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[Too Old To Work]

Oh, really?

http://tinyurl.com/36n49ho

This is, of course, ignoring the fact that untreated diabetes is not the loss of the ability of a patient to elevate their blood glucose level. For that, we can thank the medications.

And that's pretty common in your area is it? Don't make the rules by the exceptions, you'll waste a lot of time and resources.

 

[JPINFV]

So you're willing to let a patient with ALOC secondary to hypoglycemia go untreated because you want to assume that because he doesn't have a diabetic medic alert bracelet (which is, of course, ignoring that insulinomas are not a form of diabetes) and smells of alcohol that he must just be drunk?

edit: If the symptoms can be explained by hypoglycemia and a provider has the ability to test a BGL, then they should rule in or out Whipple's Triad.

 

[Too Old To Work]

So you're willing to let a patient with ALOC secondary to hypoglycemia go untreated because you want to assume that because he doesn't have a diabetic medic alert bracelet (which is, of course, ignoring that insulinomas are not a form of diabetes) and smells of alcohol that he must just be drunk?

edit: If the symptoms can be explained by hypoglycemia and a provider has the ability to test a BGL, then they should rule in or out Whipple's Triad.

No, I'm saying if he's easily arouseable, is alert and oriented once he's up, has no signs such as diaphoresis, tells you he's not a diabetic, and has no other signs or symptoms that make me suspicious, I'm not going to do a BG check.

Which is where I started before we got off track. If you do a good assessment and it reveals absolutely nothing to suggest a metabolic disorder other than an elevated ETOH level, then there isn't much reason to do a BG check.

Maybe it's my city, but I just haven't seen a lot of occult hypoglycemia masquerading as hyperETOHia. I have seen hypoglycemia in drunk people, but it didn't take a glucometer to figure it out, just to quantify the number.

It's like a Heroin user who ODs. Once I give them the Narcan, provided they wake up, I'm not going to do a BG.

How about everyone that gets punched in the head and goes down? Do you do a BG on them?

 

[Veneficus]

I just have to join the fray I guess.

I spare no effort working up ETOH patients. The alcohol can mask a great deal of problems. Some chronic, some acute.

doing nothing for the chronic frequent flyer drunk is like playing Russian Roulette.

The reason places have progressed passed thiamine is because it is generally wise to decide the patient doesn't have b12 deficency before giving the thiamine.

bedside blood glucose on all "altered" patients. Just like chem 10. Including on the patient who I have seen 3 generations of his alcoholic family rather frequently and know he is theraputic at 300.

When charting, I see a lot of value in pertinent negatives.

What happens where you do the CBG on the chronic ETOH and it comes back "hi" for the first time?