My client was a known diabetic when she came to treat at an urgent care facility in Georgia. She clearly presented with symptoms (nausea, vomiting, diarrhea for 4 days, fatigued, lightheaded, weak, short of breath and reported unintentional weight loss, etc.) that could be the result of hyperglycemia and/or diabetic ketoacidosis. Unfortunately, the attending advanced practice registered nurse failed to perform a proper differential diagnosis.
In particular, the nurse failed to: 1) order glucose testing based on patient presentation, medical history and available urinalysis results; 2) recognize and diagnose symptoms of diabetic ketoacidosis, a life-threatening medical complication of diabetes mellitus; and 3) provide appropriate medical care including intravenous insulin and/or referral to higher level of care including emergency department or hospital admission. If the nurse had followed proper diabetic protocol and differential diagnosis, then my client would be alive today.
The nurse presumed the patient was dehydrated due to her illness and provided intravenous fluid replacement. She later released my client without further diagnostic work up, treatment or referral to a higher level of care. Therefore, the resulting breaches in the standard of care prevented our client from receiving appropriate assessment and care for her condition which would have included management of hyperglycemia in the clinic or referral to a higher level of care, such as emergency room or hospital admission via EMS. Combined, the failure to diagnose diabetic ketoacidosis caused a critical delay of care resulting in the untimely death of my client. Unfortunately, this breach of the standard of care proximately caused the death of my client – simply put, the nurse should have sent my client to the ICU for an insulin drip.