So yesterday I was looking after this guy with rhabdo, who came in with a CK of 243,100 and I was wondering - what's the highest value you've seen? Not necessarily CK, any value.
An example, for example - I had a woman who had a glucose of 120.8mmol/L. I don't know how to translate that into the US scale, but the normal range is around 4 - 9 in a well-controlled diabetic.
Same patient, different admission - triglycerides 8.1 (0.0 - 2.0), cholesterol 22 (?
Highest K+? 7.6mmol/L (renal patient)
Urea - 48.6, creatinine 1.18!!! (same patient, normal levels in June this year)
Specializes in CCU (Coronary Care); Clinical Research.
I would refuse to dose anyone w/ ativan 40 mg. (???). That doesn't make sense. I have detoxed may pt and have never heard of dosage like that. Also never have heard of Haldol use for withdraw. Sounds like an Internist's experiment. Would have the crash cart warm and ready.
I agree with the ativan...haldol is the primary drug for our alcohol withdraw protocol for agitation (also bananna bag/librium q 6 or therebouts/ativan 1-2 mg per hour). The haldol we can give q5 minutes starting with five mg and doubling it until agitation/violence is controlled (up to 20 or 40 mg...i can't remember now). We don't usually need that much...this is in an ICU setting though...so the patient is closely monitored...
The highest PCO2 I saw this weekend: 140 on admit. Pt not on a vent, the pulmo was excited when her PCO2 finally got lower...all th e way to 109. Don't know anything else about the patient, she/he wasn't mine, but the pulmo said she would most likely be fine...
Found a pt. unresponsive, diaphoretic, doing routine MN vitals - had a blood sugar of 7... After 2 amps of D50, came up to 290.... Woke up and MAN was he P/O'ed - mad at all the people in his room at midnight! Orded us all out! :rotfl:
BUT... the MD had started him the evening before on glyburide, and since it was still on board, started dropping again almost immediately, even with D5 running...
The problem was that she was so fluid overloaded that her blood was practically pure plasma (so the glucose reading was false). They ended up having to do her accuchecks by drawing blood from a vein and having the lab run it.
We recently had a pt in our office who absolutely refused treatment for hyperlipidemia, including labs. We had to draw blood for him for something else and it looked like milk! The tests the doc ordered couldn't be done because there was so much in it!
We were detoxing a young man from alcohol... giving him continuous
IV Ativan and IV Haldol was given every 2 hours. The dose of Haldol was 5mg at a pop.
The dose of Ativan was 40mg. PER HOUR.
Groggy, but still awake, pulling at restraints.
This kind of dosing always blows my mind. We get patients that require like 400-500 mcg/ hr of fentanyl and 8-9 mg/hr of versed for sedation. But even after all this, they still manage to move about and respond to touch. Bizarre!
We don't really deal with etoh detox, but we frequently push 5-10 mg of haldol in our agitated population (poor souls!). It's usually ordered around the clock (q 4-6/ hr) along with an ativan dose which can vary, but I don't think I've ever seen a 40mg/hr ativan drip!! Wow!
We see serum creatinine levels as high as 5-7 in renal failure of course.
wbc <.01 a sad story of sweet year old md who was diagnosed with breast cancer during her first week peds residency. she didn make it.>
Stupid MD put a patient on K replacement without ordering a BMP for several days. Pt had undiagnosed renal insufficiency and retained all the potassium.
YIKES! Didn't a nurse think to mention to the doc that this patient might need some labs?
okay, i had to revive this thread because we had a patient over the weekend who was admitted with a blood glucose level of
2290
38 y.o. with 8 yr hx of severe etoh abuse that decided to replace booze with kool-aid and apparently went through a 5lb bag of sugar in about 4 days. full blown dts + hhnk = sick!
okay, i had to revive this thread because we had a patient over the weekend who was admitted with a blood glucose level of
2290
38 y.o. with 8 yr hx of severe etoh abuse that decided to replace booze with kool-aid and apparently went through a 5lb bag of sugar in about 4 days. full blown dts + hhnk = sick!
d-aaaaaaaaaaaaaaaaaaaaa-n-g!!!!!!!!!!!! how'd things end up?
D-AAAAAAAAAAAAAAAAAAAAA-N-G!!!!!!!!!!!! How'd things end up?
Well, he was sick as "you know what" the first day (Friday) and was requiring a truckload of Morphine and Ativan (both gtts) to keep him chilled out. Problem was the gtts kept dropping his pressure, which wasn't great to begin with, so we had to chase his BP with fluids all day. By Saturday, glucose was down in the 300 range and he was more stable, still on 4/4 Morphine and Ativan. Sunday, he spiked a huge temp (hellllo sepsis!) and was cultured. That's the last I know, but he's got a long road to recovery IMO.
This is secondhand, not a nurse so I don't really have any other stories to chuck out.
My first team manager, great boss and still a good friend, once said she had an Accu-chek done during a training session (we work MR/DD group homes and assisted living) on diabetes, everyone checked each other's BG.......hers was 22! The nurse fairly RAN to the kitchen to get the OJ......musta been pretty funny! She's NOT diabetic either. I am, and so have a lot more Accucheck result experience.......I would imagine the strip was more than likely contaminated (they can be notoriously unreliable if there's too much moisture, humidity, even bad air, you name it) somehow and therefore off. Lowest I ever got on myself was 52 and I was shaking like a baby's rattle trying to get a scoop of ice cream in. Was that guy who showed his BG of 19 still A&O or what? Do another check?
There's liars, damned liars, and then there are BG meters.....
Tom
Almost same thing happened to me. I was starting a new job, I was in school, and I was busy. I had class that morning and then had to drive like a mad woman to get to an afternoon orientation class. We checked off on accuchecks at the end of the day around 6pm. I hadn't eaten all day... BS of 45. No wonder I felt so nausated, sleepy and shaky... the poor guy who was checking me off was an RN, he was basically shoving sugar packets from the coffee maker down my throat.
I had felt so poorly that at the break right before we checked off I had called my husband to come pick me up.
I'm now treated with anti diabetic meds, so I feel much better now. I don't have the ups and downs like I used to.... not as many insulin spikes. I'm also much more careful about making sure that I eat and carry snacks!
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zambezi, BSN, RN
935 Posts
I agree with the ativan...haldol is the primary drug for our alcohol withdraw protocol for agitation (also bananna bag/librium q 6 or therebouts/ativan 1-2 mg per hour). The haldol we can give q5 minutes starting with five mg and doubling it until agitation/violence is controlled (up to 20 or 40 mg...i can't remember now). We don't usually need that much...this is in an ICU setting though...so the patient is closely monitored...
The highest PCO2 I saw this weekend: 140 on admit. Pt not on a vent, the pulmo was excited when her PCO2 finally got lower...all th e way to 109. Don't know anything else about the patient, she/he wasn't mine, but the pulmo said she would most likely be fine...