The adventure continues

I just heard about someone they wanted to fly in for treatment here. Unfortunately, they died at the outside hospital before our helicopter got there. It was diabetic ketoacidosis (DKA), a nasty complication of type I diabetes (which has been known as juvenile-onset or insulin-dependent, though those have become less accurate as America fattens and plenty of teens get type II diabetes, and plenty of type II's need insulin for control).

For the medically aware: FSG 1890. Gap was 40. No word on pH.

For the laymen: a normal FSG (=finger-stick glucose) is around 100. With most diabetics, we aim to keep it at or below 150 (as a practical matter). "Bad" is around 180. "Really bad" is around 220. She was an order of magnitude out from normal. Gap (short for anion gap) is sodium - (chloride + bicarbonate), and should be <12. It reflects unmeasured negative ions in the blood, which mostly consist of proteins in normal people. In DKA, it's high because their blood is full of acids that are negatively charged at blood pH.

Anyway, a regular bout of DKA is FSG of 500 with a gap of maybe 20. (At least, that's the case here. YMMV.)