Missed a patient initially come for shortness of breath for the metabolic acidosis part...Even if i have been handling patients for quite some time like this, I will admit I havent come across the scenario when I missed making a diagnosis.
Bicarbonates were persistently coming low. He never gave a history of diabetes and he is an 80 year old man, too well preserved to come up with an initial Diabetic Ketoacidosis. Even if I and A were working together and its beyond doubt we make a super efficient team with our doggedness, we both did not have a time when we had tea before us and did not get time to sip it. Minds were pretty crowded and with the Medicine- Chest and T B story and me being on a backfoot because of the other units LOC rigid admission criteria, we both failed to miss it.
Always, always account for a patients metabolic acidosis. I will never make this mistake again...Because DKA doesnt come with an age tag. Today's 80 year old Bijender just showed that to me.
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