Update: OK, so it’s not much of a medical mystery, is it? Maybe I should have used a question mark at the end of the title. Or maybe someone should invent a smiley for sarcasm. Our thoughts were pretty much along the same lines as the commenters. Not that the Alleged Skilled Nursing Staff would come out and admit that they made a mistake. No, that would be too simple and straightforward. With no way to prove what they did, so they’ll just get get away with it.

We were recently dispatched to an Alleged Skilled Nursing Facility for a inmate patient with Altered Mental Status. The call comments said that the Blood Glucose was 26mg/dl and that the patient was “acting strange”. Pretty typical for diabetic patients, it’s something we see pretty often. The fix is pretty routine, start an IV, give Dextrose through the IV, the patient wakes up.

The BLS crew arrived before we did and knowing the reputation of this ASNF, they prudently rechecked the blood glucose level and this time they got a reading of 18 mg/dl. While my partner got ready to start the IV, I read through the patient’s chart. Long history of Emphysema, some other medical problems, but absolutely no history of diabetes. Hmmm, that was odd, we don’t, as in almost never, see a non diabetic patient have altered mental status because of a low blood glucose level. Even though it meant a third pin prick for the patient, I asked for another check, using yet a third glucometer. Something wasn’t right.

I asked one of the staff members who actually spoke understandable English what had happened to prompt the staff to randomly check a non diabetic patient’s blood glucose at O-Dark-Thirty? She told me that one of the staff had just happened to be walking down the hallway and heard the patient thrashing about in his bed. In a flash of inspiration, she decided that the non diabetic patient had hypoglycemia and that the blood glucose needed to be checked. Very fortunate that, huh?

The third blood glucose was below the detectable limit of the device, which meant that it was probably in single digits. So, in the course of 20 or so minutes, the patient’s blood glucose level had gone from 26 to 18 to 0 mg/dl. Delving into this mystery further would have to wait as the IV was started and the Dextrose had to be administered.

We did that and got the patient ready for transport. During transport, the patient became ever more alert, oriented, and able to tell us some things about his medical history. He was in fact not a diabetic, which eliminated the possibility that the staff had given us the wrong chart for the wrong patient. Don’t laugh folks, this has happened more than once, including a case where a family member was advised that his father had gone into cardiac arrest and been transported to the hospital. Imagine everyone’s surprise when the family member arrived, looked at the recently deceased party and declared, “That’s not my father!” Ooops, the crack ASNF staff had given the ambulance crew the chart of another patient who was still at the facility and quite alive.

When we arrived at the hospital the patient was awake, had no complaint, and had no idea what had happened or why he had transported to the hospital.

I gave report to the triage nurse who gave me a very odd look when I related the story of the non diabetic hypoglycemia and the vigilant ASNF staff who had deduced what was going on. She in fact had a theory as to what had really happened which made complete sense. I had started to suspect what was going on during transport and my idea matched her’s.

Only I’m not going to share it with you right now, since this is a mystery. Please feel free to post your thoughts in the comments.