Interaction of the diabetes mellitus and cardiac diseases on survival outcomes in out-of-hospital cardiac arrest Dayea Beatrice Jang, Sang Do Shin, Young Sun Ro, Kyoung Jun Song, Ki Ok Ahn, Seung Sik Hwang, Young Taek Kim, Sung Ok Hong, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.076
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 29 2015
x Diabetes mellitus (DM) and cardiac disease (CD) both likely effect out-of-hospital cardiac arrest (OHCA) survival, but the effect of their relationship on survival outcomes is unclear. This study aims to investigate whether the association of DM and OHCA outcomes differ in patients with and without CD.
Possible association between Takotsubo cardiomyopathy, sepsis, and diabetes mellitus: a still open question Fabio Fabbian, Alfredo De Giorgi, Ruana Tiseo, Benedetta Boari, Raffaella Salmi, Fulvia Signani, Beatrice Zucchi, Roberto Manfredini
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.042
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 23 2015
x We appreciated the comments by Dr Madias [1], raising some interesting key points. On one hand, we quite agree that emotional and physical stressors are not strictly separated entities and, in most cases, may overlap as triggering factors of Takotsubo cardiomyopathy (TTC). However, this definition is widely used [2,3]. The association between diabetes mellitus (DM) and TTC has been matter of several investigations. Pelliccia et al [3], evaluating a series of 19 studies (1109 patients), after a contact with corresponding authors, asked to provide additional quantitative details, concluded that patients with TTC have a relevant prevalence of cardiovascular risk factors and associated comorbidities.
Trends in diabetes-related visits to US EDs from 1997 to 2007 Michael D. Menchine, Warren Wiechmann, Anne L. Peters, Sanjay Arora
DOI: http://dx.doi.org/10.1016/j.ajem.2011.02.028
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x The aims of the study were to describe temporal trends in the number, proportion, and per capita use of diabetes-related emergency department (ED) visits and to examine any racial/ethnic disparity in ED use for diabetes-related reasons.
Comparison of coronary calcification of the culprit lesion between diabetic and non-diabetic patients with acute coronary syndrome Dimitrios Barmperis, Konstantina Bouki, Thomas Apostolou, Athanasios Chalkias, Theodoros Xanthos
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.057
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: February 10 2014
x The risk of myocardial infarction or death in diabetic patients is similar to that of patients with a history of heart attack with coronary artery calcification being an independent predictor of mortality [1,2]. Optical coherence tomography (OCT) is one of the most precise tools in the description of the morphology of the culprit lesion, allowing for the in vivo characterization of the atherosclerotic plaques [3,4]. The purpose of this study was to compare the calcification of the culprit lesion between diabetic and non-diabetic patients who present with acute coronary syndrome (ACS).
Using a single cut-off for stress hyperglycemia in myocardial infarction decreases its prognostic value particularly in diabetes Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.027
The American Journal of Emergency Medicine , Vol. 32 , Issue 1 ,
Published online: November 11 2013
x High admission blood glycemia (ABG), that is, stress hyperglycemia (SH), is an important prognostic indicator in a variety of diseases, including acute myocardial infarction (AMI) [1]. Although this has been known for decades [2], there is, to date, no universal consensus about ABG concentration(s) required for SH in AMI patients [1,3-5]. Indeed, it is intrinsically difficult to define SH in patients with diabetes mellitus (DM) because basal glycemia is not known and could vary significantly in this patient population [6].
Clopidogrel resistance in diabetic patient with acute myocardial infarction due to stent thrombosis Matej Samoš, Radoslava Šimonová, Frantisek Kovář, Lukas Duraj, Jana Fedorová, Peter Galajda, Jan Staško, Marian Fedor, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2014.01.006
The American Journal of Emergency Medicine , Vol. 32 , Issue 5 ,
Published online: January 21 2014
x Stent thrombosis is a morbid complication after percutaneous coronary intervention. Dual antiplatelet therapy significantly reduces stent thrombosis risk and forms currently the basis in acute ST elevation myocardial infarction pharmacologic treatment. The introduction of clopidogrel has made a major advance in the acute coronary syndrome treatment. However, there is growing evidence about failure in antiplatelet response after clopidogrel, which may lead to subsequent risk of future thrombotic events.
