How Low Did He Go?

​At sign-out, I thrust this VBG at my oncoming colleague.Me: What do you think of this?Colleague: 6.76. That is pretty low. DKA?Me: Nope, the sugar was 107.Colleague: Post code?Me: Not that either.Colleague: Did you intubate him?Me: No, I was scared that would kill him with a worsening acidosis if we don't get his respiratory rate fast enough.Colleague: Did he go to the ICU?Me: He went to tele.Colleague: What made him better?Me: Fluids and midazolam. A lot of midazolam—5 mg IM followed by 15 mg IV. He was brought in crazy agitated after a first-time seizure. I thought he had a toxic delirium or an intense post-ictal phase.Colleague: How did he do?Me: Three hours later his lactate had practically cleared, and he was admitted to telemetry asking for something to eat.Tip to Remember: As with DKA, patients with severe lactic acidosis from agitation often do not need intubation if the underlying cause is reversed and the patient maintains his respiratory status.Tags: VBG, diabetic ketoacidosis, respiratory rate, midazolam, toxic delirium, post-ictal phase, seizure, intubation, lactic acidosis, emergency medicinePublished: 5/1/2019 5:49:00 PM
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs