Late-night emergency story - Ming Ming is life-threatening, but he has to go home to drink water treatment!

I can't remember it's a few o'clock in the night, because that night has been busy, busy so busy that there is no time to see the watch, busy to look up is already dawna middle-aged male patient in the emergency room, walking into the clinic with a clear mindin fact, I didn't even notice him in the emergency room if it hadn't been for the patient's own voicehe gave me the first impression is was thin, is the kind of people to forget the thin, cheekbones high, and even let me think of the first time four words: "the bones are very strange."the patient and said, "Doctor, I want to take a blood sugar test!" "
this request makes me curious, because most patients come to the emergency room in the early morning to ask for fasting blood sugarand the patient came to the emergency room late at night, patiently queuing in the sea of people, just to check blood sugar?"Why check your blood sugar now? Do you have diabetes? "I asked the patient, who was thin and had slightly longer hairpatients do not rush to answer: "I tested blood sugar twice, can not measure, want to come to the hospital to check." "
" is not too high blood sugar can not be measured, is it? See if the patient's appearance is already ketosis? "After learning the patient's explanation, my heart can not help but turn up, after all, the possibility of a blood glucose meter failure is not greatto avoid wasting time on long queues, I monitored the patient's blood sugar for the first time in the emergency roomend blood sugar has indeed reached 32.1mmol/l, and further blood ketones have been as high as 6.5mmol/l," is this related to my fever? I've been getting hot for two daysThe patient asked inexplicably"Are you hot?" How many degrees? Are there any other discomforts?patient scared and calmly answered me: "Coughing for almost a week, these two days of fever, has been low heat." "
"How do you control your blood sugar now? Do you take a stutter or take insulin? "
" I haven't taken medication for more than two months! "
the middle-aged man in front of me not only recently has some kind of infection in the body, but also has not controlled blood sugar for more than two months!this can explain why the patient gave me the intuitive feeling of "bone wonder" and why the blood sugar is so high that the results are undetectable!Since the patient's blood sugar and hemolysis are so high, and the existence of infection, it is bound to be dealt with immediately, otherwise whether it is diabetic ketoacidosis or high permeable coma are quite dangeroushowever, the patient himself doesn't think soafter knowing the results of blood sugar and hemolysis, the patient again calmly rejected the proposal for further examination and treatment," "It's okay, I'm home!" "The patient turned around and left, not even taking the medical recordI stopped him because I was not only afraid that if I didn't deal with it in a timely manner, it could lead to further deterioration of the condition, but also because the patient didn't know about his condition"Do you know what it means not to deal with it? Your condition to further check the treatment, to see the infection, correct blood sugar, acidosis, electrolytes and so on"Because the patient is particularly thin, the two eyes should stand out a little morehe answered in no hurry: "It doesn't matter, I'll go home and drink water!" "canlower blood sugar? Can drinking water cure sepsis?I've never heard of it, and I've never seen a patient do it a brief consternation, I suddenly understood a truth, the patient must mean that since the treatment of diabetic ketoacidosis needa a large number of rehydration, then go home to drink water rehydration is not also possible? it's just wishful thinking by the patient himself, or it's just a reason for him to get simply in the way of it " drinking water can't solve your problem, you need to use insulin to lower blood sugar, need to fight infection, need to do other tests! "I explained to the patient again what the priority was diabetic ketoacidosis is a common acute complication in diabetic patients, and is a clinical syndrome characterized by high blood sugar, high blood ketones and metabolic acidosis Before the invention of insulin, the mortality rate of diabetic ketoacidosis was more than 60%, and after the widespread use of insulin, the mortality rate of diabetic ketoacidosis remained at about 10% can induce patients with diabetic ketoacidosis for many reasons, such as respiratory infections and other infections, improper use of insulin, overeating, trauma surgery and other stress fulion and the middle-aged man who seems to be "skeletal" in front of me not only has obvious infections, but has been discontinued with sugar-lowering drugs for more than two months! in fact, I have spoken to patients in detail about specific treatment options for diabetic ketoacidosis and possible thorough examination but the patient refused some treatment in a firm manner and told me: "It's no big deal, it's not the first time." "
"Why did you stop using the sugar-lowering drug?" "
the patient didn't answer me, and some quivered: "You open the list you just checked, I'll pay the fee." see that they can't stop the patient's determination to refuse to check for treatment, I had to ask him again: "Since you know the dangers of acidosis, why not treat it?" Is there time or no money? It's dangerous to let you leave like this, even if you don't worry, I'm worried "
because I know that if left unchecked, the patient is likely to have a severe shock, coma and other serious conditions next patient's question and answer only silenced me: "My health insurance is in the field, there is no need to spend this money." I went home to drink water, began to take medicine, really can't stay up again "
wearing a white coat, often encounter some things that they can not control most i am sad is not their own helplessness of the patient's illness, but their own clearly still have the ability to do something but was ruthlessly rejected by the patient himself maybe we've been treating the disease but we never saved our lives eventually he left the hospital after signing the signed and disappeared into the night and I haven't seen him since most of the time the most difficult is not medical technology, but our deep-rooted misconceptions, and the causes of those diseases finally, dopamine wants to say: Although diabetic ketoacidosis is a reversible acute complication, but if left out, can still be life-threatening And for diabetic patients, in addition to actively control blood sugar, develop good living habits, respiratory infections, gastrointestinal infections and other types of infections are also need to be highly valued! last dopamine Source: last dopamine