Talk:Hadiza Bawa-Garba case

Enalapril

Reading a bit about this case, it seems one significant point of contention is that while it was not specifically documented that enalapril should be withheld, it was not prescribed. The norm in most hospitals including in the UK is that patients should not self-medicate and instead only take medicines provided for them by the hospital (which have been prescribed by the doctors in hospital). If they want a medicine not prescribed, this needs to be discussed with the doctor first. But it seems to be suggested that this was either not the policy in the hospital involved or probably more likely it was but a culture of allowing them anyway had developed.

I presume it is still the norm that when there is a medicine that the patient was on that it's important is withheld, it is important this is properly documented (and emphasised to the patient or family) and this where it's suggested the doctor failed. (Some of the non RS discussion seems to suggest she did somehow document it should be discontinued but I haven't really seen this discussed so I presume it's either a misunderstanding or simply referring to the fact it wasn't prescribed.)

Unfortunately the best sources discussing this I've found have been rapid responses in BMJ. Can anyone find better sources and should there perhaps be a limited mention of this in the article?

There is likewise some limited discussion about the possible role the administration of enalapril may have played given the known effects and timings involved. But it looks like this is something many are understandably reluctant to discuss too much given that it was administered by the patient's mother (although with the approval of a nurse). And the feeling that concentrating on that likewise is missing the point as most critics of the case against the doctor view that systemic problems and a cascade of events lead up the tragic death rather than significant error of one individual (except perhaps the nurse). So probably it's unlikely the later is something which will be well sourced enough to cover in the article.

Once upon a time we would admit patients under protocol prior to starting ACEI which was captopril as it could have a sudden deleterious effect and profound drop in BP.

Nil Einne (talk) 01:16, 11 February 2018 (UTC)

The curious Incident of the Consultant at 1630

I am confused about this case, having read it extensively. Here are the reasons : Perusing the case, Jack seems to have got BETTER. Around 12 noon at X Ray, he was 'laughing' At 1630, he was well improved ' bouncing about'. Around 1800 he was moved out to a ward. Why and by whom? We have to presume he was well.? The Consultant was shown the blood tests at 1630. He did nothing. What should he have done if, as stated, Jack was better? The improvement clearly explains his lack of action, the curious incident, because improvement suggested the treatment was working and further intervention unnecessary. What intervention was needed and when? The experts do not say.If the child was better, what was the error that was so bad that Dr BG was convicted of manslaughter? Jack was on an ACEI. With vomiting and diarrhea, ACEI cause Acute Kidney Injury. V+D is a contraindication to the use of ACEI. Was this not explained to the mother, when this rare drug in childhood was first prescribed to a child ? The blood tests were also in keeping with AKI caused by dehydration and would not therefore be only typical of sepsis, as stated by the expert. The expert states that 1]'the blood tests were so typical of sepsis that ANY competent doctor would recognise it as such'. But, I return to the curious incident, the Consultant did NOT say ' this is sepsis'. It was then stated that Dr BG did not highlight the blood tests to the Consultant. I find this argument beyond absurd. Either it is recognizable or it is not. How can I highlight something I am accused of having missed ? Why would I need to highlight something so typical? Since the Consultant did not recognise these tests for sepsis, the statement 1] is false and the judgement based on this premise is wrong.

If poor Jack was indeed better, then there can be no doubt whatsoever that it was the ACEI given around 1900 that caused the sudden collapse.

If my registrar told me a patient had a lactate of 11 and pH of 7.06 I would go straight to the patient's bedside and I wouldn't need to be asked. I don't hold Dr BG culpable for that at all. — Preceding unsigned comment added by 2A00:23C7:608D:3101:3DAA:3C18:62F8:6C65 (talk) 12:52, 10 January 2023 (UTC)

If poor Jack had got better, then Dr BG has been convicted wrongly because her treatment of fluids and antibiotics was working and no further treatment was needed. Kochay1 (talk) 20:47, 1 June 2018 (UTC)Kochay1 (talk) 20:46, 1 June 2018 (UTC)

If poor Jack was better under Dr BG's care, what is the Manslaughter ? Kochay1 (talk) 20:55, 1 June 2018 (UTC) — Preceding unsigned comment added by Kochay1 (talk • contribs) 07:43, 1 June 2018 (UTC)