# Diabetic’s fatal condition mistaken for hangover at A&E



## Northerner (Oct 30, 2016)

The NHS ombudsman has severely criticised a hospital for disastrous mistakes that led to the death of a young woman after A&E staff mistook her diabetic complications for nothing worse than a hangover.

North Middlesex hospitalfailed to spot that she had a life-threatening condition called diabetic ketoacidosis (DKA), which caused her body to produce poisonous chemicals.

The 26-year-old media studies graduate received severely inadequate care due to “unacceptable” failings, which included her being discharged when she needed urgent treatment, according to a scathing report by the ombudsman. Odlin was found dead in her kitchen by her flatmate the following morning.

Dame Julie Mellor concluded that Odlin’s death in February 2014 was “avoidable” because she would have lived if her illness had been diagnosed. However, the hospital’s failure to undertake a blood test meant it was missed, which led to Odlin going home when she needed life-saving treatment.

https://www.theguardian.com/society...ngover-ombudsman-100-cases-blunders-hospitals

 Dreadful


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## Amigo (Oct 30, 2016)

Northerner said:


> The NHS ombudsman has severely criticised a hospital for disastrous mistakes that led to the death of a young woman after A&E staff mistook her diabetic complications for nothing worse than a hangover.
> 
> North Middlesex hospitalfailed to spot that she had a life-threatening condition called diabetic ketoacidosis (DKA), which caused her body to produce poisonous chemicals.
> 
> ...



OMG! They didn't even cover the basics by taking blood when they'd been told she was diabetic. That surely must be neglect at its very worst! Poor woman must have suffered terribly.


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## Radders (Oct 30, 2016)

That is frightening.


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## Northerner (Oct 30, 2016)

Amigo said:


> OMG! They didn't even cover the basics by taking blood when they'd been told she was diabetic. That surely must be neglect at its very worst! Poor woman must have suffered terribly.


If I had got similar treatment in A&E I wouldn't be here now  And they didn't know I was diabetic when I was admitted - if they knew and didn't recognise DKA it really is poor


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## Rosiecarmel (Oct 30, 2016)

That is extremely poor!! If you know a patient is diabetic, you should always take their BGs at least during routine physical observations which everybody gets in a&E. Why didn't they do a urine dipstick that would show up ketones?! This is very sad and worrying


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## Amigo (Oct 30, 2016)

It doesn't surprise me as much as it should. I had my BG's tested in A&E when I had a serious infection and it was according to them 'predictably high'. I didn't have a diabetic diagnosis at that point (though clearly it was already fuelling the infection). My BG's were NEVER repeated in the 6 days I remained in hospital. 
I've often considered I should have made a complaint because I was diagnosed 3 months later but thankfully it didn't have such a tragic result for me.


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## Owen (Oct 30, 2016)

If that was a private company the directors would be prosecuted for criminal negligence.


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## mikeyB (Oct 30, 2016)

I suppose that shows the value of wearing a Medic Alert or similar bracelet or locket.

And possibly nasal sprays to clear the airways of the doctors so they could smell the bloody ketones. Don't they train doctors these days in clinical signs? It's such a distinctive characteristic smell you can usually pick it up as soon as you walk into the A&E cubicle in my experience. It doesn't smell like alcohol. You don't NEED blood tests to diagnose it. You smell that, take the blood, and without waiting for any results bung in a line with fluids and insulin. Do that, and they've usually woken up by the time the blood tests come back. Do fingerprick tests at leisure. Job done. Patient walks out instead of being carried out.


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## Owen (Oct 30, 2016)

mikeyB said:


> I suppose that shows the value of wearing a Medic Alert or similar bracelet or locket.
> 
> And possibly nasal sprays to clear the airways of the doctors so they could smell the bloody ketones. Don't they train doctors these days in clinical signs? It's such a distinctive characteristic smell you can usually pick it up as soon as you walk into the A&E cubicle in my experience. It doesn't smell like alcohol. You don't NEED blood tests to diagnose it. You smell that, take the blood, and without waiting for any results bung in a line with fluids and insulin. Do that, and they've usually woken up by the time the blood tests come back. Do fingerprick tests at leisure. Job done. Patient walks out instead of being carried out.


The symptoms are taught in pre hospital care, but I have witnessed people that know better being oblivious to the obvious


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## Ralph-YK (Oct 30, 2016)

I was in A&E twice in 2014 with infections ( cellulitis. Near the begging of the year, held overnight. End of year held for three weeks).
Also, I was in a&e last year, after I'd been diagnosed. I don't remember it ever being taken in a&e. Nor when I was on ward last year with my heart attach.
When I went in for my defibrillator operation they did one test not long after admission.

