# I almost died laughing after checking my patient's blood sugar.



## abckidsmom (Sep 16, 2011)

I guess I spent too much time around here this week, cause last night I went for a lady who had a syncopal episode in the bathroom then was too weak to get up.

The family said she'd been driving them crazy with getting up going to the bathroom at night and she'd been so thirsty the whole week.  She had been unable to eat, and now she was slightly short of breath and dizzy.

We checked her blood sugar, and while my partner was sticking her finger, I said, I bet it'll say "HI".  

Sure enough, it did.  _And I didn't even have a health history form._  In fact, she had not been to a doctor since 2001, so there was no documented medical history.

New onset diabetes, party of one.  DKA section, please.


----------



## Shishkabob (Sep 16, 2011)

Both my diabetic patients died this week.  But then again, both said "Lo"  h34r:


----------



## Cup of Joe (Sep 16, 2011)

"I think the meter is trying to have a conversation with me?"


----------



## usalsfyre (Sep 16, 2011)

Obviously since your also a RN, you can discern that prior to a FSBGL. Us lowly paramedics on the other hand, would have been lost h34r: .


----------



## epipusher (Sep 16, 2011)

differential dx? learn me some more


----------



## Sasha (Sep 16, 2011)

How did you know to check without a history? Dang girl, youre good!


----------



## 8jimi8 (Sep 16, 2011)

polydipsia, polyuria. I thought the same thing within the first few sentences.


another clue would have been that the urine on the floor would be sticky enough to allow you to walk on the walls...


----------



## abckidsmom (Sep 16, 2011)

8jimi8 said:


> polydipsia, polyuria. I thought the same thing within the first few sentences.
> 
> 
> another clue would have been that the urine on the floor would be sticky enough to allow you to walk on the walls...




Hey wait a minute, there was no mention in the story of urine on the floor.  The nurse did not tell you that there was urine on the floor.  However did you know that?


----------



## Sasha (Sep 16, 2011)

He is a nurse. He knows these things.


----------



## abckidsmom (Sep 16, 2011)

Sasha said:


> He is a nurse. He knows these things.



Right.  Of course.


----------



## abckidsmom (Sep 16, 2011)

epipusher said:


> differential dx? learn me some more



Serious question?  Hope so.

Middle of the night syncope always brings to mind cardiac events and CVA.

This lady, with her weakness, and apparent comfort and happiness to lay in the floor for 2 hours made me really lean toward CVA until I started talking to her and the family.  I could have been hyper-focused on my suspicions, but with the weakness, polyuria, polydipsia, tachycardia, tachypnea, and obesity, with long periods without medical care, there was really nothing else I suspected.

I wondered whether it was HHNK vs DKA, but when her ETCO2 was 80, that settled that.

Funny enough, I told the story to the ED on the phone, with the opening line being "64 yof with possible new onsent diabetes, possibly in DKA" and then filled in the story a little.  When we got there, with her in a gown, having had a liter bolus and the second one started, with a cohesive story, they thought we were doing an IFT from an outlying facility who must have forgotten to call.  They were confused when they finally understood she was coming from home.  "How did you get all this information?"

Clinical assessment.  And this was a clear cut one.


----------



## jjesusfreak01 (Sep 16, 2011)

Linuss said:


> Both my diabetic patients died this week.  But then again, both said "Lo"  h34r:



Umm, sorry to hear that. Never had a diabetic patient die on me.


----------



## 8jimi8 (Sep 17, 2011)

don't all these stories end the same?

6 firefighters had to unwedge her from the door frame of the bathroom, yet you get to load the stretcher in the rig by yourself...  meanwhile the urine is making the gravel stick to your boots like candied popcorn....


----------



## abckidsmom (Sep 17, 2011)

8jimi8 said:


> don't all these stories end the same?
> 
> 6 firefighters had to unwedge her from the door frame of the bathroom, yet you get to load the stretcher in the rig by yourself...  meanwhile the urine is making the gravel stick to your boots like candied popcorn....



We called for a lift assist, and had an old guy and a clueless girl who'd been on the VFD for 3 weeks show up.  Super helpful.


----------



## sirengirl (Sep 18, 2011)

8jimi8 said:


> polydipsia, polyuria. I thought the same thing within the first few sentences.



This. Also, that House episode where he can't pee and the girl in the clinic is drinking copious amounts of water due to her new onset diabeetus


----------



## JPINFV (Sep 18, 2011)

Just remember that DM isn't the only thing that can cause polydipsia/uria.


----------



## usalsfyre (Sep 18, 2011)

JPINFV said:


> Just remember that DM isn't the only thing that can cause polydipsia/uria.



Yep, so can DI .


----------



## abckidsmom (Sep 18, 2011)

JPINFV said:


> Just remember that DM isn't the only thing that can cause polydipsia/uria.





usalsfyre said:


> Yep, so can DI .



poly/poly with wasting and anorexia combined with CBG of HI was pretty convincing.

Nothing I would have done differently, except be wrong, lol.  

I think DI is one of the most poorly named diseases out there.  How did they label that with diabetes???


----------



## JPINFV (Sep 18, 2011)

abckidsmom said:


> I think DI is one of the most poorly named diseases out there.  How did they label that with diabetes???



Diabetes: "To siphon" in Latin = excess urine. 
http://www.thefreedictionary.com/diabetes


----------



## abckidsmom (Sep 18, 2011)

JPINFV said:


> Diabetes: "To siphon" in Latin = excess urine.
> http://www.thefreedictionary.com/diabetes



Thanks.  I never did study Latin.  Lazy chick like me, I never looked it up.


----------



## JPINFV (Sep 18, 2011)

abckidsmom said:


> Thanks.  I never did study Latin.  Lazy chick like me, I never looked it up.



Meh, I just utilized Google...


----------



## zmedic (Sep 21, 2011)

I just taste the urine, if it's sweet I give insulin. Works pretty well.


----------



## usalsfyre (Sep 21, 2011)

zmedic said:


> I just taste the urine, if it's sweet I give insulin. Works pretty well.


So how do you have a scale to quantify how sweet it taste? Brown sugar=little high, Grandma's sweet tea=obvious DKA?


----------



## 8jimi8 (Sep 22, 2011)

zmedic said:


> I just taste the urine, if it's sweet I give insulin. Works pretty well.



this is the method i use instead of a halo test


----------



## boingo (Sep 22, 2011)

abckidsmom said:


> I wondered whether it was HHNK vs DKA, but when her ETCO2 was 80, that settled that.
> 
> .



I'm not sure I follow your logic?


----------



## 8jimi8 (Sep 22, 2011)

boingo said:


> I'm not sure I follow your logic?



Kussmaul


----------



## Martyn (Sep 22, 2011)

And no one mentioned pear drops...hmmm, yummy :sad:


----------



## boingo (Sep 22, 2011)

8jimi8 said:


> Kussmaul



Sure, but an EtCO2 of 80 mm Hg certainly doesn't reflect that.


----------



## 8jimi8 (Sep 22, 2011)

boingo said:


> Sure, but an EtCO2 of 80 mm Hg certainly doesn't reflect that.



:. Not hhnk or dka


----------

