Undernutrition – Definitions & ICD 11 Codes

Definition of Undernutrition: Undernutrition is a condition in which the body’s requirements are unmet due to underconsumption or to impaired absorption and use of nutrients. It can be produced by lack of access to food, or as a consequence of illness. Undernutrition commonly refers to a deficit in energy intake, but can also refer to deficiencies of specific nutrients, and can be either acute or chronic.

Inclusions:

• Malnutrition NOS

Exclusions:

• slim disease (1C62.3)
• starvation (NF07.0)
• Intestinal malabsorption (DA96.0)
• Anorexia Nervosa (6B80)

Coded Elsewhere:

• Malnutrition in pregnancy (JA64)
• Undernutrition-dehydration cataract (9B10.2Y)

Underweight in infants children or adolescents

ICD 11 Code For Underweight in infants children or adolescents

  5B50  Underweight in infants children or adolescents

Wasting in infants children or adolescents

ICD 11 Code For Wasting in infants children or adolescents

  5B51  Wasting in infants children or adolescents

Acute malnutrition in infants children or adolescents

ICD 11 Code For Acute malnutrition in infants children or adolescents

  5B52  Acute malnutrition in infants children or adolescents

Stunting in infants children or adolescents

ICD 11 Code For Stunting in infants children or adolescents

  5B53  Stunting in infants children or adolescents

Underweight in adults

Definition of Underweight in adults: Body mass index (BMI) <18.5 kg/m²

ICD 11 Code For Underweight in adults

  5B54  Underweight in adults

Vitamin A deficiency

Definition of Vitamin A deficiency: Vitamin A deficiency (VAD) is defined as a state in which tissue concentrations of vitamin A are low enough to have adverse health consequences even if there is no evidence of clinical xerophthalmia. The term xerophthalmia encompasses the clinical spectrum of ocular manifestations of vitamin A deficiency, from milder stages of night blindness and Bitot’s spots, to potentially blinding stages of corneal xerosis, ulceration and necrosis (keratomalacia). In addition to the specific signs and symptoms of xerophthalmia and the risk of irreversible blindness, nonspecific symptoms include increased morbidity and mortality, poor reproductive health, increased risk of anaemia, and contributions to slowed growth and development.

ICD 11 Code For Vitamin A deficiency

  5B55  Vitamin A deficiency

Inclusions:

• Hypovitaminosis A

Coded Elsewhere:

• Acquired vitamin A deficiency anaemia (3A03.5)

5B55.0 Vitamin A deficiency with night blindness

Definition of Vitamin A deficiency with night blindness: Night blindness (poor adaptation to darkness) is generally the earliest manifestation of vitamin A deficiency. In mild cases, night blindness is apparent only after photic stress. Affected children no longer move around after dusk and prefer to sit in a secure corner, often unable to find their food or toys. Night blindness of recent onset in a preschool child is practically pathognomonic of vitamin A deficiency. All patients respond rapidly to therapy with vitamin A, usually within 48 hours.

5B55.1 Vitamin A deficiency with conjunctival xerosis

Definition of Vitamin A deficiency with conjunctival xerosis: In conjunctival xerosis the epithelium of the conjunctiva is transformed from the normal columnar to the stratified squamous type, with a resultant loss of goblet cells, formation of a granular cell layer, and keratinization of the surface. Clinically, these changes are expressed as marked dryness or unwettability, the affected area appearing roughened, with fine droplets or bubbles on the surface, rather than smooth and glistening. Conjunctival xerosis first appears in the temporal quadrant, as an isolated oval or triangular patch adjacent to the limbus in the interpalpebral fissure. It is almost always present in both eyes.

