DartmouthDave Posted May 22, 2010 Share Posted May 22, 2010 Sounds like he has multiple issues going on. Obviously DKA, and noncompliant with insulin, and probably noncompliant with other meds which would explain the HTN. Dark brown emesis- GI bleed? Renal issues? Lot's of issues here. Good medical call. I'd be curious about the diagnosis(es). Hello, I agree. I have seen quite a few DKA that have had a serious secondary issue as the cause. Also, from most protocols that I have seen and used it seems that the BGL was lower a little too fast (37--->12..in 3 hours). IMHO. The HTN is quite odd as well. Cheers.... Link to comment Share on other sites More sharing options...
HERBIE1 Posted May 23, 2010 Share Posted May 23, 2010 Hello, I agree. I have seen quite a few DKA that have had a serious secondary issue as the cause. Also, from most protocols that I have seen and used it seems that the BGL was lower a little too fast (37--->12..in 3 hours). IMHO. The HTN is quite odd as well. Cheers.... The doc mentioned an ASA OD because of the tinnitus. I wonder what other issues could cause this. Maybe a red herring- the tinnitus could be a chronic condition. Who knows? Link to comment Share on other sites More sharing options...
Aussieaid Posted May 23, 2010 Share Posted May 23, 2010 A lot of his symptoms sound like increased ICP whether from a stroke, meningitis or possibly cerebral edema it is unclear. The nausea, tinnitus, decreasing LOC and progressing to seizures sounds like a primary neurological condition probably complicated by the DKA which could be precipitated by the stress reaction and not taking his meds because he probably was already slightly altered. The big question is why is a 32 y/o on medications like metoprolol, lasix and lipitor. Sounds like he has some serious co-morbidities right there. Knowing more of his history would help give an idea of differential diagnoses. Lots of possible causes here but would need a lot more information. He could possibly be having a thyroid storm as well. I agree with Dave that the DKA was not treated very well. You really have to lower the glucose in a slow and controlled manner especially in someone who is already showing neurologic problems. I hope they didn't give him bicarb as well? The rapid rise in temperature after he was seizing could be as a result of the seizures, some infectious process (?meningitis) or thyroid storm. Would be interesting to see if you can get any follow up on him. I think the DKA was precipitated by something else and just added to the complications. Cheers. Link to comment Share on other sites More sharing options...
mobey Posted May 23, 2010 Author Share Posted May 23, 2010 (edited) This was a long time ago but from what I remember, he was intubated and in the ICU for 3 days. He also had aspiration pneumonia He is now a dialysis pt. Apperently he skipped his insulin as a suicide attempt, which he had done many times before. Edited May 23, 2010 by mobey Link to comment Share on other sites More sharing options...
HERBIE1 Posted May 23, 2010 Share Posted May 23, 2010 This was a long time ago but from what I remember, he was intubated and in the ICU for 3 days. He also had aspiration pneumonia He is now a dialysis pt. Apperently he skipped his insulin as a suicide attempt, which he had done many times before. Skipping insulin to kill yourself? That's like ingesting a poison, one molecule at a time. You'll eventually die, but not for a long time. This guy didn't really want to die. Link to comment Share on other sites More sharing options...
DartmouthDave Posted May 23, 2010 Share Posted May 23, 2010 (edited) The doc mentioned an ASA OD because of the tinnitus. I wonder what other issues could cause this. Maybe a red herring- the tinnitus could be a chronic condition. Who knows? Hello Herbie1, Maybe the lasix......If he took too much. Weak I know. I have seen it only with IV Lasix. Here are a few examples I have seen: Lasix - In higher doses and if give IV push too fast can cause tinnitus. Saw this in a lady who was getting 80mg IV BID in the ICU setting. Lidocaine Infusion - The patient c/o horrible ringing in his ears Bupivacaine/Fentanyl Epidural - It was inserted by the DR and a loading dose of Bupivacaine (much higher concentration that the epidural) was giving. The fellow had tinnitus for the next 36 hours. Various Abx as well.......Vancomycin I think. Just felt like typing a big unrelated FYI............ Cheers Edited May 23, 2010 by DartmouthDave Link to comment Share on other sites More sharing options...
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