UK - Nurse Lucy Letby Faces 22 Charges - 7 Murder/15 Attempted Murder of Babies #11

[marynnu]

Interesting that they say vials of insulin over the year without giving the ones which if guilty would have contained the insulin used in the crimes. Knowing it has a short shelf life one might presume the effects would be measurably different if it was past it’s best. say for instance if two Were ordered in a week wouldn’t that be a red flag? Would be useful to the prosecution I think.


I was thinking that. If that was a fresh vial it would presumably contain just under 10 ml of insulin. Are we sure a neonates dosage of insulin would be in mls not as magicarp said measured in hundredths of a ml?

It would be in 10ths of a ml.

 

[Sweeper2000]

It would be in 10ths of a ml.

I really should have realised that lol. I’m really curious as to what you could expect if a baby did receive a dose that is grossly over a amount that seems to be treatable if administered incorrectly.

so if a baby was given one tenth of one ml accidentally presumably you could treat that error easily and without dire consequences but what happens if you gave them 2 ml or 5 or even ten? I would have guessed severe consequences perhaps not even being treatable.

 

[Tortoise]

I really should have realised that lol. I’m really curious as to what you could expect if a baby did receive a dose that is grossly over a amount that seems to be treatable if administered incorrectly.

It's in Prof Hindmarsh's evidence for baby F

 

[WaxLyrical]

As with everything (it seems) in this case, context is key. For example, you could have had 4 babies in 2015 requiring insulin, all born fairly close together, and they might all have been treated with the same vial. Equally, you could have 5 babies, whose births are all spaced apart, and given the shelf life might have required doses from a new vial each time.

I would think the prosecution will have looked at how many vials would have been reasonably expected depending on which babies required it and when. I very much doubt records are kept of wasted and/or emptied vials, so it probably makes little difference either way. Nothing to stop someone taking 9ml out of a 10ml bottle which is about to be thrown away. JMO.

 

[Sweeper2000]

Right so prof Hindmarsh thinks it’s an insulin called “act rapid” that was used in the tpn bag.

“Prof Hindmarsh concluded that a commonly used synthetic human insulin known as Actrapid – a colourless solution – was administered via the infusion.”

and was 17 times the therapeutic dose.

“He also calculated from a subsequent blood sample, which showed an “extremely” high level of insulin, that the rate it was delivered was 17 times greater than a small “appropriately therapeutic” dose given to Child F in the days that followed his birth.”

Lucy Letby: Baby’s heart rate soared after receiving insulin, murder trial told

A BABY’S heart rate soared and his blood sugar level dropped dangerously low after he received fluids contaminated with insulin, the murder trial…

www.chesterstandard.co.uk

 

[MsBetsy]

Regardless of what they specifically thought, they clearly suspected that she had something to do with harming patients, whether or not intentionally, so moved her to test their theory. That's unconscionable, quite honestly - it's equivalent to running a dangerous medical trial without telling people they are being experimented on!

If you suspect that someone may be harming patients then you address the potential problem - by at the very least having them chaperoned hut preferably removed from the front line - until you know what you're dealing with.

I don't think they moved her to test a theory. I can't imagine any hospital administrator allowing that. A few doctors may have been suspicious but without proof it would be impossible to know if she was killing babies.

A few doctors noticed a connection between Letby and the life threatening collapses and deaths. I don't recall any testimony about conducting an experiment to see if babies ended up murdered on the day shift.

If anything, they may have spoken to her about her work performance. They were probably concerned for her welfare since she had so many patients suffer serious collapses or die suddenly in a short period of time. She was the only nurse this was happening to so it wouldn't be unusual to address these issues, imo.

 

[notsure]

I don't think they moved her to test a theory. I can't imagine any hospital administrator allowing that. A few doctors may have been suspicious but without proof it would be impossible to know if she was killing babies.

A few doctors noticed a connection between Letby and the life threatening collapses and deaths. I don't recall any testimony about conducting an experiment to see if babies ended up murdered on the day shift.

If anything, they may have spoken to her about her work performance. They were probably concerned for her welfare since she had so many patients suffer serious collapses or die suddenly in a short period of time. She was the only nurse this was happening to so it wouldn't be unusual to address these issues, i...

