Have any of you ever seen a patient with hypoglycemia that just dropping despite every intervention?
I have never seen anything like what I saw last noc. Pt known diabetic, reports a 2-3 day "stomach bug" with nausea, vomiting, and diarrhea. Normally takes regular insulin, set dose, Q AM, along with PO hypoglycemics. States yesterday AM, FS was in the 40's, skipped AM insulin and PO meds. States po food intake decreased, but adequate. Certainly able to take PO- watched him eat a sandwich and down quite a lot of OJ. Family called EMS later that day for FS in the 30's.
Given before arrival to floor,
2 tubes glucose gel
4 Glucose tabs
2 mg glucagon
2 amps D50 IV
IV D5 1/2 NS @ 100ml/hr
Boxed lunch
Upon arrival to floor (sometime late in evening) ... FS in the 90's. Stayed up there only about a couple of hours, then in the 30's again.
Given between 11-7
4 amps D50
2mg Glucagon SQ (in seperate doses)
16 OZ per hypoglycemia protocol
IV D10 @100ml/hr
Seemed as though he'd barely hit normal after D50 AND glucagon, but only stay there for about an hour or so!! Current thinking... either OD on oral hypoglycemics or insuloma??? Many labs still pending when I left.
What a night, though!! FSBS was checked between Q15m after interventions!! and Q1h when >70. Total FSBS's for shift >15. Have never spent so much time on blood sugar in my life! Despite all of this... FSBS@6AM-55!!! Pt was being transferred to PCU level of care from tele when I left.
I'm exhausted. I think MY blood sugar is low from running around so much!
I had a similar night many years ago. Patient's blood sugar kept dropping, q15" checks all night long, D10 infusing and amps of D50 (1-2 each hour!). Did I mention the pt was NPO after midnight?!? Turns out this guy had a tumor on his pancreas causing increased production of insulin. He did great after surgery, but I'll never forget that night:bugeyes:
I had a similar night many years ago. Patient's blood sugar kept dropping, q15" checks all night long, D10 infusing and amps of D50 (1-2 each hour!). Did I mention the pt was NPO after midnight?!? Turns out this guy had a tumor on his pancreas causing increased production of insulin. He did great after surgery, but I'll never forget that night:bugeyes:
I had a similar incident with a 18 y.o. male. He was a ward of the state, and they suspect he was/is a a drug-seeker and uses his Type 1 diabetes to get into the hospital (lets is bottom out or spike up). Once he gets in, he keeps his own insulin with him to bottom himself out (so he can use that as a reason to stay longer) or sneaks junk food (to spike his BS -- and also says he doesn't have an appetite for the ADA trays provided) for the same reason. Again, this was all just suspect, but it was really weird to see his BS plummet and spike so frequently...
I had a similar night many years ago. Patient's blood sugar kept dropping, q15" checks all night long, D10 infusing and amps of D50 (1-2 each hour!). Did I mention the pt was NPO after midnight?!? Turns out this guy had a tumor on his pancreas causing increased production of insulin. He did great after surgery, but I'll never forget that night:bugeyes:
was this an insulinoma. It's quite rare, I work with a regional endocrine surgeon and in the last 5 years I have only seen 3 of these. They tend to do very well once surgically removed
When I was a student I saw a nurse in the ER who had attempted suicide. (She was from the same hospital, but not one of the ER nurses). I guess she stole a couple of vials of insulin from the floor she worked on, and took something like 800 units. The ER tried everything to get her blood sugar up, but it was useless. She was transferred to the ICU, so I never did find out what happened after that.
any of those five happen in a previously dx Type I diabetic.....have had two patients, one very recently, with totally wacked out BS.....the recent one, i was wondering about self destructive behavior.....this patient could go from 400 to 20 in 6-8 hours.....
any of those five happen in a previously dx Type I diabetic.....have had two patients, one very recently, with totally wacked out BS.....the recent one, i was wondering about self destructive behavior.....this patient could go from 400 to 20 in 6-8 hours.....
there was 3 patients in 5 years. THe symptoms were lethargy, collapse ?cause and later found to be hypoglycaemic can't recall any of them being type I. One use to become very argumentative when hypo but no self destructive behavior.
I am stuggling with your Blood Sugar measurements, we measure in mmols/l so normal limits for us is 4-8, I am not sure how that equates to your units of measurment, my poor brain can't work it out. I recall not one of them had blood sugars above 8 prior to surgery.
The last patient I care for never had a blood sugar above 4 and that was with regular hypostop regular meals. She felt lethargic and unwell for over 6 months before a complete collapse which led to investigations and diagnosis.
ah, on two counts....the patient in question is/was a dial. pt....and
the measurements...60-120 is considered normal fasting....150 and over i understand can interfer with cardiac conductivity...much under 50 many will start to show signs of hypo....
Lorna Doon
7 Posts
I had a similar night many years ago. Patient's blood sugar kept dropping, q15" checks all night long, D10 infusing and amps of D50 (1-2 each hour!). Did I mention the pt was NPO after midnight?!? Turns out this guy had a tumor on his pancreas causing increased production of insulin. He did great after surgery, but I'll never forget that night:bugeyes: