[bezoar (OP)]

This is a question for the doc:
I review medical records for lawyers and am currently looking at a chart of a prisoner who died while incarcerated.  The prison physician claims he had no indication that the prisoner was diabetic, yet he died of diabetic ketoacidosis.  He was admitted to the hospital with a blood sugar of 781, and in renal failure.  Also had hepatitis B and C.  According to the prison authorities, he was simply found unconscious in his cell one morning, with no previous attempts to be seen in sick call by the doctor.  The hospital record notes that he was septic, but blood and urine cultures were negative.  Can't find a sputum culture, but the PE says his chest was clear.  He lived a few hours in the hospital before he expired.  I note in the record that during the time he became ill, the prisoners were on a hunger strike.

My questions:

Could the combination of his illnesses cause the ketoacidosis to develop that rapidly?

Can you be septic and still have negative blood, urine, and sputum cultures?

Could the hepatitis have compromised his immune system to cause a rapid development of sepsis?

Why, with a blood sugar of 781 did he only have trace ketones in his urine?

What effect does starvation have on a diabetic and their glucose levels -- especiallly in combination with the cirrhosis from hepatitis?

By the way, this is a prisoner who got 20 years for armed robbery.  (I think that's something you guys don't ever have to worry about in the UK.)  His family is suing the state for wrongful death.  Ah, the American way.


Bezoar

[chris]

Sorry, I've not had the chance to look at this yet, I've been too busy. I'll take a look when I get a minute.

Chris

"I never forget a face, but in your case I'll make an exception"
 - Groucho Marx

[bezoar (OP)]

Thanks Chris.  Don't mean to overload you, but I've never run across a diabetic that didn't eat.  Usually, I get them the other way around where they eat too much of the wrong stuff -- usually around Christmas and Thanksgiving.  The ER would fill up with them.  Appreciate your help.

Bezoar