“What is the nature of your emergency?” asked the 911 operator.
As I related in the last post, early Thursday morning my wife Nicole went from weak to immobile in less than an hour.
“51-year old woman with type-1 diabetes and kidney failure,” I said quickly. “She’s conscious but in a state of paralysis with decreasing heart rate and difficulty breathing. She’s had lots of diarrhea and may be dehydrated.”
I then told 911 how to come in through the back door of our apartment. The operator tried to press me with other questions but I said I can’t talk and put the phone down.
Nicole was still in the bathroom, slumped against the wall. I carried her back out to the living room and laid her on a yoga mat on the floor. She said she couldn’t breathe on her back, so I put her on her side. I cleaned her up and injected her regular morning basal insulin plus another two units of fast-acting to cover the elevated blood sugar. (Last thing we need was to add hyperglycemia to what was already proving to be a stressful day.)
The sound of sirens grew stronger. Within ten minutes the paramedics were taping ECG pads to Nicole. “Her heart’s producing a sine wave,” they said.
(According to an article in the New England Journal of Medicine such a rhythm “can degenerate into ventricular fibrillation if the cardiac membrane is not stabilized.” The American Heart Association describes ventricular fibrillation as a disordered electrical activity that “causes the heart’s lower chambers (ventricles) to quiver, or fibrillate, instead of contracting (or beating) normally. This prohibits the heart from pumping blood, causing collapse and cardiac arrest.”)
The paramedics asked Nicole questions and she explained how she’d become weaker and weaker with each bout of diarrhea.
Turning to me the male paramedic asked: “Didn’t it concern you she couldn’t walk to the bathroom on her own?”
“Concern me?” I said in disbelief. “Of course it concerned me. Do you think I call 911 every day?”
Soon Nicole was in the ambulance with a saline IV (sans glucose), racing to the hospital with dawn breaking a cold winter morning. I woke our 11-year-old son Jonah (who somehow slept through all this), packed a bag, and called a taxi.
We were all soon together in the ER. Both Nicole and I wanted her to be put on dialysis immediately. For the last week she’d been experiencing the diarrhea and muscle weakness (to a much lesser degree) which would go away after her regular dialysis treatment. She was due for her next treatment at one o’clock that afternoon. We weren’t sure why it helped (though I strongly suspected a specific cause). But what works, works.
As I suspected, however, “policy” wasn’t willing to put an emergency case on dialysis. Five years ago, Nicole had shown up for dialysis with a low blood sugar and they sent her to ER. They certainly weren’t going to take her in this paralyzed state on the verge of a heart attack. Instead, they drew blood and sent it to the lab for testing.
While we waited, the paralysis become so bad Nicole couldn’t move a muscle. The only thing that gave her relief from a intensifying case or paresthesias (“pin and needles”) was if someone moved her limbs. Jonah manned her left arm, raising and lowering it. I rotated keeping her other arm and legs going.
Interestingly, her oxygen saturation remained steady at 95% despite the fact her respiratory muscles were barely able to move. It confirmed the value of the Buteyko Breathing technique that we had been practicing for the last three years. The body, especially when not in motion, requires very little air.
It must of been about an hour before the lab finished processing the blood. When the doctor saw the results the painful waiting game came to an abrupt end: Hyperkalemia (high potassium levels). Very high.
“Levels higher than 7 mEq/L can lead to significant hemodynamic and neurologic consequences,” writes Dr. Eleanor Lederer on MedScape, “whereas levels exceeding 8.5 mEq/L can cause respiratory paralysis or cardiac arrest and can quickly be fatal.”
Nicole potassium had reached 9.1 mEq/L.
“I’ve never see it so high,” said the ER doc.
Of course, it’s the kidneys job to remove excess potassium via urine. Hence why dialysis had brought relief in past (milder) states of hyperkalemia.
Next post, I’ll sum up how they stabilized Nicole and why her potassium levels broke such a record.
In the trenches with T1D & ESRD,
–John C. A. Manley
P.S. If nothing else, I hope this story motivates those with T1D to do what is necessary to protect the health of their kidneys. You certainly cannot expect the medical system to do so. Check out one of Diabetic Dharma’s most popular posts that takes a look at a press release from the world’s leading provider of dialysis technology: Kidney Disease: Growing Epidemic or Emerging Market?