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Fatal insulin dose to trauma patient with incorrect medical ID bracelet
irresistable
verityrising wrote in little_details
Alrighty, modern setting in Georgia. Using my google-fu and my RN sister, I know how much insulin can kill someone.

If a patient has been admitted to the ER suffering extreme trauma (beating, stabbed, blood loss), and has a medical ID bracelet that falsely identifies him as a diabetic, is it possible that the hospital staff would immediately or in the very near future treat this person with insulin in a dosage large enough to be fatal?

The deal is that the bad guy killed my protag's husband, and I would like for him to die as a result or her slipping her husband's medical ID bracelet on him before he is admitted to the hospital, thus resulting in him being administered some sort of medication that kills him. I was thinking of having him high on heroin or Oxycontin and looking at possible drug interactions, but my sister suggested diabetes as a possibility because obviously insulin can be fatal. Any help is most greatly appreciated. :)

Don't count me as gospel on this because I am by no means an expert - and as such am happy to be corrected - but the first thing Doctors do - Even in an ER - is to check the patients records. They may be allergic to the medication your about to give them for example.

Chances are they'd check the records and find out that your character isn't diabetic. However, I'm not sure. The medical ID bracelet might be enough to throw them, even having checked the records.

Thanks for the reply. I was going for maybe his only ID would be from the bracelet, but as others have pointed out, they would still probably check his insulin first. Oh shwell. Thanks again. :)

I don't think those medic alert bracelets are easy to slip on or off.

I don't think the hospital would give him insulin without checking his blood glucose first anyway. This can be done easily and quickly.

Do you want your protagonist to get into trouble? 'Cause I can imagine an injured, shocky person person easy dying of insulin shock (if insulin were administered), but there'd be an investigation after they realized the bracelet wasn't his, and your protagonist would be the prime suspect.

OK, there are also MedicAlert necklaces, which can't be hard to take off/put on, so I guess the bracelets may be easy to put on, too.

The rest of my comment still stands, though.

Yeah, I was gonna do whatever type of ID thingy would be easiest to get on and off, but I definitely think the insulin is a no-go. It was just the first thing that popped into my sister's head.

And the woman has killed a metric shit-ton of people up to this point, so the ID thing is just the icing on the murder cake. I'm enamored with the idea, but it seems like it's going to be hard to get to work logistically.

Thanks!

They wouldn't administer it without checking blood glucose, and even if it were high (if he's not diabetic, they shouldn't be), most likely wouldn't administer it unless they knew what type(s) of insulin the person used, when it was last given, and for the short term type, not until the patient was being fed (unless the blood glucose was high). If they kept testing glucose levels -- and they should -- they would probably figure out he's not actually diabetic. Hospitals are fairly anal about checking records/info beyond just the ID bracelet, because they get sued enough as it is for poor procedures.

ETA: A lot of bracelets are also "registered" with a company, meaning they either have a patient's name, or have a number where you call to get the patient's name/records, so it would be linked to her husband (and her) by association.

Edited at 2009-10-07 11:17 pm (UTC)

Yes, all this.

I am pretty sure the MedicAlert brand specifically has a registration. The hospital can call, give the information on the tag/bracelet, and get further information that the patient has put up for use. This would include name/etc.

I'm sorry, OP, but I think this idea is full of holes. :-\

Thanks to both of you. I was grasping for an easy solution, but seems like it's a big no. Oh well. :)

A lot of diabetic admissions to hospital are because of hypoglycaemia, not hyperglycaemia, so I can't imagine them giving someone insulin without running a blood sugar test first.

No. As others have said, the staff would check a blood sugar or barring that, the glucose on lab work drawn first before giving insulin. Insulin CAN be fatal but in the instance of a person being in the hospital and dying from an insulin injection without having a blood sugar drawn is rare.

Your protag could have already drawn up some of her husband's insulin and injected him prior to medics getting there. But just putting a medic alert band on wouldn't do it, a diabetic med alert bracelet would actually make the checking of blood sugar more likely. Plus, the medics would have to have been pretty far away for the insulin to be fatal depending on the dose because one of the first things THEY do is check a blood sugar and could treat the low blood sugar caused by the insulin.






Edited at 2009-10-07 11:33 pm (UTC)

Yep, definitely not going to work. Thanks for the info!

The details on the bracelet are usually kept on a database these days, and one of the first things they'll do in the ER is to call through and confirm the details of the patient. I'd be surprised if someone didn't notice that the patient details are for a female, and the patient is a male. But a possible chance to harm him could be via drug allergy. If your main character's bracelet has her listed as having no allergies, and she knows the bad guy has an allergy to morphine, putting her bracelet around his wrist could be dangerous. I can see them possibly administering pain relief before confirming medical details with the database, if there's already one source of information saying he's not allergic to morphine.

Well, she was going to use her husband's ID bracelet, so at least the gender would match, but looks like they would definitely check the insulin first. The morphine idea is very intriguing. I'm just trying to find anything that would kill this guy off because he is wearing an incorrect bracelet. Thank you kindly!

Even if they don't check the records or the blood glucose levels (and they should but in near fatal trauma time is usually pressing so minor things like diabetes may take a back seat) they are unlikely to administer insulin until after they have stabilised and had time to check up on the diabetes. Unless they have reason to suspect that his blood glucose is high (and I think in severe trauma you are more likely to have low blood glucose or at least similar symptoms to it)


Even if the insulin idea doesn't work, the wrong ID can cause death by drug allergy or drug interaction. If his (wrong) medical ID doesn't say anything about that pesky sulfa drug allergy or the fact that he's on an MAOI because other anti-depressants didn't work so well for him, the results could get bleak for your bad guy pretty fast.

Try asking your sister about fatal drug interactions, she might have some good ideas for you.

There is no way a properly functioning ER would administer insulin in a fatal dose. As stated above, they would treat the trauma first.

But at some point in the game someone would run a blood sample through the lab. If his glucose numbers are good they are not going to pop him with insulin. They will monitor it and wait for the sugar levels to start climbing. Only then will they shoot him up.

Since the bracelet is fake, his sugar levels will never climb so the order for the insulin will never be given.

Just to add that extreme trauma CAN make a non-diabetic's person have high blood sugar levels. I've seen it happen in the ICU on multiple occasions. But we check blood sugar on every seriously injured trauma patient pretty regularly and would never given even a known diabetic insulin unless the sugar level was high. EMS often checks a sugar in the ambulance.