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Many thanks to all those who replied to my scenario of the high glucose out of hours. Here is is again - An on-call scenario 7pm called by BMS from lab 21 yr old patient had attended diabetic clinic at the hospital last thing in the afternoon Glucose = 36 HbA1c = 114 mmol/mol Clinical details 'Type 1 DM' No previous glucose result but 2 previous high HbA1c results. Not registered with a local GP. There were an interesting range of replies reflecting the different types of hospitals we work in and access to other staff in hospital and in primary care. My initial response (to this real case) was to request a bicarbonate to assess whether the patient had DKA - some others suggested this (plus blood ketones) too. As it happened the hospital I was covering for did not offer this assay except via a POCT blood gas machine. But would the bicarb result have made a difference to the need to contact the patient? If the bicarb had been normal would that have meant that the patient was more or less likely to be ok ie could still have developed DKA later that eve / early hours of next day? The patient was registered with a GP hundreds of miles away. The only bit of info the BMS had managed to get was the patient's home telephone number. So I spoke directly to the patient to see how she was / BM / insulin etc. What if I didn't have her number or she was out?! Having had the police knocking on my door at 4am one morning asking whether I had the keys to nextdoor (as person nextdoor had abnormal biochem and no answer from them) I would need to make sure that there was nothing else I could do before sending the police out myself! Rob ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/