Diabetes on the psych ward

[Solideliquid]

Here's a problem I run into often on the inpatient wards, especially while on call. A patient will have low sugars (<50) and the nurses will be hesitant about putting in an IV for D50. We don't even have amps of D50 on the unit from what I've heard, what if a patient syncopes with a glucose of 30?

How do you guys deal?

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[prominence]

get a medicine consult. let them do some work.

 

[Solideliquid]

get a medicine consult. let them do some work.

That's not going to do anything for me. They won't admit the patient and they won't tell me anything I don't already know. They will say hold the insulin for now and give 1 amp of D50 and some juice/crackers.

They won't be able to give D50 anyway since we don't have any and it takes the nurses like half a day to get around to putting in an IV. LOL we don't even have IV poles, they need to order it.

 

[PsychMD2100]

While low tech, the juice and crackers route is probably all that you can do. If he/she doesn't respond to juice and crackers and remains hypoglycemic, then you may have to call a code.

 

[OldPsychDoc]

While low tech, the juice and crackers route is probably all that you can do. If he/she doesn't respond to juice and crackers and remains hypoglycemic, then you may have to call a code.

We have a "sub-code", rapid response team that can be called for this stuff--we can't do IVs in our acute inpt units, but these folks can come and run one in, or monitor the situation while they decide if the O2 sats of 85 warrant a med admission or just some nebs and a 4l concentrator...

 

[whopper]

You should ask your unit director on the proper protocol the hospital expects you to follow.

In NJ, you can't do an IV in a psyche ward. It violates EMTALA rules.
In the hospital I'm at, you're going to have to call in the IM doc.

And then, as I've noticed, the IM doctor gets all ticked off and often refuses to show up.

We had a patient in the inpatient unit with retained product of conception after an abortion, the ER doctor cleared her (which he shouldn't have). So we order an Ob-Gyn consult and the Ob-Gyn doctor refused to show up.

Pretty!

The attending ended up discharging her after 1 day to prevent her from getting a POC complication while in the psyche unit. Political thing was that I really thought she wasn't suicidal (why she was committed), but this doc has a habit of never discharging after 1 day.

Sorry to get on tangent.