Chapter XX

External causes of morbidity and mortality

Complications of medical and surgical care

Includes: complications of medical devices
correct drug properly administered in therapeutic or prophylactic dosage as the cause of any adverse effect
misadventures to patients during surgical and medical care
surgical and medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure
Excludes: accidental overdose of drug or wrong drug given or taken in error ( X40-X44 )

Drugs, medicaments and biological substances causing adverse effects in therapeutic use

Note: For list of specific drugs classified under the fourth-character subdivisions, see Table of drugs and chemicals in Alphabetical Index.
Excludes: accidents in the technique of administration of drugs, medicaments and biological substances in medical and surgical procedures ( Y60-Y69 )

Y40 Systemic antibiotics
Excludes: antibiotics, topically used ( Y56.- )
antineoplastic antibiotics ( Y43.3 )
Y40.0 Penicillins
Y40.1 Cefalosporins and other beta-lactam antibiotics
Y40.2 Chloramphenicol group
Y40.3 Macrolides
Y40.4 Tetracyclines
Y40.5 Aminoglycosides
Y40.6 Rifamycins
Y40.7 Antifungal antibiotics, systemically used
Y40.8 Other systemic antibiotics
Y40.9 Systemic antibiotic, unspecified

Y41 Other systemic anti-infectives and antiparasitics
Excludes: anti-infectives, topically used ( Y56.- )
Y41.0 Sulfonamides
Y41.1 Antimycobacterial drugs
Excludes: rifamycins ( Y40.6 )
streptomycin ( Y40.5 )
Y41.2 Antimalarials and drugs acting on other blood protozoa
Excludes: hydroxyquinoline derivatives ( Y41.8 )
Y41.3 Other antiprotozoal drugs
Y41.4 Anthelminthics
Y41.5 Antiviral drugs
Excludes: amantadine ( Y46.7 )
cytarabine ( Y43.1 )
Y41.8 Other specified systemic anti-infectives and antiparasitics
Hydroxyquinoline derivatives
Excludes: antimalarial drugs ( Y41.2 )
Y41.9 Systemic anti-infective and antiparasitic, unspecified

Y42 Hormones and their synthetic substitutes and antagonists, not elsewhere classified
Excludes: mineralocorticoids and their antagonists ( Y54.0-Y54.1 )
oxytocic hormones ( Y55.0 )
parathyroid hormones and derivatives ( Y54.7 )
Y42.0 Glucocorticoids and synthetic analogues
Excludes: glucocorticoids, topically used ( Y56.- )
Y42.1 Thyroid hormones and substitutes
Y42.2 Antithyroid drugs
Y42.3 Insulin and oral hypoglycaemic [antidiabetic] drugs
Y42.4 Oral contraceptives
Multiple- and single-ingredient preparations
Y42.5 Other estrogens and progestogens
Mixtures and substitutes
Y42.6 Antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified
Y42.7 Androgens and anabolic congeners
Y42.8 Other and unspecified hormones and their synthetic substitutes
Anterior pituitary [adenohypophyseal] hormones
Y42.9 Other and unspecified hormone antagonists

Y43 Primarily systemic agents
Excludes: vitamins NEC ( Y57.7 )
Y43.0 Antiallergic and antiemetic drugs
Excludes: phenothiazine-based neuroleptics ( Y49.3 )
Y43.1 Antineoplastic antimetabolites
Y43.2 Antineoplastic natural products
Y43.3 Other antineoplastic drugs
Antineoplastic antibiotics
Excludes: tamoxifen ( Y42.6 )
Y43.4 Immunosuppressive agents
Y43.5 Acidifying and alkalizing agents
Y43.6 Enzymes, not elsewhere classified
Y43.8 Other primarily systemic agents, not elsewhere classified
Heavy-metal antagonists
Y43.9 Primarily systemic agent, unspecified

Y44 Agents primarily affecting blood constituents
Y44.0 Iron preparations and other anti-hypochromic-anaemia preparations
Y44.1 Vitamin B 12 , folic acid and other anti-megaloblastic-anaemia preparations
Y44.2 Anticoagulants
Y44.3 Anticoagulant antagonists, vitamin K and other coagulants
Y44.4 Antithrombotic drugs [platelet-aggregation inhibitors]
Excludes: acetylsalicylic acid ( Y45.1 )
dipyridamole ( Y52.3 )
Y44.5 Thrombolytic drugs
Y44.6 Natural blood and blood products
Excludes: immunoglobulin ( Y59.3 )
Y44.7 Plasma substitutes
Y44.9 Other and unspecified agents affecting blood constituents

Y45 Analgesics, antipyretics and anti-inflammatory drugs
Y45.0 Opioids and related analgesics
Y45.1 Salicylates
Y45.2 Propionic acid derivatives
Propanoic acid derivatives
Y45.3 Other nonsteroidal anti-inflammatory drugs [NSAID]
Y45.4 Antirheumatics
Excludes: chloroquine ( Y41.2 )
glucocorticoids ( Y42.0 )
salicylates ( Y45.1 )
Y45.5 4-Aminophenol derivatives
Y45.8 Other analgesics and antipyretics
Y45.9 Analgesic, antipyretic and anti-inflammatory drug, unspecified

