An inquest has revealed that no evidence exists to show that staff at St Vincent’s University Hospital in Dublin followed a protocol in the care of an elderly man who died shortly after his glucose levels reached a dangerously low level. John Byrne (73) died on September 4, 2022, after being admitted to the hospital for treatment of heart failure. A cardiologist who treated Mr. Byrne admitted that inadequate monitoring may have contributed to his death.
An inquest has revealed no evidence that staff at St Vincent’s University Hospital in Dublin followed a protocol in the care of an elderly man who died shortly after his glucose levels reached a dangerously low level. John Byrne (73), a married father-of-three from Glencar Lawn, Ballybrack, Co Dublin , died on September 4, 2022, in St Vincent’s where he had been admitted over three weeks earlier for treatment for heart failure.
Matthew Barrett, a cardiologist at SVUH, who was responsible for Mr. Byrne’s care for part of his hospital stay, admitted that he retrospectively believed the patient may have developed dangerously low glucose levels as a result of 'inadequate monitoring.' The consultant told an inquest into Mr. Byrne’s death at Dublin District Coroner’s Court on Wednesday that he also thought the failure to conduct blood tests on the patient over two days – September 1-2, 2022 – may have facilitated a deterioration in the patient’s condition. Mr. Byrne, who had a complex medical history, had been admitted to SVUH on August 11, 2022, with acute decompensated heart failure and transferred to the hospital’s intensive care unit on August 21, 2022, where he remained for 10 days. Although his condition had improved, he was discharged to an infectious diseases ward after testing positive for Covid-19. The inquest heard the patient was given an insulin dextrose infusion after his potassium levels were recorded at 6.3 millimoles per litre on September 3, 2024, when normal levels are considered 3.6-5.2mmol/L. His glucose levels at the time were normal. Dr. Barrett – who is the partner of former Taoiseach, Leo Varadkar – said a high potassium level would cause concern about an imminent risk of cardiac arrythmia (an irregular heartbeat) and death. However, the cardiologist said he was satisfied that the treatment with the infusion was working and the situation did not require escalation but potassium levels should still be checked at 6-12 hour intervals. Further tests showed that while Mr. Byrne’s potassium levels began to stabilise, his glucose levels started to drop sharply. From a review of the medical notes in the case, Dr. Barrett said he had not anticipated that it would happen and it was the first time that he had experienced it with a patient, although it was not medically unknown. In reply to questions from the coroner, Aisling Gannon, the consultant said he believed hypoglycaemia (low glucose levels) was more likely to have been a contributory factor in the patient’s death than the high potassium levels. However, he said the priority had been given to tackling the patient’s high potassium levels. Dr. Barrett said low glucose levels were a recognised cause of cardiac arrythmia if left untreated. The inquest heard Mr. Byrne’s glucose levels went from 5.6mmol/L at 8.35pm on September 3, 2022, to 3.3mmol/L at 11.55pm later that evening and had fallen to 1.5mmol/L by 1.48am the next morning. Normal levels in healthy individuals are 4.0-5.4mmol/L. Mr. Byrne was found unresponsive at 6.04am on September 4, 2022, and was formally pronounced dead about 30 minutes later. Dr. Barrett said he understood that St Vincent’s had a protocol whereby patients with high potassium levels were also monitored for their glucose levels through blood tests taken by nursing staff. The consultant said the protocol recommended that blood tests were taken after 15, 30, 60 minutes and thereafter after four and 12 hours following an insulin dextrose infusion. However, he accepted that there was no evidence that such monitoring had been carried out in relation to Mr. Byrne. Dr. Barrett said the patient could have been treated simply with a drink and a biscuit at the time his glucose level was at 3.3mmol/L. He also stated he would have anticipated that doctors would have been alerted to medically review Mr. Byrne after his glucose levels had fallen to 1.5mmol/L. Cross-examined by counsel for the deceased’s family, Esther Earley BL, Dr. Barrett said he understood a review following Mr. Byrne’s death had found nothing wrong with the existing protocol but it had recommended greater education to staff about the management of high potassium levels and associated monitoring of glucose levels. At the conclusion of the inquest, Ms. Gannon recorded a narrative verdict based on the evidence as it most appropriately reflected the complexity of the case which included the impact of the patient being infected with Covid-19. The coroner said it was not appropriate to consider alternative verdicts such as death due to natural causes or misadventure. Ms. Gannon recorded the cause of death as presumed cardiac arrythmia and presumed hypoglycaemia as well as a number of heart conditions.
Health Inquest Hospital Death Protocol Hypoglycaemia Potassium Dublin St Vincent's University Hospital
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