The second time I was in with an infection I was transfered to another hospital (2am, why always 2am).
When the doctors came round in the morning, almost the first thing they said was "are you diabetic?"
At no point had my BG been tested.


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## Northerner (Oct 30, 2016)

mikeyB said:


> And possibly nasal sprays to clear the airways of the doctors so they could smell the bloody ketones.


Indeed - very strong and distinctive 'pear drops' smell. I also had very shallow breathing and a racing heart, and although I could just about understand questions being asked, I found it hard to speak


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## trophywench (Oct 30, 2016)

Have to say our A&E automatically do a fingerprick on absolutely everybody at triage* - but if you've just turned up and nobody pre-knows you are D and don't alert Reception to the fact - you could be waiting a long time for triage.

If you are unconscious/in a state of collapse, then AFAIK it's straight in to one of the Emergency cubicles.

* Pete had a catheter blockage about 10 days after his prostate op - the ward stress to you that should this happen, straight to A&E and ask to see the On-call Urologist, which we did.  Nowt happened for over half an hour so I went back to the desk and asked again.  Shortly after this, he was triaged - the nurse doing the thing was baffled as to why he had been told to ask for the On-call Neurologist and enquired why?  We did have a laugh about that - but it goes to show you have to be absolutely clear about your prob when checking in - don't think putting 3-way catheters in is a particular area of expertise for most Neurologists!


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## Sally71 (Oct 30, 2016)

Apparently some people are unable to smell ketones, it's genetic. Either you can or you can't.  No problem there for me, I often wonder why we've got a ketone meter, it's usually glaringly obvious to me if daughter has problems in that direction!
It doesn't excuse the hospital from not doing a basic finger prick test though, especially if they knew the person was diabetic, that should have been the first thing they checked


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## grovesy (Oct 30, 2016)

mikeyB said:


> I suppose that shows the value of wearing a Medic Alert or similar bracelet or locket.
> 
> And possibly nasal sprays to clear the airways of the doctors so they could smell the bloody ketones. Don't they train doctors these days in clinical signs? It's such a distinctive characteristic smell you can usually pick it up as soon as you walk into the A&E cubicle in my experience. It doesn't smell like alcohol. You don't NEED blood tests to diagnose it. You smell that, take the blood, and without waiting for any results bung in a line with fluids and insulin. Do that, and they've usually woken up by the time the blood tests come back. Do fingerprick tests at leisure. Job done. Patient walks out instead of being carried out.


Not everyone has a sense of smell, mine comes and goes as result of having allergic rhinitis and nasal polyps for over 40 years!


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## Owen (Oct 30, 2016)

DKA should be easy to spot, the danger is Hyperosmolar Hyperglycemia, this develops slower and does not have any of the DKA telltale smells or ketones. The dehydration is more severe and the occurrence of mortality higher. Anyone running high blood sugars over extended periods need to get checked out. There is little that can be done in the pre hospital environment except transportation.


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## Amigo (Oct 30, 2016)

mikeyB said:


> I suppose that shows the value of wearing a Medic Alert or similar bracelet or locket.
> 
> And possibly nasal sprays to clear the airways of the doctors so they could smell the bloody ketones. Don't they train doctors these days in clinical signs? It's such a distinctive characteristic smell you can usually pick it up as soon as you walk into the A&E cubicle in my experience. It doesn't smell like alcohol. You don't NEED blood tests to diagnose it. You smell that, take the blood, and without waiting for any results bung in a line with fluids and insulin. Do that, and they've usually woken up by the time the blood tests come back. Do fingerprick tests at leisure. Job done. Patient walks out instead of being carried out.



I agree Mike but I'm not sure why she would need a medical alert bracelet or such when her father was tapping them on the shoulder telling them she was diabetic! It's unbelievable neglect of basic testing.

From the article;

'Her father is furious that, despite him telling A&E staff that Phillippa was a diabetic, they did not take either blood or urine samples to establish what was wrong.'


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## HOBIE (Oct 30, 2016)

NHS staff not being trained. A lot still don't understand Diabetes. A lot of staff are themselves heading in the wrong direction. They have to deal with all sorts of conditions inc drugs. I was flat out & Ambulance tuned up & Fire Engine & I herd a voice say "Give him some Insulin" I was in a state of Hypo & nearly got up & ran. Sad


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## Hazel (Oct 30, 2016)

If diabetes is costing 10% of the NHS budget perhaps their staff should have 10% of their training devoted to caring for diabetics


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## grovesy (Oct 30, 2016)

When money is tight in the NHS training is often one of the first budget that is cut!


