A Very Basic Failure

[marmar]

from OurFuture.org:



A Very Basic Failure
by Terrance Heath

January 30th, 2008 - 9:32am ET


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Everyone has heard at least one "health care nightmare" story, like the death of 17-year-old Nataline Sarkysian hours after her insurance company approved coverage a liver transplant after repeated denials. Before that, it was the death of Diamonte Driver, for want of an $80 dental procedure. These stories naturally provoke outrage, but what happened to an anonymous 68-year-old man last year is categorized as weird news, even though it's as much about our failed health care system as the familiar "nightmare" stories.

The abstract of the article published in Journal of Emergency Medicine, in December 2007, is about as dry as you might expect a medical journal to be.

A 68-year-old man presented to the Emergency Department with a severe metabolic alkalosis after ingesting large quantities of baking soda to treat his dyspepsia. His underlying pulmonary disease and a progressively worsening mental status necessitated intubation for respiratory failure. Laboratory studies revealed a hyponatremic, hypochloremic, hypokalemic metabolic alkalosis. The patient was successfully treated after cessation of the oral bicarbonate, initiation of intravenous hydration, and correction of electrolyte abnormalities.

Aaron Rowe of Wired Science gave a more colorful summary of the story. Basically, a 68-year-old man slips, falls, and ends up in the emergency room. Upon arrival, he's disheveled, incoherent, and acting strangely. Tests reveal that, while he doesn't have a head injury, the pH of his blood and urine were extremely high. As Rowe puts it, "his body fluids were way too basic."

The man becomes agitated, and emergency room staff give him tranquilizers, but ended up having to intubate him when the medication suppressed his breathing.Their patient stabilized, the medical staff finally learns why he ended up in such bad shape. See if you can spot the reason.

Once their patient was stable, the doctors questioned his niece. She had found several empty boxes of baking soda at his home and explained that her uncle, who lacked health insurance, had been using it to cope with severe indigestion.

With an understanding of what had went wrong, the doctors gave the patient fluids and potassium and potassium, which invigorated his kidneys. Slowly, the problem fixed itself.

You might think that what went wrong was the man's use of baking soda to treat what he thought was indigestion. (According to Rowe, it was stomach pain caused by an ulcer.) You might think that, but you'd be wrong. What went wrong was that this 68-year-old man did not have health insurance, and faced the the same singular option as 47 million Americans without health insurance: making do.

When I read the story, I thought "there but for employer-provided health care go I." I've been in the same position as this guy, including the baking soda remedy. My story didn't end in the emergency room, after suffering for who knows how long with an undiagnosed and untreated condition. .......(more)

The complete piece is at: http://www.ourfuture.org/blog-entry/very-basic-failure