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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.

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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.

We had a guy who often came in with Hb around 3 still trying to walk. He didn't walk when he came in with Hb 1.something. Sad case.
 
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I have two or three Hgb values a fair bit less than this (somewhat tachy, but otherwise well-compensated); however, a potassium like that I doubt I will ever see -- even with hemolysis!

HH
 
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.
 
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.
 
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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.

Did you tell her to draw blood or draw the potassium? lol
 
Nursing home patient.....bed bound...Na 183. The highest I have seen.....some one must have seen higher.

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.



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.)

Could be myocarditis with a clean cath.
 
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.

An A1c of 20 is off of the high end curve used to calculate the estimates with average glucose. It's more likely a guy with an A1c has a high average glucose number, but probably not quite that high as the curve begins to flatten out.
 
Saw a lady with an acute on chronic fibroid bleed. Hemoglobin was 1.9 when she came into the ED. She walked out of the hospital about 3 weeks later.
 
Highest EtOH this month - 560 and walking / talking. I know I've seen higher in the past though.
 
New glucose high for me - 1560.

Same patient had an anion gap of 43.
 
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Highest EtOH this month - 560 and walking / talking. I know I've seen higher in the past though.

Fred, one my chronic patients can estimate his score so well that the nurses won't let him join the betting pool.

I am excluded from the pool for all patients because I ask the question "is this your best drunk ever?" of the patient before I place my wager.


PS: Yes, Fred is a such a regular, and figured out that the nurses were taking bets, that for a number of years Fred was a player in his own betting pool.
 
Glucose 2140, took 10L IVF before we got 100cc of urine
 
Glucose 2177.

Patient was thirsty and had been chugging Baja blast for a while (days-week?)...came in AMS and looked like maybe it was an antifreeze suicide attempt or something. Survived.
 
Highest Cr from an AKI? For me, 32
 
Arterial lactate 291 Only time I've ever actually seen a methylene blue infusion running and the MAP was still in the 20s. It had been that way for ~3 days.
 
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.

To the other end of the spectrum, had a landscaper come in after collapsing with AMS, rectal temp 107.6!!! Agonal resp, tubed immediately, tachy in 160s with EKG showing STEMI in lateral leads. Call Cards, ice packs everywhere, cold IV fluids...get him down to 102...ST elevations resolve...to ICU. Also Acute Renal Failure with K of 7.3.
 
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.

I checked the MICU today abd she was extubated and alive. Mindboggling.
 
compartment pressure of 145mmHg. My colleague showed me a WBC of 583,000 on an AMS pt from the other night.
 
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.....

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 ?
 
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.....

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.
 
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 ?
I think that this is a great idea. Mods?
 
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.
No. Definitely not on a pump
 
"Paradoxical cerebral acidosis can occur with NaHCO3 administration due to formation and diffusion of CO2 from the systemic circulation into the central nervous system. Rapid administration of NaHCO3 can cause intracellular influx of potassium and induce acute hypokalemia. NaHCO3 therapy has been associated with cerebral edema, the most common cause of mortality for children with DKA. NaHCO3 supplementation should only be considered in the critical instance of severe acidosis (serum pH < 7.0) associated with myocardial depression and circulatory insufficiency."

"Pediatric Diabetic Ketoacidosis: An Outpatient Perspective On Evaluation and Management", EB Medicine, March 2013 Volume 10, Number 3. By William Bonadio, MD

---

Morris LR, Murphy MB, Kitabchi AE. Bicarbonate therapy in severe diabetic ketoacidosis. Ann Intern Med. 1986;105(6):836- 840. (Prospective randomized study; 21 patients)

Green SM, Rothrock SG, Ho JD. Failure of adjunctive bicarbonate to improve outcome in severe pediatric diabetic ketoacidosis. Ann Emerg Med. 1998;31(1):41-48. (Retrospec- tive study; 147 cases)

Ohman JL Jr, Marliss EB, Aoki TT, et al. The cerebrospinal fluid in diabetic ketoacidosis. N Engl J Med. 1971;284(6):283- 290.

Soler NG, Bennett MA, Dixon K, et al. Potassium balance during treatment of diabetic ketoacidosis with special reference to the use of bicarbonate. Lancet. 1972;2(7779):665-667. (Prospective study)

Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. N Engl J Med. 2001;344(4):264-269.
 
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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.
 
Ooh, I had one the other day. Just learned where our lab's cutoff for the new NT-pro-BNP is.
>70,000.

Now, we haven't had it long enough for me to know if this is really that crazy bad, or just my typical black cloud...
 
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.
 
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.
 
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.
 
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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
 
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

Def true. That and now that I'm out on my own, "I guess I never realized frequent cocaine use that daddy is no longer here to make sure I'm not doing will get me routinely admitted to Dr. Boston in DKA". You get a pass after the first. But when I have already intubated you twice and put lines in you at least 4 times in a 24 month span for severe DKA before the age of 23.... Houston we have a problem.
 
My best: BNP of 100,580, Hb of 5.5, and K of 6.4

All in one patient
And he looked good... when medicine came down to admit him he was outside smoking.
 
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


Saw a patient with lipase of 4.424 million.....highest I have seen, dont even know if that is accurate. He didnt look too hot.
 
I just wanted to resurrect this epic thread. I thought I had a lab from today that could compete....but wasn't even close.
 
this is an awesome thread.
My personal records thus far:
Hgb: 4.5 in a totally symptomatic infant
Ca: 18.7. Multiple myeloma relapse with pathologist rib fx
Platelets: 1. S/p transfusion of 2 units of platelets. She had the craziest auto antibodies.
 
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Took care of a pt 2 weeks ago who had a BMI of 147.
 
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