Wilderness Scenario 3

[Chief1C]

You said he had been hydrating.. and he didn't eat between breakfast and lunch? Is that abnormal? Millions of school children do this everyday, and we're not being tapped out for them wander about.

[Dustdevil]

I guess I am confused as to how the diagnoses of diabetes was made here.. :roll:

He must have been in the ER a VERY long time! :?

We're not really given enough history to have even speculated upon diabetes in this scenario. His output is just as important to consider as his intake. Without both, you have no context within which to consider your information. Suspicion of diabetes would be spurred by presence of the 3Ps. You didn't get a history of any of them.

And his BGL was 75 three short hours after a meal. Not a typical diabetic presentation. In fact, that is not typical of anybody.

If this kid was new onset diabetes, I certainly can't fault you for not figuring it out out there in the bush with no facilities and what little info you had. But I think the ER doc may have dropped the ball on this kid.

[Chief1C]

But I think the ER doc may have dropped the ball on this kid.

So that's what his problem is... Blunt trauma!

[Doczilla]

In the end the Skittles in the Water the ER doc found he had been making his own Glucose by adding Candy to Water (turns out he was diabetic and family doc had missed it)

I also fail to see how this diagnosis was made in the ER unless the kid was sneaking insulin. Untreated diabetes is marked by hypERglycemia, not hypOglycemia. He may very well be diabetic, but that's not what is causing this kid's problem.

Fever with altered LOC in a child is a big red flag for badness. He needs a spinal tap.

The hypoglycemia is interesting as well. Now, 75mg/dL is not all that low. This could be a simple thing, like the kid really didn't eat all he said he did. If it was lower, I'd be more inclined to be worried. Sepsis, meningitis, adrenal crisis can all lead to this.

I suppose this could be simple heat illness with hypotonic rehydration resulting in hyponatremia, but I would look to see that the fever resolves quickly with treatment. If not, then infection must be ruled out.

He's been drinking water and not eating, so he hasn't been taking in any sodium. If he's drinking a whole lot of water without sodium intake, then hyponatremia is on the list.

I agree with not waiting for ALS. You can be at the hospital faster, and he's not so unstable that you can't move him. If you were ALS, you could start an IV and give him a bolus of NS, which would help the heat illness and possible hyponatremia, but if you transport to the ER, he'll be on the road to recovery much faster.

'zilla