart conditions, in an attempt to harm themselves. This document refers to the initial medical encounter for such a case.

#### Causes
- Intentional ingestion of an excessive dose of ACE inhibitors as an act of self-harm.

#### Risk Factors
- History of mental health conditions, such as depression.
- Access to ACE inhibitors, either through prescription or someone else's medication.
- Previous suicide attempts or self-harming behavior.

#### Symptoms
- Low blood pressure (hypotension)
- Dizziness or fainting
- Elevated potassium levels (hyperkalemia)
- Renal impairment or acute kidney failure
- Cough or shortness of breath

#### Diagnosis
- Patient history and physical examination
- Blood tests to check electrolyte levels and kidney function
- Monitoring of vital signs

#### Treatment Options
- Activated charcoal if ingested recently to limit absorption.
- Intravenous fluids to stabilize blood pressure.
- Medications to counteract hyperkalemia.
- Hospital admission for continuous monitoring and psychiatric evaluation.

#### Prognosis and Follow-Up
- The prognosis depends on the amount ingested and promptness of treatment. With immediate care, outcomes can be favorable.
- Follow-up involves psychiatric support and monitoring for recurrent behavior or complications.

#### Complications
- Persistent hypotension and shock
- Severe hyperkalemia leading to cardiac issues
- Kidney failure requiring dialysis

#### Lifestyle & Prevention
- Secure storage of medications to prevent misuse.
- Regular mental health check-ups for individuals known to be at risk.
- Engagement in therapy or mental health programs to manage underlying issues.

#### When to Seek Professional Help
- Symptoms of overdose such as severe dizziness, confusion, or unconsciousness.
- Any indication of self-harm or suicidal thoughts.

#### Additional Resources
- National Suicide Prevention Lifeline
- American Foundation for Suicide Prevention
- Substance Abuse and Mental Health Services Administration (SAMHSA)

#### Tips for Medical Coders
- Ensure specificity by noting that this is an initial encounter for self-harm by ACE inhibitor overdose.
- Double-check for the correct application of the code T46.4X2A, distinguishing it from accidental poisoning or assault.
- Be aware of coexisting mental health diagnoses that may also need coding.

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