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## James 048 (Oct 30, 2016)

Well you guys have  said it all , my thoughts and prayers are with the family and friends of this special young lady


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## Martin Canty (Oct 31, 2016)

When we run medical aids (Fire hat on now) it is very common for us to check BG, particularly for an altered LOC (Level of Consciousness). If the patient is reported as diabetic we always check BG.


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## Owen (Oct 31, 2016)

Martin Canty said:


> When we run medical aids (Fire hat on now) it is very common for us to check BG, particularly for an altered LOC (Level of Consciousness). If the patient is reported as diabetic we always check BG.


Do you use y the AVPU system


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## Martin Canty (Oct 31, 2016)

Owen said:


> Do you use y the AVPU system


Yes we do.... Figure that we could probably speak the same language if we ever met.....

A recent FB discussion with a friend who's son had a scare with Diabetes had a comment from my brother "is there an app to translate that?"..... Worrying thing is that my brother is pre-D in New Zealand; little/no support in that country either


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## macabee (Nov 1, 2016)

A charge of negligent manslaughter would get people to think more about the dangers.


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## Redkite (Nov 1, 2016)

The hospital was indeed negligent, but I can't help wondering why the Dad was so easily palmed off.  Why didn't he want to know what her BG and ketones were?


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## Northerner (Nov 1, 2016)

Redkite said:


> The hospital was indeed negligent, but I can't help wondering why the Dad was so easily palmed off.  Why didn't he want to know what her BG and ketones were?


The thought did cross my mind, I suppose it's possible he wasn't that clued up about it. Always hard to tell what really went on from a newspaper report  There do seem to be quite a few stories of healthcare professionals being pretty clueless about diabetes. I know they can't know everything about everything, but there are over a million people in this country on insulin and it affects a significant percentage of the population (7-8%?). Let's face it, I was expected to understand it and learn how to control it in a disjointed 10 minute chat with the hospital DSN - the basics, of course - and I have no medical training.


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## Ralph-YK (Nov 1, 2016)

Redkite said:


> The hospital was indeed negligent, but I can't help wondering why the Dad was so easily palmed off.  Why didn't he want to know what her BG and ketones were?





Northerner said:


> The thought did cross my mind, I suppose it's possible he wasn't that clued up about it. Always hard to tell what really went on from a newspaper report  There do seem to be quite a few stories of healthcare professionals being pretty clueless about diabetes.


Authority gradient.  It's been known for decades.  We English are rubbish talking about medical. There are issues with questioning medical people.
This is why we don't ask about tests etc & have trouble if we try.  It is why so many people just go home and say & do nothing.  It is shy it's so important for the medical profession to promote patient involvement.
It's something that I've seen touched on on this forum.  Strougles over statins, being kept informed etc.


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## mikeyB (Nov 1, 2016)

What I'm about to say isn't meant to diminish what happened here...

We have such a good health service that incidents like this are so rare they get in the national press. Most of the time, it works fine, despite everything.

Don't forget that we are a self selected vocal group; we can all recount our bad experiences, so it can seem worse than it actually is.


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## Northerner (Nov 1, 2016)

mikeyB said:


> What I'm about to say isn't meant to diminish what happened here...
> 
> We have such a good health service that incidents like this are so rare they get in the national press. Most of the time, it works fine, despite everything.
> 
> Don't forget that we are a self selected vocal group; we can all recount our bad experiences, so it can seem worse than it actually is.


This is very true @mikeyB. I think it's often overlooked just how incredibly complex the NHS is, this never comes over in anything you read about it - it's always boiled down to big money numbers and a broad sweep of 'hospitals' 'GPs' 'Nurses' etc. Not everyone is at the top of their game all the time, and not everyone is as capable as the very best - it's the same in any walk of life.


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## pav (Nov 1, 2016)

Unfortunately I am not surprised, the care varies drastically in my local hospital from excellent to virtually non existent with I am only here for the wage packet at the end of the month.


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## Amigo (Nov 1, 2016)

I agree that we are a more clued up vocal group but in relation to this particular case, there's really no excuse or room for dodging the blame. The Health Ombudsman report makes it clear that the death of this woman was entirely avoidable. Checking the blood of a diabetic patient must be the most basic obligatory test in A&E. If not, why not? 
Who knows why the father didn't push the matter...perhaps he trusted the medics and couldn't imagine that they hadn't done it. 
I can't believe they hadn't done it!!!


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## mikeyB (Nov 1, 2016)

I quite agree, Amigo, but the point I made was that this sort of catastrophe is rare. I think we all agree this was was an appalling case.


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