5B55.2 Vitamin A deficiency with conjunctival xerosis or Bitot’s spots

Definition of Vitamin A deficiency with conjunctival xerosis or Bitot’s spots: Generalised conjunctival xerosis suggests advanced vitamin A deficiency. The entire conjunctiva appears dry, roughened, and corrugated, sometimes skin-like. In some individuals keratin and saprophytic bacilli accumulate on the xerotic surface, giving it a foamy or cheesy appearance. Such lesions are known as Bitot’s spot. With treatment active conjunctival xerosis and Bitot’s spot begin to resolve within 2-5 days. Most will disappear within 2 weeks, though a significant proportion of temporal lesions may persist, in shrunken form, for months.

5B55.3 Vitamin A deficiency with corneal xerosis

Definition of Vitamin A deficiency with corneal xerosis: Clinically, the cornea develops classical xerosis, a hazy, lustreless, dry appearance, first apparent near the inferior limbus. Many children have characteristic superficial punctate lesions of the inferior-nasal aspects of their cornea that stain brightly with fluorescein. Early in the disease they are visible only through a slit-lamp examination. With more severe disease the punctate lesions become more numerous and spread upwards over the central cornea, and the corneal stroma becomes oedematous. Thick, keratinized plaques resembling Bitot’s spot may form on the corneal surface. These are often densest in the interpalpebral zone. With treatment, these corneal plaques peel off, sometimes leaving superficial erosion which quickly heals. Corneal xerosis responds within 2-5 days to vitamin A therapy, the cornea regaining its normal appearance in 1-2 weeks.

5B55.4 Vitamin A deficiency with corneal ulceration or keratomalacia

Definition of Vitamin A deficiency with corneal ulceration or keratomalacia: Ulceration/keratomalacia indicates permanent destruction of part or all of the corneal stroma, resulting in permanent structural alteration. Ulcers are classically round to oval “punched-out” defects, as if a trephine or cork-borer had been applied to the eye. The surrounding cornea is generally xerotic but otherwise clear, and typically lacks the grey, infiltrated appearance of ulcers of bacterial origin. There may be more than one ulcer. Small ulcers are almost invariably confined to the periphery of the cornea, especially its inferior and nasal aspects. The ulceration may be shallow, but is commonly deep. Perforations become plugged with iris, thereby preserving the anterior chamber. In more advanced disease the necrotic stroma sloughs, leaving a large ulcer or descemetocele. As with smaller ulcers, this is usually peripheral and heals as a dense, white, adherent leukoma. With therapy, superficial ulcers often heal with surprisingly little scarring; deeper ulcers, especially perforations, form dense peripheral adherent leukomas.

5B55.5 Vitamin A deficiency with xerophthalmic scars of cornea or blindness

Definition of Vitamin A deficiency with xerophthalmic scars of cornea or blindness: Xerophthalmia or “dry eye” remains the most important cause of childhood blindness in many developing countries. Healed sequelae of prior corneal disease related to vitamin A deficiency include opacities or scars of varying density (nebula, macula, leukoma), weakening and outpouching of the remaining corneal layers (staphyloma and descemetocele) and, where loss of intraocular contents has occurred, phthisis bulbi, a scarred shrunken globe. Such end-stage lesions are not specific for xerophthalmia and may arise from numerous other conditions, notably trauma and infection.

5B55.Y Vitamin A deficiency with other specified manifestations

5B55.Z Vitamin A deficiency unspecified

Vitamin C deficiency

Definition of Vitamin C deficiency: This condition groups several clinical consequences secondary to vitamin C deficiency with scurvy being the most severe presentation. The populations at risk of vitamin C deficiency are those for whom the fruit and vegetable supply is minimal. Epidemics of scurvy are associated with famine and war, when food supply is small and irregular. Children fed predominantly heat-treated (ultra-high-temperature or pasteurized) milk or unfortified formulas and not receiving fruits and fruit juices are at significant risk for symptomatic disease.

