Friday, May 27

It’s not always hypoglycemia…

Call: "Unresponsive female at [store]".

Our ambulance rolls to a stop in front of a store, and as we go into the entryway we see a crowd around a bench. On the bench is a mid-50’s female lying supine, legs elevated and head on a coat. A person approaches us with a tube of glucose in her hand. She identifies herself as a bystander, and has taken a brief history (she asked the patient her age and whether she has diabetes). The bystander tells us our patient is a diabetic, has lost consciousness twice in the last hour, and currently has a pulse of 77. She was about to give the patient glucose when we arrived. She hands the tube to me expectantly, and when I go to get more information from the patient the bystander states “this patient needs glucose NOW”. She practically puts her hands on her hips and taps her foot as I go about assessing the patient.

Alert and oriented to time, place and self. Strong sense of humor evident from the start, and no signs that she’s feeling anxious, confused or like she’s about to buy the big farm in the sky. She is, however, pale. VERY pale. She is a diabetic, but she is not insulin dependent, is current on her meds, and did eat her normal breakfast and lunch. Her vitals are not scary (I’m not sure the state recognizes “scary” as a category for vital signs, but I now do…). Patient and her daughter report that both episodes of syncope were for about 15 seconds each and that the pt returned to normal mental status within a minute.

Blood glucose level? High normal. The opened tube of glucose goes in the trash and we get the patient in the rig.

The cardiac monitor is showing a first-degree heart block, which the patient claims is new onset and may well explain the syncope. I start a line, and we start rolling to the hospital. The patient is hemodynamically stable the whole trip.

Lesson learned: Diabetics with altered mental status are not necessarily having a hypoglycemic episode, and asking someone if they are a diabetic is not enough history taking.