Sunday, January 10, 2010

Missed It

A lot of what we do is pattern recognition. With experience, our diagnostic process moves from the 'scattergun' approach to the focussed, guided by the signs, subtle or obvious.

Often, we rely on bypassing a lot of 'routine' or standard investigation, if the pattern before us stands out strongly enough. Sometimes the pattern shouts at you. An 'end-of-the-bed' diagnosis.

Of course, not all disease choses to present that way. Sometimes the obvious is not what it appears, and sometimes, perhaps often, the presentation is atypical.

Sometimes it's not.

A young man with a few week history of general malaise. Tired, weak, off his food, weight loss. Even a dose of oral thrush. Three days before, he had taken to his bed, nauseated, vomiting, listless.

He lay on the bed, looking like nothing more than a survivor of Bergen-Belsen. Like cancer, like AIDS.

His eyes were sunken, his tongue dry and sticking to his mouth, his respirations deep, and sighing. Pulse weak, thready and racing.

he'd seen his GP at some stae in his illness. It must have been at the beginning, because no-one cpould pass this off as anything else.

I aked the only question that needed asking. His blood sugar was 52 mmol/dl. He has diabetes, until now undiagnosed, and had drifted slowly into keto-acidosis.

There is satisfaction in even this most simple of diagnoses.

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