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
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