Not surprisingly, he lapses into a coma mid-flight.
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This really doesn’t add up. Hypoglycemia, caused by insulin, would produce a potentially rapid loss of consciousness. Clearly having insulin available would be of no benefit with hypoglycemia.
Hyperglycemic coma or diabetic ketoacidosis however takes some time to develop. If he had reasonably dosed insulin at any time within the previous 12 hours it is most improbable that either of these conditions developed precipitously within the duration of a few hours.
Without a few lab results it’s impossible to know if the insulin issue is a red herring.
I’m with Gasman. This story seemed ridiculous when I read it. The time between routine dosing of insulin is usually LESS then the duration of a flight from Auckland to Christchurch. That a patient could develop such severe DKA or HONC (requiring a 2 week hospital stay)in such a short period strains credulity.
In fact, before paramedics commonly carried glucometers, when a diabetic patient is in a coma, the usual emergency treatment used to be an amp of D50 because even if the patient was hyperglycemic, the bolus wouldn’t hurt him. Obviously it could save his brain if his coma was from hypoglycemia.
John
I’m with them. It isn’t like stopping a Flolan infusion for PPH. Even the most brittle diabetic can go a few hours without insulin. Sheesh.
Um, so, yeah…I’m with you guys…this makes little sense.
Maybe the guy ate too many snicker’s bars?
/still a med student
Um, so, yeah…I’m with you guys…this makes little sense.
Maybe the guy ate too many snicker’s bars?
/still a med student
Glad to see there is another med student posting on kevinmd. Most of my classmates don’t even know what the weather is like outside of the library, let alone keep up with current issues in healthcare.
Glad to see there is another med student posting on kevinmd.
I’m a newly minted doc from Pakistan studying for the USMLE boards. I come here everyday. Good stuff.
And yes, this case doesn’t make sense, DKA should take at least 24 hours to kick in. Even if he flew around the world, it shouldn’t have developed. Still, it’s kind of retard for the airlines to take his insulin away. Mebbe the patient smelled an opportunity and binged…
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