ICD 11 Code For Vitamin C deficiency

  5B56  Vitamin C deficiency

5B56.0 Scurvy

Definition of Scurvy: Scurvy is a disease caused by a lack of vitamin C (ascorbic acid) in the diet. Vitamin C plays a central role in collagen and ground-substance formation, metabolism of aromatic amino acids (phenylalanine, tyrosine), reduction of folic acid to folinic acid and a broad range of biochemical redox reactions. Clinical features include perifollicular haemorrhages, ecchymoses, swollen bleeding gums, stomatitis and epistaxis.

Coded Elsewhere:

• Scorbutic anaemia (3A03.2)

5B56.Y Other specified vitamin C deficiency

5B56.Z Vitamin C deficiency unspecified

Vitamin D deficiency

Definition of Vitamin C deficiency unspecified: Vitamin D is a fat-soluble vitamin contained naturally in very few foods, added to milk, available as a supplement, and produced endogenously with exposure to sunlight. Vitamin D deficiency can be caused by inadequate intake due to dietary factors (e.g., special diets (veganism), lactose intolerance or allergies) and/or limited exposure to sunlight due to geographic location, sun avoidance, or shiftwork. Severe deficiency results in disordered bone modelling called rickets in childhood (open growth plates), and osteomalacia in adults (fused growth plates).

ICD 11 Code For Vitamin D deficiency

  5B57  Vitamin D deficiency

5B57.0 Vitamin D deficiency rickets

Definition of Vitamin D deficiency rickets: Rickets is a disease of growing bone that is due to unmineralized matrix at the growth plates and occurs in children only before fusion of the epiphyses. There are many causes of rickets, including vitamin D disorders, calcium deficiency, phosphorous deficiency, and distal renal tubular acidosis. With the increased survival rate of very low birthweight infants, rickets in this age group has become a significant problem.

5B57.1 Vitamin D deficiency osteomalacia

Definition of Vitamin D deficiency osteomalacia: Osteomalacia is a disorder of defective mineralization of newly formed osteoid at sites of bone turnover. Several different disorders cause osteomalacia via mechanisms that result in hypocalcaemia, hypophosphatemia, or direct inhibition of the mineralization process. Severe vitamin D deficiency, secondary to inadequate dietary intake, lack of sun exposure, gastric bypass or malabsorption (celiac disease), is the most common cause of osteomalacia in adults.

5B57.Y Other specified vitamin D deficiency

5B57.Z Vitamin D deficiency unspecified

Vitamin E deficiency

Definition of Vitamin E deficiency: Vitamin E deficiency is a condition that causes haemolysis and/or neurologic manifestations. Red blood cell fragility occurs and can produce a haemolytic anaemia. Neuronal degeneration produces peripheral neuropathies, ophthalmoplegia, and destruction of posterior columns of spinal cord. Neurologic disease is frequently irreversible if deficiency is not corrected early enough. Vitamin E deficiency may also contribute to the haemolytic anaemia and retrolental fibroplasia seen in premature infants.

ICD 11 Code For Vitamin E deficiency

  5B58  Vitamin E deficiency

Coded Elsewhere:

• Acquired vitamin E deficiency anaemia (3A03.6)
• Dementia due to vitamin E deficiency (6D85.Y)

Vitamin K deficiency

Definition of Vitamin K deficiency: Vitamin K is necessary for the synthesis of clotting factors II, VII, IX, and X, and deficiency of vitamin K can result in clinically significant bleeding. Vitamin K deficiency typically affects infants, who experience a transient deficiency related to inadequate intake, or patients of any age who have decreased vitamin K absorption. Mild vitamin K deficiency can affect long-term bone and vascular health.

ICD 11 Code For Vitamin K deficiency

  5B59  Vitamin K deficiency

Coded Elsewhere:

• Neonatal vitamin K deficiency (KA8F)

Vitamin B1 deficiency

Definition of Vitamin B1 deficiency: Vitamin B1 deficiency manifests itself principally with changes involving the nervous system (polyneuritis and paralysis of the peripheral nerves), the cardiovascular system (cardiac insufficiency and generalised oedema), and also the gastrointestinal tract (constipation, vomiting, and abdominal pain).