Prevalence of diabetes mellitus in patients with sepsis-triggered Takotsubo syndrome John E. Madias
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.041
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 23 2015
x The article by Fabbian et al [1] published on line ahead of print on June 18, 2015 in the journal about the concurrence of infections/sepsis and Takotsubo syndrome (TTS) is of interest from the pathogenetic point of view, that a physical stress like sepsis can trigger TTS, and that male patients afflicted with this combinations have worse in-hospital mortality than do their female counterpart. It is conceivable that we are in error when we think that we can separate physical and emotional stresses, and it is possible to consider an emotional overlay over the physical stress of sepsis, as a trigger of TTS.
Subject Index
DOI: http://dx.doi.org/10.1016/S0735-6757(15)00997-3
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published in issue: December 2015
Positive predictive value of an elevated cardiac troponin for type I myocardial infarction in ED patients based on the chief complaint Ronald Maag, Susie Sun, Michael Hannon, Rhian Davies, Peter Alagona, Andrew Foy
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.003
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: February 10 2015
x Cardiac troponin testing is used to aid the diagnosis of myocardial infarction (MI) in the emergency department (ED) for patients who present with a range of symptoms. From a clinical perspective, the distinction between MI due to acute coronary artery thrombosis (type I MI) and other forms of direct and secondary myocardial injury (type II MI) is very important. However, the positive predictive value (PPV) of an elevated troponin for diagnosing type I MI, based on clinical history, has not been described.
Coronary atherosclerosis and adverse outcomes in patients with recent-onset atrial fibrillation and troponin rise Alberto Conti, Elena Angeli, Margherita Scorpiniti, Andrea Alesi, Federica Trausi, Delia Lazzeretti, Luigi Padeletti, Gian Franco Gensini
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.013
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 16 2015
x The relationship between troponin and atrial fibrillation (AF) without acute coronary syndrome is still unclear. We sought to investigate the presence of coronary atherosclerosis and adverse outcomes in patients with AF.
The impact of body mass index on patient survival after therapeutic hypothermia after resuscitation Khadijah Breathett, Nishaki Mehta, Vedat Yildiz, Erik Abel, Ruchika Husa
DOI: http://dx.doi.org/10.1016/j.ajem.2015.12.077
The American Journal of Emergency Medicine , Vol. 34 , Issue 4 ,
Published online: December 29 2015
x Therapeutic hypothermia improves survival in patients after cardiac arrest, yet the impact of body mass index (BMI) on survival is lesser known. We hypothesized that nonobese patients would have greater survival post–therapeutic hypothermia than obese patients.
Validation of the use of B-type natriuretic peptide point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the ED Zhixin Wu, Mingming Zhao, Mingfeng He, Hongke Zeng, Feng Tan, Kuangyi Li, Shenglong Chen, Qianpeng Han, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.01.013
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: January 16 2015
x The aim of the study is to validate of the use of plasma B-type natriuretic peptide (BNP) point-of-care test platform in preliminary recognition of cardioembolic stroke patients in the emergency department (ED).
Various admission glucose cut-offs for prognostication and for therapeutic threshold in acute myocardial infarction Goran P. Koracevic
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 1 ,
Published online: October 2 2014
x Glycemia is a crucial laboratory parameter; and from a “therapeutic” point of view, it is essential to avoid/correct both hypoglycemia and hyperglycemia, particularly if they are pronounced. This also holds true for patients with acute myocardial infarction (AMI). Indeed, in addition to general principles, one of the reasons why correction of high/low glycemia is important in AMI comes from precise investigations of prognostic impact of dysglycemia in this diasease.
