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Small Town Jericho

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I'm on board with pavehawk; this fits very well with a patient I had two weeks ago with a similar presentation and an ultimate Dx of an insulin-secreting tumor (due to pancreatic cancer, which had not previously been diagnosed). An initial BGL of 37 which only goes up to 80 after 50g D50 IVB, and then declines after only 20 minutes, is seriously concerning to me. (And that matches my recent patient PERFECTLY).

Time to count the D50s and get an ETA to an OR? Or are Pavehawk and I way off-base?

Edited by Miz Black Crow

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I'm on board with pavehawk; this fits very well with a patient I had two weeks ago with a similar presentation and an ultimate Dx of an insulin-secreting tumor (due to pancreatic cancer, which had not previously been diagnosed). An initial BGL of 37 which only goes up to 80 after 50g D50 IVB, and then declines after only 20 minutes, is seriously concerning to me. (And that matches my recent patient PERFECTLY).

If his BGL does up then down what could that mean is happening inside him?

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his body is creating way too much insulin.

did he give himself too much?

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did he give himself too much?

You know you give yourself too much at night mate :D

Yes, he did, it was an insulin overdose

Shit you guys are too good for me!

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What's the basis/cause/etiology for the elevated lactate in insulin OD? (And good for him for not having cancer!)

Also, in hindsight, horses/zebras. I guess pancreatic CA is the zebra...

Edited by Miz Black Crow

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A good differential Dx is essential to medicine, the patient is hypoglycemic AND acidotic, with a HX of hypertension (which is not well controlled or noncompliant) and has other problems. Hypoglycemia that does not correct well and or reoccurs after TX is obviously caused by too much insulin..."from one source or an other" and once he is lucid and can be questioned the answer may be obvious but until then the simple to the not so simple need to be factored in.

Regardless of "how the hell..." the EMERGENT treatment is still going to the be the same...trying to figure out causeation is why internal medicine is so cool!

cheers!!

Pave

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What's the basis/cause/etiology for the elevated lactate in insulin OD?

When I figure it out I will let you know

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SCORE ONE FOR ME!!!!!!! Wish I caught it sooner

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