ICD 11 Code For Vitamin B1 deficiency

  5B5A  Vitamin B1 deficiency

5B5A.0 Beriberi

Definition of Beriberi: The clinical picture of Beriberi is usually divided into a dry (neuritic) type and a wet (cardiac) type. The disease is wet or dry depending on the amount of fluid which accumulates in the body due to factors like cardiac function, kidney lesions and others; even though the exact cause for this oedema has never been successfully explained. Many cases of thiamine deficiency show a mixture of the two main features and are more properly termed thiamine deficiency with cardiopathy and peripheral neuropathy. The infant shows signs of cyanosis and an acute cardiac attack can follow with the infant usually dying within 2 to 4 hours. The common age for this form of the deficiency disease is one month up through the third month. This type of deficiency responds very dramatically to thiamine.

5B5A.00 Dry beriberi

Definition of Dry beriberi: Neuritic form of Beri Beri

5B5A.01 Wet beriberi

Definition of Wet beriberi: Cardiac form of Beri Beri.

5B5A.0Z Beriberi unspecified

5B5A.1 Wernicke-Korsakoff Syndrome

Definition of Wernicke-Korsakoff Syndrome: A thiamine-deficiency syndrome characterised by symmetric hyperaemic lesions of the brainstem, hypothalamus, thalamus, and mammillary bodies with glial proliferation, capillary dilatation, and perivascular haemorrhage. The syndrome is manifested by a confusional state, disorientation, ophthalmoplegia, nystagmus, diplopia, and ataxia (Wernicke encephalopathy), with severe loss of memory for recent events and confabulation (the invention of accounts of events to cover the loss of memory) (Korsakov psychosis) occurring following recovery. Defective binding of thiamine diphosphate by transketolase has been found. It appears that the disorder is of autosomal recessive inheritance but is expressed as clinical disease only in the event of thiamine deficiency.

Coding Note:

• Chronic alcohol use may be associated with thiamine deficiency, but alcohol may also have effects on the brain via other mechanisms. This category should be used to describe cognitive symptoms due to chronic alcohol use if there is evidence of thiamine deficiency.

Exclusions:

• Amnestic disorder due to use of alcohol (6D72.10)

5B5A.10 Wernicke encephalopathy

Definition of Wernicke encephalopathy: Wernicke’s encephalopathy is an acute neuropsychiatric syndrome characterised by nystagmus, ophthalmoplegia, changes in the mental status, an uncoordinated gait and truncal ataxia. Wernicke’s encephalopathy is usually accompanied or followed by Korsakoff’s syndrome/Korsakoff’s dementia (a continuum of Wernicke’s encephalopathy characterised by severe memory defects, ataxia, apathy, disorientation, confabulations, hallucinations, paralysis of muscles controlling the eye and coma). The disorder results from a deficiency in vitamin B1, and mostly occurs in adults with a history of alcohol abuse or in patients with AIDS.

5B5A.11 Korsakoff syndrome

Definition of Korsakoff syndrome: A disease of the nervous system, caused by deficiency of vitamin B1 in the brain. This disease commonly follows Wernicke encephalopathy, and may present with inability to form new memories, amnesia, confabulation, or hallucinations.

Coding Note:

• Chronic alcohol use may be associated with thiamine deficiency, but alcohol may also have effects on the brain via other mechanisms. This category should be used to describe cognitive symptoms due to chronic alcohol use if there is evidence of thiamine deficiency.

Exclusions:

• Amnestic disorder due to use of alcohol (6D72.10)

5B5A.1Y Other specified Wernicke-Korsakoff Syndrome

Coding Note:

• Chronic alcohol use may be associated with thiamine deficiency, but alcohol may also have effects on the brain via other mechanisms. This category should be used to describe cognitive symptoms due to chronic alcohol use if there is evidence of thiamine deficiency.

