Confused and sweaty patient on the ward
PLAB 2 practice station
Acute management · 1 min to read · 8 min to perform
Try a real conversation · PLAB 2AI practice
Assess and manage him, and explain what you are doing.
Alan PrenticeI am all right. Just feeling a bit peculiar. Go away and let me rest.
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You are the foundation doctor on an acute medical ward. Mr Alan Prentice, aged 66, has type 1 diabetes and is being treated for cellulitis of his leg. Staff Nurse Fiona Reid asks you to see him urgently because he became shaky, sweaty and confused early this afternoon. Assess and manage him, and explain what you are doing. The nurse is with you and will carry out your requests. The examiner will not take part in the conversation.
What this station tests
- Check capillary glucose in any confused or drowsy patient, especially if on insulin.
- If conscious and able to swallow, give 15 to 20 g fast-acting carbohydrate; recheck at 10 to 15 minutes and repeat if below 4 mmol/L.
- If unable to swallow or unconscious, give intravenous glucose or intramuscular glucagon and call 2222.
- Follow with a longer-acting carbohydrate and look for the cause.
- Review insulin, meal timing and system errors, and report incidents. Do not stop insulin altogether in type 1 diabetes.
Sources for the clinical content
- Joint British Diabetes Societies: The hospital management of hypoglycaemia in adults with diabetes mellitus
- NICE NG17: Type 1 diabetes in adults: diagnosis and management
- Diabetes UK: Hypos (low blood sugar)
- GOV.UK: Diabetes mellitus, assessing fitness to drive
An original practice scenario with invented patients. Not an exam question.