 

[marynnu]

I really should have realised that lol. I’m really curious as to what you could expect if a baby did receive a dose that is grossly over a amount that seems to be treatable if administered incorrectly.

so if a baby was given one tenth of one ml accidentally presumably you could treat that error easily and without dire consequences but what happens if you gave them 2 ml or 5 or even ten? I would have guessed severe consequences perhaps not even being treatable.

Too much won't be given accidentally. The amount is calculated in mls on a computer program and checked & mixed with saline by 2 nurses. It's then given as an infusion. Everyone involved knows you add no more than 1ml to 50mls saline.

 

[Sweeper2000]

Human Soluble Insulin (Actrapid) is a pancreatic hormone involved in the regulation of blood glucose concentration.
Indications for use
 Control of high blood glucose levels (as defined in the Hyperglycaemia on NNU UHL Neonatal Guideline C26/2006).

 Control of hyperkalaemia (glucose-insulin infusion).

 100 units in 1 ml human soluble insulin

 Vial contains 10 ml =1000 units insulin

seems it only comes in 10 mls as posted before.

https://secure.library.leicestershospitals.nhs.uk/PAGL/Shared%20Documents/Insulin%20Use%20on%20NNU%20UHL%20Neonatal%20Guideline.pdf

 

[Sweeper2000]

One might think a empty vial of insulin would be noticed as highly suspect. It wouldn’t just be LL keeping an eye on the stuff presumably. It’s also the case that if insulin was taken from a vial about to be disposed of that insulin would have to be used fairly close to the time of disposal or end of shelf life.

 

[marynnu]

One might think a empty vial of insulin would be noticed as highly suspect. It wouldn’t just be LL keeping an eye on the stuff presumably. It’s also the case that if insulin was taken from a vial about to be disposed of that insulin would have to be used fairly close to the time of disposal or end of shelf life.

In my opinion nobody would really notice if a vial went missing, or had a few mls removed.

 

[MsBetsy]

Too much won't be given accidentally. The amount is calculated in mls on a computer program and checked & mixed with saline by 2 nurses. It's then given as an infusion. Everyone involved knows you add no more than 1ml to 50mls saline.

That would explain why Letby agreed that it would not have been done accidentally.

In Baby E's case only Letby signed for the medication. Does that mean there wasn't another nurse there to check that it was prepared properly?

 

[Sweeper2000]

In my opinion nobody would really notice if a vial went missing, or had a few mls removed.

I can totally see how a few mls wouldn’t be missed but a whole vial? I might have thought if you came across the fridge being empty of insulin or an empty vial that might raise questions? I would have thought if it’s protocol to keep it stored ready for use it would be replenished upon disposal? Thereby you could trace who ordered it.

 

[magikarpmagikarp]

In my opinion nobody would really notice if a vial went missing, or had a few mls removed.

In my opinion, agreed. Stuff spills, or it's drawn up but accidentally contaminated (from an aseptic standpoint, like your hand brushes the syringe - not from an "other substances" standpoint), so it's discarded and drawn up again. Doctor orders something, it gets prepared, and then the order is canceled, so the drug is discarded and not given. Someone pulls a vial of something non-controlled, uses a partial volume, and then forgets it in their pocket because they get interrupted and are so darn busy. Three days later it surfaces in the laundry and they just throw it away because it's useless now. The idea that nurses should be tracking stock of everything - no one has time for that on top of actual patient care.

 

[katydid23]

Are you able to speculate as to why the number of vials ordered in one year was much higher than preceding or later years? It would appear that the prosecution are implying that it is of relevance to their case. Although I can't see how it is unless they were ordered by LL.

I don't think it matters who ordered the insulin. I think the relevant point is that they seemingly used much more insulin than previous years.

 

[katydid23]

Sometimes, you can accidentally take more insulin than you need, which can result in an overdose. This can be very serious, and may lead to severe hypos. The worst cases can make you feel disorientated, cause you to have seizures and could even lead to death.

If you think you’ve taken too much insulin accidentally - or the wrong type of insulin- then make sure you closely monitor your blood sugar levels, as you could be at risk of hypos for several hours, depending on what type of insulin you have taken and the dose.