5B5A.1Z Wernicke-Korsakoff Syndrome unspecified

Coding Note:

• Chronic alcohol use may be associated with thiamine deficiency, but alcohol may also have effects on the brain via other mechanisms. This category should be used to describe cognitive symptoms due to chronic alcohol use if there is evidence of thiamine deficiency.

5B5A.Y Other specified vitamin B1 deficiency

5B5A.Z Vitamin B1 deficiency unspecified

Vitamin B2 deficiency

Definition of Vitamin B2 deficiency: The signs of riboflavin deficiency are sore throat, hyperaemia, oedema of the pharyngeal and oral mucous membranes, cheilosis, angular stomatitis, glossitis, seborrheic dermatitis, and normochromic normocytic anaemia associated with pure red cell cytoplasia of the bone marrow. The major cause of hyporiboflavinosis is inadequate dietary intake as a result of limited food supply, which is sometimes exacerbated by poor food storage or processing. Children in developing countries will commonly demonstrate clinical signs of riboflavin deficiency during periods of the year when gastrointestinal infections are prevalent. Decreased assimilation of riboflavin also results from abnormal digestion, such as that which occurs with lactose intolerance.

ICD 11 Code For Vitamin B2 deficiency

  5B5B  Vitamin B2 deficiency

Inclusions:

• Riboflavin deficiency

Coded Elsewhere:

• Acquired riboflavin deficiency anaemia (3A03.41)

Vitamin B3 deficiency

Definition of Vitamin B3 deficiency: Niacin deficiency classically results in pellagra, which is a chronic wasting disease associated with a characteristic erythematous dermatitis that is bilateral and symmetrical, a dementia after mental changes including insomnia and apathy preceding an overt encephalopathy, and diarrhoea resulting from inflammation of the intestinal mucous surfaces. Pellagra occurs endemically in poorer areas of Africa, China and India.

ICD 11 Code For Vitamin B3 deficiency

  5B5C  Vitamin B3 deficiency

Inclusions:

• Niacin deficiency NOS

5B5C.0 Pellagra

Definition of Pellagra: Pellagra is a potentially life-threatening disorder due to niacin deficiency and is observed in malnourished individuals, especially alcoholics, and as a complication of isoniazid therapy. The diagnosis is often overlooked or delayed. Pellagra manifests as diarrhoea, dermatitis, dementia, which usually appear in this order. Gastrointestinal tract symptoms always precede skin involvement, which presents initially with a sunburn-like blistering erythema, typically affecting the dorsal surfaces of the hands, face, neck, arms, and feet. With time the skin becomes thickened, scaly and pigmented.

5B5C.Y Other specified vitamin B3 deficiency

Vitamin B6 deficiency

Definition of Vitamin B6 deficiency: A deficiency of vitamin B6 alone is uncommon because it usually occurs in association with a deficit in other B-complex vitamins. Hypovitaminosis B6 may often occur with riboflavin (vitamin B2) deficiency. The classical clinical symptoms of vitamin B6 deficiency are a seborrheic dermatitis, microcytic anaemia, epileptiform convulsions, and depression and confusion. Infants are especially susceptible to insufficient intakes, which can lead to epileptiform convulsions. Moreover, there is usually a decrease in circulating lymphocytes and sometimes a normocytic, microcytic, or sideroblastic anaemia as well. As is the case with other micronutrient deficiencies, vitamin B6 deficiency results in an impairment of the immune system. Several medical conditions can also affect vitamin B6 metabolism and thus lead to deficiency symptoms.

