Drop of Ketones in the ER - Carbs in IV drugs

[Guest guest]

As you may remember from one of our previous posts, Logan was 40+,

1.005 in the ER following Phenobarb IV (Luminal) boluses. I believe

we may have found out why.

Upon entering the ER on Saturday, Logan was 160, 1.030. He recieved

two Phenobarb IV boluses (210mg) in 100 ml of normal saline prior to

the 40+, 1.005. The drop in specific gravity was expected because of

the rapid infusion of IV fluids. The drop in ketones was NOT

expected. The following day (Sunday) we were unable to raise his

ketones any higher than 15.

From what we've seen in the past, whenever we saw the ketones so low

for a whole day it was because excess carbohyrates were introduced.

On careful review of diet management, Logan had not either been given

or " got into " any extra carbs. We then started to look elsewhere.

He had only been given Tylenol suppositories and the Phenobarb IV.

The Tylenol has no carb impact. We had our RN friend at the ER look

up the inactive ingredients of the Phenobarb IV (Luminal) solution.

This is what she found:

Drug concentration: 130mg/ml (Logan was given a total dose of 280mg)

Alcohol = 0.1 ml

Glucol = 0.68 ml

Benzyl Alcohol = 0.015 ml