@UnaDispatch @apricot24 @LeahHoustonMD @JaimeFNP1 @DrNoNonsense1 @pppforpatients @gayfrose @DocStrange_1 @fpapro1 @amytownsendmd @Rebekah_Bernard @monkeymed1 12 y/o female, with an undiagnosed congenital amino acid disorder, presents to a minute clinic c/o loss of appetite, dehydration, URI and fever 102 in the last week. Mom states she seems more irritable than normal. Pharmacist checks a urine, notes leukocytes(but not the
@UnaDispatch @apricot24 @LeahHoustonMD @JaimeFNP1 @DrNoNonsense1 @pppforpatients @gayfrose @DocStrange_1 @fpapro1 @amytownsendmd @Rebekah_Bernard @monkeymed1 2)epi cells) and that the urine smells "funny". Urine has ketones so patient is advised to drink more fluids and eat more. Mom reiterates she has no appetite, so pharmacist recommends a protein drink. She gets a Rx for Tamiflu(since it is flu season) and is sent home. A day later
@UnaDispatch @apricot24 @LeahHoustonMD @JaimeFNP1 @DrNoNonsense1 @pppforpatients @gayfrose @DocStrange_1 @fpapro1 @amytownsendmd @Rebekah_Bernard @monkeymed1 3)the patient is taken by ambulance to the ED, unresponsive. Foley placed and RN notices urine smells "funny". Tells doc. Doc recognizes it smells sweet, like maple syrup. Gets more history from Mom about the URI and gets a CXR. Pneumonia. Chemistry shows an acidosis. Pt given
@UnaDispatch @apricot24 @LeahHoustonMD @JaimeFNP1 @DrNoNonsense1 @pppforpatients @gayfrose @DocStrange_1 @fpapro1 @amytownsendmd @Rebekah_Bernard @monkeymed1 4)appropriate abx and fluids, Peds intensivist called and patient admitted to PICU. Peds doc immediately recognizes that the maple syrup urine smell is associated with an amino acid disorder and treats patient accordingly. She also understands that the pneumonia sent the patient
@UnaDispatch @apricot24 @LeahHoustonMD @JaimeFNP1 @DrNoNonsense1 @pppforpatients @gayfrose @DocStrange_1 @fpapro1 @amytownsendmd @Rebekah_Bernard @monkeymed1 5)into crisis and the protein drink only worsened the problem. Most physicians will have heard of Maple Syrup Disease in their education. It's distinctive, even if one doesn't recall everything about it, we know what that urine smell means. It's bad. Pharmacist has never heard of
@UnaDispatch @apricot24 @LeahHoustonMD @JaimeFNP1 @DrNoNonsense1 @pppforpatients @gayfrose @DocStrange_1 @fpapro1 @amytownsendmd @Rebekah_Bernard @monkeymed1 6)it. Can't treat what you have never heard of. Can't refer when you don't recognize a symptom that portends a more critical issue. He ignored the "funny" smell of the urine. It meant nothing to him. That's why he has no business writing prescriptions. Can a doctor make the same
@UnaDispatch @apricot24 @LeahHoustonMD @JaimeFNP1 @DrNoNonsense1 @pppforpatients @gayfrose @DocStrange_1 @fpapro1 @amytownsendmd @Rebekah_Bernard @monkeymed1 7)mistake? Yep. But we are held to that standard; hence, our high malpractice premiums. The pharmacist is not held to the same medical standard. Excuse being that he could not be expected to know since he is not a physician. Tell that to the mother.
@UnaDispatch @apricot24 @LeahHoustonMD @JaimeFNP1 @DrNoNonsense1 @pppforpatients @gayfrose @DocStrange_1 @fpapro1 @amytownsendmd @Rebekah_Bernard @monkeymed1 8)This is why medical education is extensive. It should be respected, not demeaned. Everyone cannot practice medicine, despite how easy it looks. Because appearances are deceiving. The right training allows one to see/smell/hear/touch the nuances others may not.