ICD 11 Code For Vitamin B6 deficiency

  5B5D  Vitamin B6 deficiency

Exclusions:

• Pyridoxine-responsive sideroblastic anaemia, not elsewhere classified (3A72.1)

Coded Elsewhere:

• Acquired pyridoxine deficiency anaemia (3A03.40)
• Pyridoxine dependent epilepsy with antiquitin mutations (8A61.0Y)

Folate deficiency

Definition of Folate deficiency: Nutritional deficiency of folate is common in people consuming a limited diet. This can be exacerbated by malabsorption conditions, including coeliac disease and tropical sprue. Pregnant women are at risk for folate deficiency because pregnancy significantly increases the folate requirement, especially during periods of rapid fetal growth (i.e. in the second and third trimester). During lactation, losses of folate in milk also increase the folate requirement. During pregnancy, there is an increased risk of fetal neural tube defects (NTDs), with risk increasing 10-fold as folate status goes from adequate to poor. Between days 21 and 27 post-conception, the neural plate closes to form what will eventually be the spinal cord and cranium. Spina bifida, anencephaly, and other similar conditions are collectively called NTDs. They result from improper closure of the spinal cord and cranium, respectively, and are the most common congenital abnormalities associated with folate deficiency.

ICD 11 Code For Folate deficiency

  5B5E  Folate deficiency

Vitamin B12 deficiency

Definition of Vitamin B12 deficiency: Vegetarianism and poverty-imposed near-vegetarianism are the most common causes of nutritional cobalamin insufficiency worldwide in all age groups. In such populations, low maternal cobalamin status is associated with adverse pregnancy outcomes (preterm birth, intrauterine growth retardation, early recurrent miscarriage), neural tube defects, reduced neurocognitive performance in children, accelerated bone turnover, and low bone mineral density with fractures. Insufficient cobalamin intake is also seen in breast-fed infants of mothers with pernicious anaemia.

ICD 11 Code For Vitamin B12 deficiency

  5B5F  Vitamin B12 deficiency

Inclusions:

• cobalamin deficiency
• cyanocobalamin deficiency

Coded Elsewhere:

• Vitamin B12 deficiency anaemia due to low intake (3A01.2)
• Vitamin B12 deficiency anaemia due to intrinsic factor deficiency (3A01.3)
• Vitamin B12 deficiency anaemia due to intestinal disease (3A01.4)
• Drug-induced vitamin B12 deficiency anaemia (3A01.5)
• Acquired vitamin B12 deficiency anaemia (3A01.Y)
• Dementia due to vitamin B12 deficiency (6D85.Y)

Biotin deficiency

Definition of Biotin deficiency: Isolated biotin deficiency is rare. Signs of biotin deficiency in humans have been demonstrated in individuals who consume raw egg white over long periods and in total parenteral nutrition (TPN) before biotin supplementation in patients with malabsorption. The clinical findings of biotin deficiency include dermatitis, conjunctivitis, alopecia, and central nervous system abnormalities. In adults fed raw egg white (which contains avidin, a protein that binds biotin with such high affinity that it renders it biounavailable) or receiving biotin-free TPN for months to years, thinning of hair, frequently with loss of hair colour, has been reported. Most adults with the deficiency demonstrate a red, scaly, skin rash, frequently around the eyes, nose, and mouth. Most of the adults have neurological symptoms, including depression, lethargy, hallucinations, and paraesthesia of the extremities.

ICD 11 Code For Biotin deficiency

  5B5G  Biotin deficiency

Pantothenic acid deficiency

Definition of Pantothenic acid deficiency: Pantothenic deficiency is rare: only reported as a result of feeding semisynthetic diets or an antagonist to the vitamin. Experimental, isolated deficiency in humans produces fatigue, abdominal pain, vomiting, insomnia, and paraesthesias of the extremities.

ICD 11 Code For Pantothenic acid deficiency

  5B5H  Pantothenic acid deficiency

Choline deficiency

Definition of Choline deficiency: Choline deficiency is rare. Individuals fed with total parenteral nutrition (TPN) solutions lacking choline develop fatty liver and liver damage.

