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	kookaburra 2009-01-22 10:39 am UTC (link)
	But...that makes no sense. You get KTA from HIGH blood sugar. And it takes like a week or more to develop. /confused EMT-presumtive (Reply to this)(Parent)(Thread)

	catmoran 2009-01-22 06:30 pm UTC (link)
	Keep your logic out of this -- he's obviously a speshul snowflaque just like his bride! Or more likely, she doesn't really know or care what almost killed him. Maybe next week she'll say it was rabies. (Reply to this)(Parent)

frequentmouse
2009-01-22 07:30 pm UTC (link)

You can get high BG and especially ketoacidosis if you're dehydrated from vomiting or diarrhea (and therefore need rehydration and IV glucose at the same time); I suspect that what we have is not-genius Bride misunderstanding the docs. And ketosis can set in a whole lot faster than "weeks" in Type 1 diabetics with salmonella or listeria, it's not like ketoacidosis resulting from poor control. (I lived with insulin dependent diabetics in the household from the time I was a little kid; this is all daily survival information for me).

Non-diabetics can end up with ketosis in cases of severe gastritis, for that matter.

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	delineated 2009-01-22 08:41 pm UTC (link)
	This. My worst episode of ketoacidosis was when I had food poisoning so bad that I couldn't keep anything down, and thus got massively dehydrated. Ketosis set in in a matter of hours, and I was in hospital with an IV in each hand for a week, after spending a day in the ICU. It's entirely plausible that the guy had that sort of situation. (Reply to this)(Parent)

	evilsqueakers 2009-01-22 08:55 pm UTC (link)
	This. I think had a milder case since my coma whapped out of me by the docs in the ER and I don't know for certain, but I'd been dehydrated and vomiting before going to the ER. Of course, that's when I learned I was diabetic so may be I was just a special snowflake. I was bad before but that day I was like woo-woo land. (Reply to this)(Parent)

	kookaburra 2009-01-22 10:21 pm UTC (link)
	That makes sense. The people I usually see on calls are Type 1's who were sick but kept taking insulin, so they end up with hypoglycemia. Everyone I've been on a call to in DKA was a previously undiagnosed Type II, or a type II who didn't manage their diabetes. (Reply to this)(Parent)(Thread)

	frequentmouse 2009-01-22 10:25 pm UTC (link)
	Which means, right now, that if you were diagnosed with diabetes you'd need to take the week-long class that my HMO offers to diabetics, because what you "know" could kill you. (I am Type 2 and have caught some sort of stomach flu, and am struggling, at the moment, with meds and food and fluids, so this is snark from the gut, quite literaly). (Reply to this)(Parent)(Thread)

kookaburra
2009-01-22 10:36 pm UTC (link)

*adds this to the list of things she is going to be writing the AAOS strong letters about their Emergency Care curriculum*

I knew they had to be lacking in areas other than respiratory/gynecological emergencies (those are the only areas I, personally had experience with before going through the course, and I was pretty astonished at some of the stuff that was left out). So I really shouldn't be surprised that they only mentioned Insulin Shock, and not DKA as a risk of acute abdomen in diabetics.

Of course then there's the Paramedic book I just got for next year's classes, and in several places it's pretty much like, "Yeah, that stuff you learned in Basic? Forget it, it's useless, ~~but those dumb firefighters couldn't handle anything more complex~~." (OK, I made that last part up, but it's pretty heavily implied.) :/

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	frequentmouse 2009-01-22 11:08 pm UTC (link)
	I cannot tell you how reassured that reply makes me. Hypoglycemic shock is scary stuff, but it's the high end of things which end up doing long term damage. (Reply to this)(Parent)

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