Question about D50

[ambodriver]

So my partner and I were talking about a call in our service where someone gave an amp of D50 b/c of a misread glucometer. They believed the pt. was hypoglcemic when in fact BGL was aprox. 150. (non-diabetic pt.) It was a CP pt. I didn't believe an amp of D50 would be too harmful, as I thought it would be absorbed pretty quickly.

My partner stated if the pt. was having an MI the amp of D50 would worsen the MI by making the blood more viscous. Thoughts on this?

I couldn't find anything to support his claim. I thought this mistake was pretty harmless.

[DartmouthDave]

So my partner and I were talking about a call in our service where someone gave an amp of D50 b/c of a misread glucometer. They believed the pt. was hypoglcemic when in fact BGL was aprox. 150. (non-diabetic pt.) It was a CP pt. I didn't believe an amp of D50 would be too harmful, as I thought it would be absorbed pretty quickly.

My partner stated if the pt. was having an MI the amp of D50 would worsen the MI by making the blood more viscous. Thoughts on this?

I couldn't find anything to support his claim. I thought this mistake was pretty harmless.

Hello,

Elevated BGL worsens outcomes for AMI patients. This was demostated in the DIGAMI study in 1995. However, it is not due to viscosity from my understanding. Elevated BGL worsen the immune/inflammatory response.

However, in this situation, a brief increase in serum glucose wouldn't be dire....IMHO. If in fact this fellow had a STEMI or a NSTEMI his glucose would be normalized with an insulin infusion or sliding scales insulin.

The risk is a prolonged elevation of serum glucose.

Cheers,

DD

[Aussieaid]

Actually hyperglycemia has been shown to contribute to morbidity and mortality in many acute conditions, MI and CVAs being 2 of them. Multiple studies have shown that it can reduce hospital survival rates and glucose levels are often looked at as predictors of outcomes. Pt's are started on insulin drips to strictly control the glucose levels even when they are only slightly elevated no matter what the cause of the hyperglycemia. There are plenty of studies out there and it the adverse effects of hyperglycemia with head injuries and sepsis is also well documented.

Here are just a couple of article to get you started:

Controlling hyperglycemia in the hospital.

hyperglycemia and MI

For every 18-mg/dL increase in glucose level, there is a 4% increase in mortality in nondiabetic subjects.5 When admission glucose level exceeds 200 mg/dL, mortality is similar in non-DM and DM subjects with MI. Admission glucose has been identified as a major independent predictor of both in-hospital congestive heart failure and mortality in STEMI.

Just learn from this mistake and remember that none of the treatments we administer are completely benign and all have some degree of risk associated with them.

Cheers!

[ambodriver]

1st this was not my mistake! My partner and I did not do this.

The studies say elevated bgl's lead to higher morbidity, but how long would this non-diabetic pt.'s bgl stay elevated? Wouldn't his pancreas compensate? Remeber it was not originally elevated, he was just given an amp of D50 when his BGL was 183.

[Aussieaid]

1st this was not my mistake! My partner and I did not do this.

The studies say elevated bgl's lead to higher morbidity, but how long would this non-diabetic pt.'s bgl stay elevated? Wouldn't his pancreas compensate? Remeber it was not originally elevated, he was just given an amp of D50 when his BGL was 183.

I didn't say it was your mistake....I said learn from it. (A wise person learns from other people's mistakes as well as his own!)

You said in the original post his BGL was 150 (now it is 183) which is already elevated and depending on the institution some places will initiate insulin therapy even at this level because hyperglycemia has been shown to increase mortality and morbidity whether it is caused by a stress response or from DM. Elevated glucose from stress response doesn't stay elevated forever either but it is still aggressively treated. Eventually the body may compensate but in the meantime there is still a state of hyperglycemia which is detrimental to the pt's overall well being and adding to the workload of an already overstressed body.

The lesson to take from the case was don't be blase about any of the treatments we administer and technically this was a medication error that could have caused harm to the patient. (Something that would be hard to actually document though).

Cheers.

[croaker260]

I am making a couple of assumptions.

1- Since the complaint presented was not an altered mental state, etc, but chest pain, I am curious why the provider didn't go..."Hmmm this BG isnt adding up in this overall picture"... (as in treat the patient not the ...monitor/glucometer/tool) and at least second guess it. Re check the BG or the equipment. Not saying that a BG wouldnt be pretty standard in my assessments, but a profoundly low BG in an otherwise normotensive, dry, alert patient without a history if DM should make one at least make sure you didnt switch your BG over to mmol.

2- As mentioned , elevated BGs have been associated with increased mortality. Viscosity is an issue. So is immune function too.

3- We all make mistakes, as one poster mentioned, learn from it. What ever you do, don't minimize it. No body can be perfect its true, but striving for perfection and having ridiculously high personal standards is what separates the world class professionals from the amateurs.

Food for thought.

As a side note, I had 2 diabetics last night who had unexplained and atypical hypoglycemic episodes, one was completely NIDDM. We did sort it out, and both got glucose in one form or another, but both were atypical presentations from dispatch to end of call. So Im not saying you should only give D50 to textbook cases, only that a healthy bit of self skepticism is an essential paramedic survival trait.

Edited February 20, 2010 by croaker260

[crotchitymedic1986]

Croaker hit the nail on the head, "TREAT THE PATIENT, NOT THE MACHINE". But don't feel bad, this is a common problem throughout healthcare. Just find a labtech who is over age 50, and ask them their opinion of today's doctors who can not make a diagnosis without a minimum of 7 labtests. As we become more technologically advanced, many in our profession rely on that technology way to much.

[mobey]

Croaker hit the nail on the head, "TREAT THE PATIENT, NOT THE MACHINE". But don't feel bad, this is a common problem throughout healthcare. Just find a labtech who is over age 50, and ask them their opinion of today's doctors who can not make a diagnosis without a minimum of 7 labtests. As we become more technologically advanced, many in our profession rely on that technology way to much.

Oh I can't disagree more.

I am so sick of this treating the patient not the machine thing that everyone is so hung up on. How bout an UnCx diabetic??... just intubate & transport? What about perfusing V-Tach? What about silent STEMI? How many diabetics have you seen that can go as low as 1 mmol without having any read symptoms? Your saying just wait till they become altered??

To be honest I think the crap that is spewed in this "treat the symptoms" is a catch-all for those who can't critically think for themselves. The machines are an assessment tool, they should be used to guide Tx.

Reactive medicine treats symptoms. Proactive medicine treats signs.

You decide.

As for the bold text above; I would be interested to know if these same Dr's could diagnose without the "fancy tests".

I gotta tell you though...... feel free to ultrasound, draw blood, or CT me anyday to ward off "exploratory surgery". Each to thier own though.

[JPINFV]

Croaker hit the nail on the head, "TREAT THE PATIENT, NOT THE MACHINE". But don't feel bad, this is a common problem throughout healthcare. Just find a labtech who is over age 50, and ask them their opinion of today's doctors who can not make a diagnosis without a minimum of 7 labtests. As we become more technologically advanced, many in our profession rely on that technology way to much.

...but without the labs we can't write out those cool little shorthand diagrams to record lab values. >---<

[chbare]

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Take care,

chbare.