Y46 Antiepileptics and antiparkinsonism drugs
Excludes: acetazolamide ( Y54.2 )
barbiturates NEC ( Y47.0 )
benzodiazepines ( Y47.1 )
paraldehyde ( Y47.3 )
Y46.0 Succinimides
Y46.1 Oxazolidinediones
Y46.2 Hydantoin derivatives
Y46.3 Deoxybarbiturates
Y46.4 Iminostilbenes
Y46.5 Valproic acid
Y46.6 Other and unspecified antiepileptics
Y46.7 Antiparkinsonism drugs
Y46.8 Antispasticity drugs
Excludes: benzodiazepines ( Y47.1 )

Y47 Sedatives, hypnotics and antianxiety drugs
Y47.0 Barbiturates, not elsewhere classified
Excludes: deoxybarbiturates ( Y46.3 )
thiobarbiturates ( Y48.1 )
Y47.1 Benzodiazepines
Y47.2 Cloral derivatives
Y47.3 Paraldehyde
Y47.4 Bromine compounds
Y47.5 Mixed sedatives and hypnotics, not elsewhere classified
Y47.8 Other sedatives, hypnotics and antianxiety drugs
Y47.9 Sedative, hypnotic and antianxiety drug, unspecified
· draught
· drug
· tablet

Y48 Anaesthetics and therapeutic gases
Y48.0 Inhaled anaesthetics
Y48.1 Parenteral anaesthetics
Y48.2 Other and unspecified general anaesthetics
Y48.3 Local anaesthetics
Y48.4 Anaesthetic, unspecified
Y48.5 Therapeutic gases

Y49 Psychotropic drugs, not elsewhere classified
Excludes: appetite depressants [anorectics] ( Y57.0 )
barbiturates NEC ( Y47.0 )
benzodiazepines ( Y47.1 )
caffeine ( Y50.2 )
cocaine ( Y48.3 )
methaqualone ( Y47.8 )
Y49.0 Tricyclic and tetracyclic antidepressants
Y49.1 Monoamine-oxidase-inhibitor antidepressants
Y49.2 Other and unspecified antidepressants
Y49.3 Phenothiazine antipsychotics and neuroleptics
Y49.4 Butyrophenone and thioxanthene neuroleptics
Y49.5 Other antipsychotics and neuroleptics
Excludes: rauwolfia ( Y52.5 )
Y49.6 Psychodysleptics [hallucinogens]
Y49.7 Psychostimulants with abuse potential
Y49.8 Other psychotropic drugs, not elsewhere classified
Y49.9 Psychotropic drug, unspecified

Y50 Central nervous system stimulants, not elsewhere classified
Y50.0 Analeptics
Y50.1 Opioid receptor antagonists
Y50.2 Methylxanthines, not elsewhere classified
Excludes: aminophylline ( Y55.6 )
theobromine ( Y55.6 )
theophylline ( Y55.6 )
Y50.8 Other central nervous system stimulants
Y50.9 Central nervous system stimulant, unspecified

Y51 Drugs primarily affecting the autonomic nervous system
Y51.0 Anticholinesterase agents
Y51.1 Other parasympathomimetics [cholinergics]
Y51.2 Ganglionic blocking drugs, not elsewhere classified
Y51.3 Other parasympatholytics [anticholinergics and antimuscarinics] and spasmolytics, not elsewhere classified
Y51.4 Predominantly alpha-adrenoreceptor agonists, not elsewhere classified
Y51.5 Predominantly beta-adrenoreceptor agonists, not elsewhere classified
Excludes: salbutamol ( Y55.6 )
Y51.6 Alpha-adrenoreceptor antagonists, not elsewhere classified
Excludes: ergot alkaloids ( Y55.0 )
Y51.7 Beta-adrenoreceptor antagonists, not elsewhere classified
Y51.8 Centrally acting and adrenergic-neuron-blocking agents, not elsewhere classified
Excludes: clonidine ( Y52.5 )
guanethidine ( Y52.5 )
Y51.9 Other and unspecified drugs primarily affecting the autonomic nervous system
Drugs stimulating both alpha- and beta-adrenoreceptors

