Case study: Badly Managed Insulin Therapy Leads to Brain Damage
Compensation: £2.1 million
Baby Claire, Liverpool
With the help of JMW, a young girl has been awarded £2.1 million after badly managed insulin therapy led to brain damage.
Claire was born with a congenital heart abnormality in which the left coronary artery originated from the pulmonary artery rather than the aorta - in other words on the wrong side of the heart.
Aftermath of corrective heart surgery
When Claire was nearly one year old she underwent corrective open heart surgery at Royal Liverpool Children's Hospital (RLCH).
After the operation Claire was admitted to ICU in a stable condition. It was decided that it was in her interests to commence glucose/insulin/potassium (GIK) therapy.
Stress-induced hyperglycaemia frequently occurs in critically ill patients, including those undergoing open heart surgery, and can result in increased morbidity and mortality. The aim of GIK therapy is to maintain a normal blood glucose level thereby increasing the chances of recovery. The treatment that requires very close biochemical monitoring as insulin lowers both blood sugar and potassium levels. It is well known that very low or very high potassium levels can lead to cardiac arrhythmias and very low blood sugar levels can result in brain damage.
Claire's potassium levels varied between normal and very low and her blood sugar level was at the lower end of normal. The GIK therapy continued throughout for two days despite Claire’s potassium falling dangerously low. A fast pulse was also noted, which was almost certainly the result of the very low potassium level.
Change in medication and cardiac arrest
On the third day after the operation, Claire appeared to be improving although her heart rate remained fast. The GIK therapy continued and a diuretic was commenced even though the potassium level remained very low. That night Claire’s blood sugar level was exceptionally low so the insulin was reduced and the dextrose increased.
The following day Claire suffered an episode of ventricular fibrillation resulting in a cardiac arrest. She was resuscitated although it is not known how long this process took. Claire’s potassium at this time was very low. As a direct result Claire’s brain was starved of oxygen and this resulted in severe and permanent brain damage.
The case for negligence
JMW Solicitors argued that the management of the GIK therapy in Claire’s case was inadequate and substandard for the following reasons:
- The dose of insulin was excessive.
- The balancing of insulin, dextrose and potassium infusions to maintain near normal (and therefore safe) blood chemistry was not achieved.
- A careful treatment plan to ensure this biochemical balance was achieved was not implemented.
- The persistently low potassium levels were not acted upon.
- Digoxin was administered even though it is well recognised that in the presence of low potassium it can cause ventricular fibrillation and cardiac arrest.
- A diuretic was administered in the presence of already low potassium levels even though it is known to deplete levels even further.
- Claire's blood sugar was allowed to fall to dangerously low levels.
Permanent effects
Claire is now severely brain damaged and although she is now 28 years old she has the developmental age of a 7-year-old. She has frequent epileptic seizures and requires full-time supervision as she cannot tolerate being left alone for more than a few minutes. She has behavioural problems, particularly anxiety and aggression.
Claire must rely on the dedicated care of her mother and father, together with other members of her family, to provide for all of her care needs.
Compensation
The hospital admitted that the care afforded to Claire was negligent. Compensation was awarded in way of payment of a lump sum of £2,150,000 and a periodical payment schedule ranging from £82,500 a year to £132,500 a year for the rest of Claire’s life.
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