The ITU team often gets called to the Emergency Department to assess patients who may or may not need not be managed in ITU. Today's offering was a 45 year old gentleman who had imbibed nearly a litre of antifreeze the previous day and decided to keep quiet about it. He eventually started feeling unwell and told an ex-partner (there's always an ex-partner) who phoned his parents who brought him to hospital.
When we saw him he had fairly deranged blood gases (was moderately acidaemic with a low PCO2) and was hyperventilating to compensate. So from a physiological point of view, quite an interesting case. Helpfully he had washed it all down with a bottle of red wine, and, ironically, alcohol (ethanol) being the antidote to antifreeze had slowed down the process of poisoning himself.
It's interesting the effect self harm cases has on the medical team. Truly suicidal people tend just to get on with it and are sadly found deceased or beyond help. Similarly truly depressed people tend not to tell anyone about how bad they're feeling. The Emergency Department has to deal with a huge number of people "crying for help" on a daily basis, taking ineffectual overdoses or cutting themselves and presenting immediately for TLC. The medical team's duty of care means a lot of time and resources are spent patching these patients up and either referring them to mental health services or discharging them home where they become down and desperate and repeat the cycle of turning up at hospital where people will listen to and care for them. It can be hugely frustrating trying to help somebody who doesnt want to be helped or who are perceived as "attention seeking".
Mr Ethylene Glycol was quite difficult to manage, partly due to his co-existing needle phobia not going well with the requirement to obtain several blood samples for ethylene glycol/methanol levels (in fact the lab rejected the samples saying they "dont do ethylene glycol or methanol levels"), partly because by this point he was realising the seriousness of what he had done and was feeling very unwell. While it is understandable that the chap was frightened and most of his acting up was probably due to this, it is also very difficult to continue to empathise when you know you have to get that needle/line/catheter into him in order to administer the correct treatment.
Speaking of treatment, there's a new antidote to ethylene glycol called fomepizole which costs £4000 per vial. Apparently it works better than ethanol (by irreversibly inhibiting the relevant enzymes) and is thus the best treatment for the patient, but with the NHS needing to save money perhaps there would have been justification for simply filling the chap with vodka! Indeed most Emergency Departments have a bottle of some spirit somewhere for the antifreeze/methanol drinkers out there, and not for the stressed out doctors.
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