Help! His passed out in the toilet!

[hammerpcp]

If he hasn't had any food in the last 48 hours, then his liver has used up the glycogen stores. The body has been turning to non-carb substances to convert to glucose (process called gluconeogenesis). EtOH impairs gluconeogenesis, leading to no glucose... ie this scenario. Treat it with oral carbs if the pt comes around enough to control his airway and can eat safely. If not oral, D50. He'll also need fluid resuscitatation. Thiamine is a great thought if you have it pre-hospital. EtOH-induced hypoglycemia does not respond to glucagon, although it wouldn't harm him either.

"Inhibition of gluconeogenesis has also been implicated in the etiology of alcoholic hypoglycemia in the clinical setting. Freinkel et al. (9) presented indirect evidence for the inhibition of gluconeogenesis by EtOH when they were unable to counteract EtOH-induced hypoglycemia with infusion of glucagon in normal subjects who had fasted 24–48 h. Other groups have measured a decrease in hepatic glucose production as hypoglycemia developed during the infusion of EtOH after a 2- to 3-day fast." Web Page Name

He may have been having PACs, brought on by the caffeine in Red Bull and No-Doz. That's an arrhythmia that will "fix itself."

Yes, your right although the fluid infusion will likely have very little to no effect on PAC's. Rather they will abate once the stimulants have worn off.

I'm curious where the ethnicity/Muslim question came from... were you thinking G6PD deficiency?

Is that similar to a WD40 deficiency often found in women?

[itxtme]

I remember doing some study on G6PD in pharmo and while I did not consider it originally it does make a lot sense. Of course being the case ethnicitys at risk include african american males, asian as well as arab individules

[sjslennon]

Is that similar to a WD40 deficiency often found in women?

I'm not aware of a WD40 deficiency in females. Are women in your area especially tight and squeaky?

[firedoc5]

I was wondering about the use of Glucagon myself. Why would ALS providers use it when any provider capable of IV access could use D50 or D10 to bring the sugars up (preferably with thiamine if available)? As was mentioned just previous those "emergency stores" would probably be used up in this case anyway. I would only ever use glucagon if I was unable to get a line. Maybe that's just me. I look at glucagon as an absolute last resort. Plus it's absurdly expensive compared to D10 or D50.

Sometimes more simple is better. Crowded in a bathroom/locker room, not a lot to move around.

Would the Muslim thing could not allow IV's to be started? I don't know their beliefs.

[chbare]

Depends on the person. They can receive medications and medical therapy for illness during Ramadan; however, some people may decide against the said concept.

Take care,

chbare.

[sjslennon]

In my *limited* experience with Muslims, they tend to be more concerned about the potential for pork-derived substances in medications than the route itself. I recently diagnosed a pt with strep pharyngitis, which I usually treat with a single shot of long-acting penicillin (pcn). The mother knew that there are some formulations that have porcine-derivatives, so she chose oral pcn - 4 times per day for 10 days. She also chose liquid instead of pills, because she knew the liquid was more likely to be pure. Her son drank 3 tablespoons of elixir 40 times instead of one shot. I've also had Muslims request that medications be given at a specific time during Ramadan. They are allowed (and expected) to take any medications that cannot safely be delayed until sunset.

[firedoc5]

We've got a lot of Amish and Mennonites around here. Since I'm out of the field I've only heard of some refusal of treatments, but not a whole lot.

When I was in the field there were a couple of churches that had parishioners that would refuse any invasive care at all, and some really needed it. But you can only do what you can do. Drove us nuts though.

Sorry, not intending to high-jack this thread.

[hammerpcp]

I'm not aware of a WD40 deficiency in females. Are women in your area especially tight and squeaky?

It is an increasingly rare condition, it is even less frequently found in populations where the males have either less naturally occuring C19H28O2, or have been socialized to control its behavioural effects.

[sjslennon]

It is an increasingly rare condition, it is even less frequently found in populations where the males have either less naturally occuring C19H28O2, or have been socialized to control its behavioural effects.

Scandalous!!

[rock_shoes]

Sometimes more simple is better. Crowded in a bathroom/locker room, not a lot to move around.

Would the Muslim thing could not allow IV's to be started? I don't know their beliefs.

I see where you're coming from. I just hate the idea of using a hormone to solve a problem that could be solved with dextrose. I've also heard of some patients feeling quite ill following glucagon administration. I haven't witnessed it personally as I've managed to start a line on the low BGL patients I've had so far. Myself I like to put a lock in the line so if the line is in the way it can be discontinued without losing IV access. Then the line can be restarted in the car if need be and the hospital has IV access available on the patients arrival.