A Felixstowe schoolboy who went to A&E twice before his death was suffering from complications due to diabetes, an inquest has heard.
Regan Smith was 11 when he died at King’s College Hospital in London, on January 31 last year.
Those gathered at Suffolk Coroners' Court heard that, in the ten days prior to his death, Regan had been suffering from a sore throat, and his parents were concerned about his strange and laboured breathing.
The inquest heard that Regan was suffering from diabetic ketoacidosis (DKA) which is when a when a lack of insulin causes harmful substances called ketones to build up in the blood.
The condition is known to be life-threatening and requires urgent treatment in hospital.
However, the court heard from several clinicians who treated Regan in the days leading up to his death, who said that he did not present as they would expect a patient suffering from DKA.
On Monday, January 23, Regan’s father had taken him to A&E at Ipswich Hospital, where it was thought he may have laryngitis.
The following day, Regan was diagnosed with laryngitis by nurse practitioner Clare Bramhill at the Howard House surgery.
The inquest heard that despite having subsequently spent many “hours” poring over her notes with the surgery’s doctors, Ms Bramhill said there was nothing to raise alarm bells about Regan’s blood sugar levels.
On January 25, Regan’s parents called for an ambulance as his breathing had changed rapidly.
The call was responded to by paramedics Joseph Piper, James Gillingham and John Best. Mr Gillingham told the court that he noted that Regan was pale and that his breathing was increased.
The paramedics carried out several tests, including a finger prick test. This showed that Regan’s blood glucose levels were high, at 12.5 millimoles per litre. His heart rate was also elevated.
Regan was taken to Ipswich Hospital and was seen by Julia Day-Stewart, who was the junior paediatric sister who received the handover for Regan’s care.
She described the handover she received from Mr Piper as “muddled”. She initially queried whether Regan had been brought in with anxiety before this was clarified.
It was also noted that the handover document incorrectly described Regan’s blood glucose level as “normal”.
Regan spent the next four and a half hours in the emergency department before being discharged. He was observed and the ‘sepsis six’ pathway was followed after his heart rate was found to be elevated, but a further glucose test was not carried out as his symptoms did not lead clinicians to take this action.
With hindsight, Dr Uday Muniratnam said that, had he been aware of Regan’s high glucose reading, he would have repeated the test and carried out tests for ketones.
If ketones had been found, he said Regan would have been admitted to hospital “straight away”.
The next day, Regan collapsed at home, and was once more conveyed by ambulance to Ipswich Hospital.
This time, he was quickly identified as being acidotic, with his blood sugar levels now at 19 millimoles per litre. The court heard that a normal reading would be between four and seven.
The inquest is expected to conclude on Tuesday, when evidence will be heard relating to Regan’s transfer to Addenbrookes Hospital, and then to King’s College Hospital.
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