ICD 11 Code For Choline deficiency

  5B5J  Choline deficiency

Mineral deficiencies

ICD 11 Code For Mineral deficiencies

  5B5K  Mineral deficiencies

Exclusions:

• Disorders of mineral absorption or transport (5C64)

Coded Elsewhere:

• Hypokalaemia (5C77)
• Hypomagnesaemia (5C64.41)

5B5K.0 Iron deficiency

Definition of Iron deficiency: Iron deficiency is a state in which there is insufficient iron to maintain the normal physiological function of blood, brain and muscles. It can exist in the absence of anaemia if it has not lasted long enough or if it has not been severe enough to cause the haemoglobin concentration to fall below the threshold for the specific sex and age group. Iron deficiency is the most common nutritional deficiency.

Exclusions:

• Iron deficiency anaemia (3A00)

Coded Elsewhere:

• Acquired iron deficiency anaemia due to blood loss (3A00.0)
• Acquired iron deficiency anaemia due to low intake (3A00.1)
• Acquired iron deficiency anaemia due to decreased absorption (3A00.2)
• Acquired iron deficiency anaemia due to increased requirement (3A00.3)
• Acquired iron deficiency anaemia (3A00.Y)
• Dementia due to iron deficiency (6D85.Y)

5B5K.1 Calcium deficiency

Definition of Calcium deficiency: Hypocalcaemia is defined as a total serum calcium concentration of less than 8.4 mg/dl (2.1 mmol/litre) or an ionized calcium concentration of less than 4.48 mg/dl (1.12 mmol/litre). There are numerous causes of hypocalcaemia, being chronic kidney disease the most common cause. Other causes are: vitamin D deficiency, disorders associated with acquired or genetic hypoparathyroridism, including intravenous bisphosphonate therapy, post-thyroidectomy and post-parathyroidectomy, and acute pancreatitis. Hypocalcaemia may be associated with a spectrum of clinical manifestations, ranging from few symptoms if the hypocalcaemia is mild, to life-threatening seizures, refractory heart failure, or laryngospasm if it is severe. In addition to severity, the rate of development of hypocalcaemia and chronicity determine the clinical manifestations.

Exclusions:

• Disorders of calcium metabolism (5C64.5)

Coded Elsewhere:

• Neonatal hypocalcaemia (KB61.2)
• Neonatal osteopenia (KB61.3)
• Myopathy due to calcium deficiency (8D40.2)

5B5K.10 Tetany due to acute calcium deficiency

Definition of Tetany due to acute calcium deficiency: The hallmark of acute hypocalcaemia is tetany, which is characterised by neuromuscular irritability. The symptoms of tetany may be mild (peri-oral numbness, paresthesias of the hands and feet, muscle cramps) or severe (carpopedal spasm, laryngospasm, and focal or generalised seizures, which must be distinguished from the generalised tonic muscle contractions that occur in severe tetany). Other patients have less specific symptoms such as fatigue, hyperirritability, anxiety, and depression, and some patients, even with severe hypocalcaemia, have no neuromuscular symptoms. Factors that determine the variation in frequency and severity of symptoms include acid-base status (hypocalcaemia and alkalosis act synergistically to cause tetany), hypomagnesaemia, and potassium balance.

5B5K.1Y Other specified calcium deficiency

5B5K.1Z Calcium deficiency unspecified

5B5K.2 Zinc deficiency

Definition of Zinc deficiency: The clinical features of severe zinc deficiency in humans are growth retardation, delayed sexual and bone maturation, skin lesions, diarrhoea, alopecia, impaired appetite, increased susceptibility to infections mediated via defects in the immune system, and the appearance of behavioural changes. The effects of marginal or mild zinc deficiency are less clear. A reduced growth rate and impairments of immune defence are so far the only clearly demonstrated signs of mild zinc deficiency in humans. Other effects, such as impaired taste and wound healing, which have been claimed to result from a low zinc intake, are less consistently observed.

