Re: DKA question
- From: wmmckee@xxxxxxx
- Date: Tue, 31 Jan 2006 19:45:42 GMT
On 31-Jan-2006, Jenny <lottadata@xxxxxxxxxxx> wrote:
> If you may recall, a month or so ago, I posted about a case I handled in
> >> which the patient died from what might be termed over-aggressive
> >> treatment
> >> of DKA. Briefly, what happened was that her brain swelled, to the
> >> point that
> >> she herniated her uncus....
> >>
> >> Gotta be careful with insulin, especially in DKA.
> >>
> >> Will, T2
> Extract:
> "If the patient has treatment begun at this point [after prolonged
> hyperglycemia has "caused osmolyte concentration in cells, causing them
> to swell moderately"], with fluid having an osmotic concentration below
> plasma, water will flow disproportionately into the brain and
> intracranial pressure will rise. A large iv bolus of insulin metabolizes
> glucose to water that further aggravates the process. The excess water
> will be pulled to cells by the osmolytes and as the cycle continues,
> intracranial pressure progresses to cause headache, coma, and possibly
> death."
> "Give insulin by slow drip; do not give a bolus dose. Hyperglycemia
> should be reduced gradually."
>
> --Jenny
This is exactly what happened in the case in which I represented the family
of the deceased diabetic patient, who suffered a herniation to the uncal
area of her brain.
One minute, she reportedly felt better, was laughing, and joking,.... then
she lost consciousness, and subsequently died, after heroic measures to save
her proved to be of no avail.... She left behind a 3 week old little girl.
DKA is nothing to play around with, and administration of too much insulin
can prove to be the very thing that finishes a person off.
Will, T2
.
- References:
- DKA question
- From: RK
- Re: DKA question
- From: wmmckee
- Re: DKA question
- From: David
- Re: DKA question
- From: Jenny
- DKA question
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