- The causes of confusion or altered LOC in a middle aged diabetic male are numerous.
- Most causes could be delineated by a thorough history, examination and a few simple investigations.
- Hypoglycaemia – history of hypo’s, episode in relation to taking medications, BSL.
- Diabetic ketoacidosis – history of DKA, polyuria, polydipsia, thrist, compliance with medications, type I or II diabetes, ABG, BSL, dehydration on examination.
- Hyper-osmotic hyperosmolar syndrome (HHS) – unwell with concomitant infection, severe dehydration, severe hyperglycaemia, hyperosmolality (plasma).
- Hyperglycaemia – history of control, compliance, BSL.
- Lactic acidosis – type II diabetics on metformin (biguanides) -> sepsis or renal failure.
- Cerebrovascular accident – TIA or stroke – DM is a risk factor for vascular disease, history of focal neurological symptoms, brainstem or cortical infarct/bleeding.
- Sepsis with encephalopathy – the diabetic patient is at risk of systemic infections from a number of sources.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.