kidney stones and a bgl?

[PotatoMedic]

Someone was telling me you should do a bgl for a pt with possible kidney stones? Is there any useful information pertaining to kidney stones that you can get out of a bgl?

 

[TransportJockey]

I dunno about there being any correlation, but I start an IV on those patients and I usually get a glucose check off of my IV sticks anyways, so all my kidney stone patients get sugar checked.

 

[Medic Tim]

I dunno about there being any correlation, but I start an IV on those patients and I usually get a glucose check off of my IV sticks anyways, so all my kidney stone patients get sugar checked.

This^^^. Plus some toradol or other pain medication usually.

 

[Carlos Danger]

I dunno about there being any correlation, but I start an IV on those patients and I usually get a glucose check off of my IV sticks anyways, so all my kidney stone patients get sugar checked.

Why? Do you check a BG every time you start an IV?

 

[DesertMedic66]

Why? Do you check a BG every time you start an IV?

Why not? You already have a blood sample from the flash on the IV. It's the same around here, every time an IV is started a BGL test is done on the blood from the flash.

 

[blindsideflank]

it will probably be elevated from a stress response.

also, is this questioning assuming that you KNOW its kidney stones or is this flank pain that you assume is kidney stones?

edit: read OP again, pancreatitis is a bigger worry than kidney stones. gall bladder blockages and infections leading to the pancreas, peritonitis to sepsis (a stretch)
lots of reasons to get a sufgar i suppose, hard to say why you are thinking "possible kidney stones"

 

[Carlos Danger]

Why not? You already have a blood sample from the flash on the IV. It's the same around here, every time an IV is started a BGL test is done on the blood from the flash.

I realize that if you are starting an IV anyway, there is very little additional effort or cost involved in checking a BG, but "why not" just doesn't strike me as a great reason for doing things that are otherwise not indicated.

So I just wondered if there was a better (physiologic) reason for the practice.

 

[Carlos Danger]

Someone was telling me you should do a bgl for a pt with possible kidney stones? Is there any useful information pertaining to kidney stones that you can get out of a bgl?

You sure it was kidney stones and not gallstones?

 

[DesertMedic66]

I knew someone would say that. And I thought that might be the reason for the practice, but I just wondered if there was a better (physiologic) one.

I realize that if you are starting an IV anyway, there is very little additional effort or cost involved in checking a BG, but "why not" just doesn't strike me as a great reason for doing things that are otherwise not indicated.

Maybe I'm just lazy.

It might not be indicated but it takes less than 30 seconds to do and costs next to nothing. Ive been surprised by numbers before.

We had a 40 Y/O male who had a tib/fib fracture. Medic got the IV to push pain meds and I got a sugar on it. 357 for the sugar with no history or family history of diabetes and no other C/C.

 

[PotatoMedic]

This was not a clinical situation rathan more of a question of 'is there any clinical info between the two?'. On a semi related note would right or left flank pain present with pancreatitis or gualstones?

 

[VFlutter]

We had a 40 Y/O male who had a tib/fib fracture. Medic got the IV to push pain meds and I got a sugar on it. 357 for the sugar with no history or family history of diabetes and no other C/C.

Stress induced hyperglycemia can occur fairly quickly especially with catecholamine excess as you would see in a patient with extreme pain.

 

[milehimedic]

Stress induced hyperglycemia can occur fairly quickly especially with catecholamine excess as you would see in a patient with extreme pain.

This^^. The way I understand it, the fight or flight response we experience during extreme pain events like a kidney stone causes the liver to release more glucose, that in turn isn't metabolized, because pt is writhing in pain rather than running from a threat. Hence, hyperglycemia. Is this basically what's happening?

 

[TransportJockey]

This^^^. Plus some toradol or other pain medication usually.

Yep. The prime reason I do IVs for all my abd pain patients.

Why? Do you check a BG every time you start an IV?

