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- Oct 31, 2005
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Had an insulin overdose case tonight. Apologies if any/all of the questions have already been answered on sdn...
50's male diabetic decides to inject himself (suicide attempt) with 1000 units of Humalog 70/30 in his deltoid (probably IM). Becomes symptomatically hypoglycemic and decides to drink sodas/eat sugary foods to save himself... EMS gives him 2 amps of D50, (unknown FS) and arrives in ED.
FS = 305 on arrival, pt somewhat lethargic, but arousable to loud voice. K never dropped below 3.3, monitored FS, which was ~200-250 over 3-4 hours.
My question concerns the lactate... On the ABG pH was 7.37, lactate was 5.4... Pt was not septic. Yes, he was also on metformin but he said he hadn't taken it since wednesday. Repeat lactates were 5.4, then 4.6 (pH 7.43) after lots of D5 fluid resuscitation. Pt is alert, oriented, in NAD, VS normal except for HR to 110's secondary to likely opioid withdrawal (takes 20 vicodin per day for arthritis pain, last took 2 days ago)
What is the reason for the elevated lactate?
As VBG lactates can reflect localized hypoperfusion, how much does that really matter, compared to ABG lactates?
thanks.
50's male diabetic decides to inject himself (suicide attempt) with 1000 units of Humalog 70/30 in his deltoid (probably IM). Becomes symptomatically hypoglycemic and decides to drink sodas/eat sugary foods to save himself... EMS gives him 2 amps of D50, (unknown FS) and arrives in ED.
FS = 305 on arrival, pt somewhat lethargic, but arousable to loud voice. K never dropped below 3.3, monitored FS, which was ~200-250 over 3-4 hours.
My question concerns the lactate... On the ABG pH was 7.37, lactate was 5.4... Pt was not septic. Yes, he was also on metformin but he said he hadn't taken it since wednesday. Repeat lactates were 5.4, then 4.6 (pH 7.43) after lots of D5 fluid resuscitation. Pt is alert, oriented, in NAD, VS normal except for HR to 110's secondary to likely opioid withdrawal (takes 20 vicodin per day for arthritis pain, last took 2 days ago)
What is the reason for the elevated lactate?
As VBG lactates can reflect localized hypoperfusion, how much does that really matter, compared to ABG lactates?
thanks.