Thank you for your question and comments about the Hospital Harm - Severe Hypoglycemia eCQM, CMS816. A severe hypoglycemic event is a glucose result of less than 40 mg/dL that occurs within 24 hours of administration of a hypoglycemic medication, such as insulin. The reason for administering the hypoglycemic medication, such as to treat hyperkalemia, is not considered in the evaluation because any severe hypoglycemic event is considered a harm. Treatment of severe hyperkalemia often involves insulin administration to drive potassium into the cells, primarily by enhancing the activity of the Na-K-ATPase pump in skeletal muscle. It is well recognized that hypoglycemia occurs in 6% to 18% of patients in this setting ( https://pubmed.ncbi.nlm.nih.gov/27148740/, https://pubmed.ncbi.nlm.nih.gov/32979855/) .