Actually yea I do. It's a minimal cost and minimal time assessment if I've already got the blood at hand. Gives me a more complete picture... Plus our local hospitals ask for a sugar on everyone anyways.

 

[Carlos Danger]

This^^. The way I understand it, the fight or flight response we experience during extreme pain events like a kidney stone causes the liver to release more glucose, that in turn isn't metabolized, because pt is writhing in pain rather than running from a threat. Hence, hyperglycemia. Is this basically what's happening?

That's exactly what's happening.

And it's one of the reasons why a single BG on an asymptomatic patient is not valuable information.

 

[Carlos Danger]

It might not be indicated but it takes less than 30 seconds to do and costs next to nothing. Ive been surprised by numbers before.

We had a 40 Y/O male who had a tib/fib fracture. Medic got the IV to push pain meds and I got a sugar on it. 357 for the sugar with no history or family history of diabetes and no other C/C.

Do you put a NC on everyone, too?

 

[DesertMedic66]

Do you put a NC on everyone, too?

If O2 is clinically indicated then yes, but not may patients need O2.

I don't get what that has to do with getting a BGL on a flash from the IV. You already have a blood sample so it's not going to hurt anything, delay patient care, or cost any money.

 

[Rialaigh]

If O2 is clinically indicated then yes, but not may patients need O2.

I don't get what that has to do with getting a BGL on a flash from the IV. You already have a blood sample so it's not going to hurt anything, delay patient care, or cost any money.

I think the basic premise is it is a low cost start to "poor medicine". We constantly complain that we (EMS) want more ability to practice in the field and make independent decisions but we consistently do things like bgl's on tons of people with no indication that shows we just follow the tree of treatment....


Do all abd. pains need bgl's, no they do not. Do many of our diabetic patients need their sugar checked, no they do not.


As far as the OP's question goes, I think chase hit it on the head

 

[DesertMedic66]

I think the basic premise is it is a low cost start to "poor medicine". We constantly complain that we (EMS) want more ability to practice in the field and make independent decisions but we consistently do things like bgl's on tons of people with no indication that shows we just follow the tree of treatment....


Do all abd. pains need bgl's, no they do not. Do many of our diabetic patients need their sugar checked, no they do not.


As far as the OP's question goes, I think chase hit it on the head

But once again what is the harm in testing the blood that you already have? I have found many patients BGLs to be out of the normal range by doing the test on all IV starts.

Our hospitals take blood and test it for a whole range of stuff on almost every patient and one of the tests they do is a BGL test. It helps the doctors get a better picture of what's going on and that is what it allows us to do also.

 

[TransportJockey]

I think the basic premise is it is a low cost start to "poor medicine". We constantly complain that we (EMS) want more ability to practice in the field and make independent decisions but we consistently do things like bgl's on tons of people with no indication that shows we just follow the tree of treatment....


Do all abd. pains need bgl's, no they do not. Do many of our diabetic patients need their sugar checked, no they do not.


As far as the OP's question goes, I think chase hit it on the head

Do all patients in a facility need a CBC or BMP drawn? No, but doctors in the ER tend to order them as a shotgun test. And those also include a glucose level. It's a noninvasive diagnostic procedure. You're not administering a drug just for the hell of it. Comparing it to oxygen administration is kind of apples to oranges.

 

[Trashtruck]

Just because I start an IV doesn't mean I'm going to check a sugar(and yes, the strips are costly so there is a cost component to using these all the time)
Just because I start an IV doesn't mean I'm going to draw labs.
Just because I have a pulse oximeter doesn't mean I'm going to use it on every patient.
Just because the pulse oximeter will measure carboxyhemoglobin doesn't mean I'm going to use that function just because I place it on a patient. I mean, yeah, it takes less than a few seconds for a reading, but I don't care about somebody's SpCO for the most part.
12-leads on everybody? Why?

I do see the flip-side of all this. Some call it 'comprehensive' and some call it 'overkill'.

The classic VOMIT acronym comes to mind.

Why does everybody receive this treatment(in some systems)?