When a patient is dying, there are a number of physiologic derangements that are universally present. Many appear early and worsen (sometimes gradually, sometimes rapidly) until the person's demise. These commonly include low blood pressure, low oxygen saturations, labile heart rates/rhythms, and an altered or depressed mental state. Many, if not all, of these aberrations, are apparent even to the lay person or the junior medical trainee as worrisome. For the most part however, these findings, though very concerning, do not NECESSARILY spell the imminent death of the patient. There is one derangement though, that once it appears is a harbinger of the end: hypoglycemia. It turns out that maintaining physiologic blood sugar - specifically avoiding LOW blood sugar - is an absolutely fundamental condition of life. So much that this function, largely fulfilled by the liver (with some input from the pancreas), is more protected and preserved than even maintenance of blood pressure or blood oxygen levels. So when a patient's blood sugar begins to tank, requiring administration of dextrose to correct, this spells liver failure and is an undeniable tell that the end is nigh. This is often missed by family members or novice clinicians as meaningful because hypoglycemia seems so innocuous when compared to the other concomitant physiologic abnormalities in the critically ill.
...why do I mention this?
Lately, when I listen to people like @NikBhatia, Luke Gromen, Dr. Jeff Ross, @Preston, @MartyBent, to name a few, I get the impression that the silent (as far as MSM is concerned) geopolitical and macroeconomic tremors we are experiencing are America's hypoglycemia moment. These tremors highlight fault lines in the post 1971 USD hegemonic structure. But - just like low blood glucose - to the lay person these events seem like esoteric concerns, easily corrected by a hit of sugar. Bond auction and repo market fragility aren't felt as palpably as inflation, unemployment, or unaffordable housing, but they are nonetheless telling signs of things to come. I'm no economist. But I know a sick patient when I see one. And, as I listen to the people with expertise in this domain, I see some concerning parallels. Just my 2 sats.