Coded Elsewhere:

• Neonatal nutritional zinc deficiency (5C64.21)

5B5K.3 Iodine deficiency

Definition of Iodine deficiency: Iodine deficiency disorders (IDD), caused mainly by a low dietary supply of iodine, refer to all of the consequences of iodine deficiency in a population that can be prevented by ensuring that the population has an adequate intake of iodine. Iodine deficiency is the most frequent cause of preventable brain damage in childhood.

Coded Elsewhere:

• Iodine-deficiency-related thyroid disorders or allied conditions (5A00.1)
• Acquired hypothyroidism (5A00.2)
• Congenital hypothyroidism due to iodine deficiency (5A00.04)

5B5K.4 Fluorine deficiency

Definition of Fluorine deficiency: A condition caused by a deficiency of fluoride. Low Fluorine concentrations in an individual’s dental plaque and enamel may result in an increased risk for dental caries at any age. Fluorine deficiencies might also show negative effects on human’s bone health.

5B5K.5 Sodium chloride deficiency

Definition of Sodium chloride deficiency: Sodium and chloride are usually found together in most foods as sodium chloride, also termed salt. For that reason, the effects of sodium and chloride deficiency are considered together. Deficiency can be caused by poor intake or increased losses (e.g., diuretics increase the urinary excretion of water, sodium, and chloride; in cystic fibrosis the sodium and chloride content of sweat is very high; gastrointestinal losses are associated with diarrhoeal diseases, emesis, ostomy output and other causes).

5B5K.6 Copper deficiency

Definition of Copper deficiency: Dietary deficiency is rare; it has been observed in premature and low birthweight infants fed exclusively a cow’s milk diet and in individuals on long-term total parenteral nutrition without copper. Clinical manifestations include depigmentation of skin and hair, neurologic disturbances, leukopenia, hypochromic microcytic anaemia, and skeletal abnormalities.

Coded Elsewhere:

• Copper deficiency anaemia (3A03.3)

5B5K.7 Selenium deficiency

Definition of Selenium deficiency: Selenium deficiency is rare but has been observed in individuals on long-term total parenteral nutrition lacking selenium. Clinical manifestations of deficiency arising from such situations are uncommon and poorly defined. They include muscular weakness and myalgia with, in several instances, the development of congestive heart failure. The importance of selenium for thyroid hormone metabolism is evident from changes in the T3–T4 ratio which develop after relatively mild selenium depletion in infants and elderly subjects.

5B5K.8 Chromium deficiency

Definition of Chromium deficiency: Deficiency in humans is only described in long-term total parenteral nutrition patients receiving insufficient chromium. Hyperglycaemia or impaired glucose tolerance occurs. Elevated plasma free fatty acid concentrations, neuropathy, encephalopathy, and abnormalities in nitrogen metabolism are also reported.

5B5K.9 Manganese deficiency

5B5K.A Molybdenum deficiency

Definition of Molybdenum deficiency: Molybdenum functions as a cofactor for a limited number of enzymes in humans: sulphite oxidase, xanthine oxidase and aldehyde oxidase. A rare severe metabolic defect causing molybdenum cofactor deficiency and preventing these enzymes from being synthesized has been described. Few infants with such defects survive the first days of life, and those who survive have severe neurological abnormalities. Although molybdenum deficiency related to a dietary deficiency is extremely rare in humans, it has been described in long-term total parenteral nutrition as being secondary to the administration of sulphite. Symptoms include: tachycardia, headache, night blindness, irritability and coma. Biochemical changes can consist of elevated plasma and methionine concentration, low serum uric acid concentration, high urinary thiosulfate and low urinary uric acid and sulphate levels.

5B5K.B Vanadium deficiency

Definition of Vanadium deficiency: A biological role of vanadium in humans has not yet been identified.

5B5K.Y Other specified mineral deficiency

5B5K.Z Mineral deficiency unspecified