Insulin overdose (accidental)

What to do if you’ve taken too much insulin Sometimes, you can accidentally take more insulin than you need, which can result in an overdose. This can be very serious, and may lead to severe hypos. The worst cases can make you feel disorientated, cause you to have seizures and could even lead to...

www.diabetes.org.uk

I think if it’s the case that a dose of insulin that grossly exceeded the recommended dose ie less than a ml you would see more severe consequences even with treatment. I’m not sure if it would lead to permanent damage either but would assume so. do we know enough to assume it wasn’t much over what the recommended original dose was?

There was no recommended dosage in the cases we are considering here. It was used, allegedly' as a poison and not as a beneficial treatment.

 

[Amp_C]

Regardless of what they specifically thought, they clearly suspected that she had something to do with harming patients, whether or not intentionally, so moved her to test their theory. That's unconscionable, quite honestly - it's equivalent to running a dangerous medical trial without telling people they are being experimented on!

If you suspect that someone may be harming patients then you address the potential problem - by at the very least having them chaperoned hut preferably removed from the front line - until you know what you're dealing with.

We'd be better off finding out if "the consultants" were all Dr. Ravi Jayaram. I heard he was the first to see the "correlation" between her and the events. He was also the one that left the needle in baby H's chest before the cardiac arrest they've accused Lucy of inducing.

 

[Amp_C]

There was no recommended dosage in the cases we are considering here. It was used, allegedly' as a poison and not as a beneficial treatment.

The doctors have stated that insulin wasn't prescribed for any of the babies in the ward (although one of them, I forget which, was given a shot of insulin at birth) but they haven't shown the baby's prescriptions as evidence to back it up. One would assume it would be something they'd keep a record of, but I could be wrong.
The fact that the blood sugars were relatively stable, though too low, could suggest a clerical error. They were expecting the blood sugars to rise with the dextrose solutions. The fact they remained in the 2 -3 range was distressing the doctors, however, it didn't drop below the birth reading. I.e. it wasn't really a poisonous dose.

 

[Amp_C]

I don't think it matters who ordered the insulin. I think the relevant point is that they seemingly used much more insulin than previous years.

This is a good point. It should be investigated why they used more insulin that year. It wouldn't make a lot of sense, given the babies seemed to mostly have LOW blood sugar. Unless they were worried about accidentally giving them diabetes, and wanted it at hand...

 

[katydid23]

The doctors have stated that insulin wasn't prescribed for any of the babies in the ward (although one of them, I forget which, was given a shot of insulin at birth) but they haven't shown the baby's prescriptions as evidence to back it up. One would assume it would be something they'd keep a record of, but I could be wrong.
The fact that the blood sugars were relatively stable, though too low, could suggest a clerical error. They were expecting the blood sugars to rise with the dextrose solutions. The fact they remained in the 2 -3 range was distressing the doctors, however, it didn't drop below the birth reading. I.e. it wasn't really a poisonous dose.

Not sure I can agree that it wasn't a poisonous dosage. Here is one example which was:

Blood samples taken from Child F returned an "extremely high" insulin level of 4,657 and a very low C-peptide level of less than 169, indicating synthetic insulin was in his system.
Expert Dr Dewi Evans, who was asked to review the case by Cheshire Police, said there was "only one explanation" for the "astonishing" blood readings.
"These were very, very striking results. There's only one explanation for this. [Child F] had received insulin from some outside source," he said.

Dr Sandie Bohin, who reviewed Dr Evans' findings, was asked whether she agreed that "this was a case of insulin poisoning via [feed bag]".
"Yes," she told the court.

Dr Evans said he had concluded the drug had most likely been added to the baby's nutrient bag, which is used to intravenously provide feeds to infants.
He explained insulin was a "very dangerous drug" that could cause a sharp drop in glucose levels.
If left untreated, that could "lead to seizures, coma or death", he told the jury.


The court has previously heard that Child F's glucose levels remained low on the day shift of 5 August even after a a second intravenous line and nutrient bag had been fitted.
They rose to safe levels later that evening after the nutrients were stopped and extra sugar was given independently.
He went on to make a full recovery and was later discharged.

Lucy Letby trial: Astonishing level of insulin found in baby, jury told

Lucy Letby is accused of trying to murder a premature twin boy by intentionally giving him insulin.

www.bbc.com

So in the case of baby F, this was considered a poisoning, according to the medical expert's testimony.