Miz Black Crow Posted March 5, 2012 Posted March 5, 2012 (edited) 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 March 5, 2012 by Miz Black Crow
Kiwiology Posted March 5, 2012 Author Posted March 5, 2012 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?
runswithneedles Posted March 5, 2012 Posted March 5, 2012 his body is creating way too much insulin. did he give himself too much?
Kiwiology Posted March 5, 2012 Author Posted March 5, 2012 did he give himself too much? You know you give yourself too much at night mate Yes, he did, it was an insulin overdose Shit you guys are too good for me!
Miz Black Crow Posted March 5, 2012 Posted March 5, 2012 (edited) 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 March 5, 2012 by Miz Black Crow
Pavehawk Posted March 5, 2012 Posted March 5, 2012 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
Kiwiology Posted March 6, 2012 Author Posted March 6, 2012 What's the basis/cause/etiology for the elevated lactate in insulin OD? When I figure it out I will let you know
runswithneedles Posted March 6, 2012 Posted March 6, 2012 SCORE ONE FOR ME!!!!!!! Wish I caught it sooner
Recommended Posts