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- May 10, 2011
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Not bad. I had a guy with an H&H of 2/6 from a lower GI bleed back in my interfacility transport medic days.
Not bad. I had a guy with an H&H of 2/6 from a lower GI bleed back in my interfacility transport medic days.
I have no idea what that K was about. I sent a medical student to draw it without adequate supervision. I think she may have drawn it from a banana. Repeat K drawn by me was 3.7.
Did she draw it straight from a bag of LR or something? Maybe just a bag of IV K+ supplement? I can't even imagine where she got it from...seriously no idea.
Nursing home patient.....bed bound...Na 183. The highest I have seen.....some one must have seen higher.
Just out of curiosity, what made you order a trop on a 17yo with no significant history?
Coke kills (re: 17 yo with CP, trop >>200.)
Recently had a sodium of 190 in a little old man.
If a different person had a guy come in with HHS with an A1C of 20.2. Doing the math that means his average glucose runs about 530.
Highest EtOH this month - 560 and walking / talking. I know I've seen higher in the past though.
one my chronic patients can estimate his score so well that the nurses won't let him join the betting pool.
No identifying information in the post. No violation.I'm assuming you made up this patient's name, otherwise *cough* HIPAA *cough*.
That K is friggin ridiculous! LMAO
52 yo female "found down" naked in her basement.
Temp: 26.3 via bladder. Still breathing (sorta) spontaneously. After warm saline, she rose to 26.5. Warmed her with the same system as we use for the theraputic hypothermia, and currently in the ICU, had a temp of 30 (going slow). Rhythm was slow AF. Bicarb by abg: 4. pH 6.83. Glucose 1083, CK 4976.
52 yo female "found down" naked in her basement.
Temp: 26.3 via bladder. Still breathing (sorta) spontaneously. After warm saline, she rose to 26.5. Warmed her with the same system as we use for the theraputic hypothermia, and currently in the ICU, had a temp of 30 (going slow). Rhythm was slow AF. Bicarb by abg: 4. pH 6.83. Glucose 1083, CK 4976.
Case from the other day:
12 yoM with known T1DM p/w abdominal pain after mother stated that he had missed "only one dose of insulin." Extremely tachycardic, tachypneic, extremely dry/cracked lips, could barely talk due to amount of dehydration. Exquisite RUQ abdominal pain. Borderline mental status
From memory...
pH: 6.99 (ABG)
Lactate 5.8
K: 6.5
CO2: 4
WBC: 33K
Glucose: 814
Serum Osm: 364
Shipped that kid off in a helo ASAP. Door to helo liftofff under 60 minutes.
Wanted to slap that mother.....
Case from the other day:
12 yoM with known T1DM p/w abdominal pain after mother stated that he had missed "only one dose of insulin." Extremely tachycardic, tachypneic, extremely dry/cracked lips, could barely talk due to amount of dehydration. Exquisite RUQ abdominal pain. Borderline mental status
From memory...
pH: 6.99 (ABG)
Lactate 5.8
K: 6.5
CO2: 4
WBC: 33K
Glucose: 814
Serum Osm: 364
Shipped that kid off in a helo ASAP. Door to helo liftofff under 60 minutes.
Wanted to slap that mother.....
I think that this is a great idea. Mods?Hey.... this sounds like a good "management" case to spin off into its own thread. How to treat all the nuances of DKA in a pediatric patient, the plus-es and minus-es of bicarb, etc....
Make it happen ?
No. Definitely not on a pumpWas the kid not on a pump? Ill admit I obviously don't see kids but even the 16-17-18 y/o type 1s that I've seen in the ED have all been on insulin pumps. At least if mom forgets to remind him to bolus the basal should still be going and keep him out of DKA most of the time. I haven't seen a type 1 not on a pump yet.
Was the kid not on a pump? Ill admit I obviously don't see kids but even the 16-17-18 y/o type 1s that I've seen in the ED have all been on insulin pumps. At least if mom forgets to remind him to bolus the basal should still be going and keep him out of DKA most of the time. I haven't seen a type 1 not on a pump yet.
you are lucky then, vast majority of the type I's I see are not on pumps, they treat their diabetes w/o fancy machines.
If you are seeing them in the ED, then they are not managing their sugars well without the pump I have seen many type 1s in endo clinic not on pumps and doing very well, not being admitted to the hospital. But when I'm in the hospital, the recurrent frequent flyer DKA'rs are all poor compliance patients on pumps.
so it seems that the pumps don't fix poor compliance I still say you're lucky because vast majority of patients in NY and Florida area are not on insulin pumps. I see maybe one pump a year. And pumps make my job a lot easier ("Hi Mr. Endocrinologist, please tell me what to set the pump to and I will follow your instructions and shut my brain off") Though I'll say that at least a third of my DKA's have less to do with home sugar management and more to do with dehydration or an underlying illness.
Haha to an extent your right. In the COMPLIANT type 1 patient who is still not at goal, the pump helps them get under 8 and stay out of the hospital more. But for the non compliant type 1, they will be poorly controlled on and off the pump. Usually a little better on pump because the basal goes on its own. But I had a 22 y/o the other day with a1c of 14 on pump. I looked at pump, she hadn't bolused in 6 days....how hard is it to take an accucheck and type in the number?? Can't help those patients. But in general, good pts who have a1cs around 9-10 whom you know are compliant, they get better on a pump. The ones I mentioned that frequent fly on a pump in DKA, the endocrinologist told me he has these pts on pump so that the continuous basal and intermittent boluses they may take will hopefully decrease there yearly DKA admissions from 4 to 2...goal is just to keep them out of the hospital irrespective of the a1c.
It's always the 18-22 yo's isn't it you get out of the house and get so excited about being on your own that you don't realize what it actually takes to be on your own
34yo female with excruciating abdominal pain of sudden onset. all labs come back except for lipase, which is "pending." a few hours of pestering the lab later... Lipase: 41,000