Y52 Agents primarily affecting the cardiovascular system
Excludes: metaraminol ( Y51.4 )
Y52.0 Cardiac-stimulant glycosides and drugs of similar action
Y52.1 Calcium-channel blockers
Y52.2 Other antidysrhythmic drugs, not elsewhere classified
Excludes: beta-adrenoreceptor antagonists ( Y51.7 )
Y52.3 Coronary vasodilators, not elsewhere classified
Excludes: beta-adrenoreceptor antagonists ( Y51.7 )
calcium-channel blockers ( Y52.1 )
Y52.4 Angiotensin-converting-enzyme inhibitors
Y52.5 Other antihypertensive drugs, not elsewhere classified
Excludes: beta-adrenoreceptor antagonists ( Y51.7 )
calcium-channel blockers ( Y52.1 )
diuretics ( Y54.0-Y54.5 )
Y52.6 Antihyperlipidaemic and antiarteriosclerotic drugs
Y52.7 Peripheral vasodilators
Nicotinic acid (derivatives)
Excludes: papaverine ( Y51.3 )
Y52.8 Antivaricose drugs, including sclerosing agents
Y52.9 Other and unspecified agents primarily affecting the cardiovascular system

Y53 Agents primarily affecting the gastrointestinal system
Y53.0 Histamine H 2 -receptor antagonists
Y53.1 Other antacids and anti-gastric-secretion drugs
Y53.2 Stimulant laxatives
Y53.3 Saline and osmotic laxatives
Y53.4 Other laxatives
Intestinal atonia drugs
Y53.5 Digestants
Y53.6 Antidiarrhoeal drugs
Excludes: systemic antibiotics and other anti-infectives ( Y40-Y41 )
Y53.7 Emetics
Y53.8 Other agents primarily affecting the gastrointestinal system
Y53.9 Agent primarily affecting the gastrointestinal system, unspecified

Y54 Agents primarily affecting water-balance and mineral and uric acid metabolism
Y54.0 Mineralocorticoids
Y54.1 Mineralocorticoid antagonists [aldosterone antagonists]
Y54.2 Carbonic-anhydrase inhibitors
Y54.3 Benzothiadiazine derivatives
Y54.4 Loop [high-ceiling] diuretics
Y54.5 Other diuretics
Y54.6 Electrolytic, caloric and water-balance agents
Oral rehydration salts
Y54.7 Agents affecting calcification
Parathyroid hormones and derivatives
Vitamin D group
Y54.8 Agents affecting uric acid metabolism
Y54.9 Mineral salts, not elsewhere classified

Y55 Agents primarily acting on smooth and skeletal muscles and the respiratory system
Y55.0 Oxytocic drugs
Ergot alkaloids
Excludes: estrogens, progestogens and antagonists ( Y42.5-Y42.6 )
Y55.1 Skeletal muscle relaxants [neuromuscular blocking agents]
Excludes: antispasticity drugs ( Y46.8 )
Y55.2 Other and unspecified agents primarily acting on muscles
Y55.3 Antitussives
Y55.4 Expectorants
Y55.5 Anti-common-cold drugs
Y55.6 Antiasthmatics, not elsewhere classified
Excludes: beta-adrenoreceptor agonists ( Y51.5 )
anterior pituitary [adenohypophyseal] hormones ( Y42.8 )
Y55.7 Other and unspecified agents primarily acting on the respiratory system

Y56 Topical agents primarily affecting skin and mucous membrane and ophthalmological, otorhinolaryngological and dental drugs
Includes: glucocorticoids, topically used
Y56.0 Local antifungal, anti-infective and anti-inflammatory drugs, not elsewhere classified
Y56.1 Antipruritics
Y56.2 Local astringents and local detergents
Y56.3 Emollients, demulcents and protectants
Y56.4 Keratolytics, keratoplastics and other hair treatment drugs and preparations
Y56.5 Ophthalmological drugs and preparations
Y56.6 Otorhinolaryngological drugs and preparations
Y56.7 Dental drugs, topically applied
Y56.8 Other topical agents
Y56.9 Topical agent, unspecified

Y57 Other and unspecified drugs and medicaments
Y57.0 Appetite depressants [anorectics]
Y57.1 Lipotropic drugs
Y57.2 Antidotes and chelating agents, not elsewhere classified
Y57.3 Alcohol deterrents
Y57.4 Pharmaceutical excipients
Y57.5 X-ray contrast media
Y57.6 Other diagnostic agents
Y57.7 Vitamins, not elsewhere classified
Excludes: nicotinic acid ( Y52.7 )
vitamin B 12 ( Y44.1 )
vitamin D ( Y54.7 )
vitamin K ( Y44.3 )
Y57.8 Other drugs and medicaments
Y57.9 Drug or medicament, unspecified

Y58 Bacterial vaccines
Y58.0 BCG vaccine
Y58.1 Typhoid and paratyphoid vaccine
Y58.2 Cholera vaccine
Y58.3 Plague vaccine
Y58.4 Tetanus vaccine
Y58.5 Diphtheria vaccine
Y58.6 Pertussis vaccine, including combinations with a pertussis component
Y58.8 Mixed bacterial vaccines, except combinations with a pertussis component
Y58.9 Other and unspecified bacterial vaccines

Y59 Other and unspecified vaccines and biological substances
Y59.0 Viral vaccines
Y59.1 Rickettsial vaccines
Y59.2 Protozoal vaccines
Y59.3 Immunoglobulin
Y59.8 Other specified vaccines and biological substances
Y59.9 Vaccine or biological substance, unspecified