Iatrogenic Neglect -
 
Condition resulting from deprivation of oxygen (hypoxia) long enough to cause apparent harm results most commonly from a drop in blood pressure or interference with blood flow to the  brain. This can occur due to inadequate circulation or perfusion, impaired respiratory effort, or inadequate ventilation.
Acute respiratory distress syndrome , including Sleep apnea. can be signs of chemical or physiological interference with respiration. Asphyxia is caused by a severe lack of oxygen to the body. If the lack of oxygen is prolonged or if no medical action is taken to combat the deficiency, then unconsciousness and death will occur.
 
Condition called cerebral hypoxia or cerebral ischemia  is  the direct result of oxygen deprivation to the brain cells.
 
If  proper balance is not restored, the heart and lungs may fail and the brain will literally begin to suffocate. After several minutes of total oxygen deprivation, the brain may not be able to recover any meaningful function. The autonomic system controlling the heart and lungs fails next, leading to the ultimate cause of all human death – oxygen deprivation of the brain cells.
A CT scan is useful only in pretty severe cases, such as trauma, and also during the few days after an anoxic (lack of oxygen) brain injury. It’s useful in an emergency-room setting. But if the question is ischemic injury [brain damage caused by lack of blood/oxygen to part of the brain] you want an MRI and PET. For subsequent evaluation of brain injury, the CT is pretty useless unless there has been a massive stroke.”
Why did Dr. McLellan  list the Cause of death as "natural causes " (metastatic cancer), and not the true cause, which was brain damage from oxygen deprivation and Dehydration? I find this bizarre. Is it Dr. McLellan's belief that Arlene Berry  ceased to be a human being after becoming obtunded? Or is it his way of exonerating Arlene's executioners?
 

diabetic ketoacidosis and the hyperglycemic hyperosmolar state

 

Cerebral edema in diabetic ketoacidosis and cardiac complications of iatrogenic hypokalemia.

 

Iatrogenic hypokalaemia is a major and avoidable cause of death in diabetic ketoacidosis.

 

DIABETIC KETOACIDOSIS

 

Hyperglycemic Crises in Patients With Diabetes Mellitus ...

 

ACID/BASE AND ELECTROLYTES

 

Vasogenic edema

1. Hypoxia induced damage of the blood brain barrier (BBB): Acidosis and dehydration decrease CNS perfusion and induce hypoxia which in turn damages the blood brain barrier. On the background of a damaged less restrictive blood brain barrier, as soon as rehydration is begun and the plasma osmolality falls, there occurs movement of water from the lower osmolal plasma to the higher osmolal interstitial fluid of the brain, thus increasing intracranial pressure. Compare with drug- induced BBB breach.

2. A bolus of saline during initial therapy increases the hydrostatic pressure in the capillaries and forces water out into the interstitium more rapidly.

Cytotoxic edema

1. The formation of osmolytes within the brain cell: During the period of prolonged hyperglycemia prior to the institution of treatment for diabetes or DKA, the plasma and interstitial osmolality rise. The osmolality within the cells is kept up by the formation of osmolytes (formerly called idiogenic osmoles), which are now known to be molecules such as taurine and myoinositol(17). When intravenous fluid therapy is started, even normal saline is hypotonic compared to the plasma osmolality of the patient. Thus, the plasma osmolality is suddenly lowered, whereas due to slow movement of osmolytes intracellular osmolality remains high, forcing water from the low osmolal region (plasma) into the high osmolal region (the astrocyte).

 

Insulin deficiency is the main underlying abnormality. Associated with elevated levels of counterregulatory hormones, insulin deficiency can trigger hepatic glucose production and reduced glucose uptake, resulting in hyperglycemia, and can also stimulate lipolysis and ketogenesis, resulting in ketoacidosis. Both hyperglycemia and hyperketonemia will induce osmotic diuresis, which leads to dehydration. Clinical diagnosis is based on the finding of dehydration along with high capillary glucose levels with or without ketones in the urine or plasma. The diagnosis is confirmed by the blood pH, serum bicarbonate level and serum osmolality. Treatment consists of adequate correction of the dehydration, hyperglycemia, ketoacidosis and electrolyte deficits.