Catamenial diabetic ketoacidosis—a diagnostic dilemma in ED Nayer Jamshed, Bharatraj Banavaliker, Praveen Aggarwal
DOI: http://dx.doi.org/10.1016/j.ajem.2012.08.038
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: October 29 2012
x Diabetic ketoacidosis (DKA) is a frequent medical emergency. The most common precipitating events are absolute or relative deficiency of insulin, infection, and noncompliance with medication. We describe a 32-year-old lady with type 1 diabetes mellitus in whom DKA was precipitated 1 to 2 days before her menstrual periods resulting in repeated admissions to hospital. Menstruation may precipitate DKA. Emergency physicians must keep this in mind if no other precipitating event can be found in a patient with DKA.
Diabetic ketoacidosis as the initial presentation of hyperthyroidism Chao-Yen Huang, Wei-Lung Chen
DOI: http://dx.doi.org/10.1016/j.ajem.2015.07.065
The American Journal of Emergency Medicine , Vol. 33 , Issue 10 ,
Published online: July 29 2015
x Abdominal pain is a common chief complaint that encompasses a broad differential diagnosis at emergency department (ED), ranging from general discomfort to life-threatening disease. Abdominal pain induced by a metabolic disorder should also be considered. Diabetic ketoacidosis (DKA) is a common complication of new-onset type 1 diabetes mellitus in young patients. Although DKA that presented to the ED with complaint of abdominal pain is not uncommon, it is precipitated by hyperthyroidism, which is rare and more complicated.
Serum procalcitonin level for the prediction of severity in women with acute pyelonephritis in the ED: value of procalcitonin in acute pyelonephritis Jeong Ho Park, Jung Hee Wee, Seung Pill Choi, Kyu Nam Park
DOI: http://dx.doi.org/10.1016/j.ajem.2013.04.012
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: May 22 2013
x Predicting medical outcomes for acute pyelonephritis (APN) in women is difficult. Delay in diagnosis and treatment often results in rapid progression to circulatory collapse, multiple-organ failure, and death. The aim of this study was to investigate the value of procalcitonin (PCT) level in women with APN at ED.
The pregnant heart: cardiac emergencies during pregnancy Alyson J. McGregor, Rebecca Barron, Karen Rosene-Montella
DOI: http://dx.doi.org/10.1016/j.ajem.2015.02.046
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: March 6 2015
x Cardiovascular emergencies in pregnant patients are often considered a rare event; however, heart disease as a cause of maternal mortality is steadily increasing.
Transient ischemic attack (TIA): the initial diagnostic and therapeutic dilemma Peter D. Panagos
DOI: http://dx.doi.org/10.1016/j.ajem.2011.03.004
The American Journal of Emergency Medicine , Vol. 30 , Issue 5 ,
Published online: May 13 2011
x Many patients with transient ischemic attacks (TIA) are at high risk of stroke within the first few days of onset of symptoms. Emergency physicians and primary care physicians need to assess these patients quickly and initiate appropriate secondary stroke prevention strategies. Recent refinements in diagnostic imaging have produced valuable insight into risk stratification of patients with TIA. Clinical data regarding urgent initiation of antiplatelet therapy specifically in this patient population with non-cardioembolic TIA are limited but promising.
Thoracic spine fracture in the course of severe nocturnal hypoglycemia in young patients with type 1 diabetes mellitus—the role of low bone mineral density Liliana Majkowska, Ewa Waliłko, Piotr Molęda, Andrzej Bohatyrewicz
DOI: http://dx.doi.org/10.1016/j.ajem.2013.12.055
The American Journal of Emergency Medicine , Vol. 32 , Issue 7 ,
Published online: January 6 2014
x Thus far, only a few spine fracture cases related to severe nocturnal hypoglycemia in type 1 diabetes patients have been reported. Due to the relatively young age of these subjects, osteoporosis was not taken into consideration and bone mineral density was not assessed.
A risk stratification model of acute pyelonephritis to indicate hospital admission from the ED Changwoo Kang, Kyuseok Kim, Soo Hoon Lee, Chanjong Park, Joonghee Kim, Jae Hyuk Lee, You Hwan Jo, Joong Eui Rhee, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2013.03.048
The American Journal of Emergency Medicine , Vol. 31 , Issue 7 ,
Published online: April 29 2013
x There are no guidelines regarding the hospitalization of female patients with acute pyelonephritis (APN); therefore, we performed a retrospective analysis to construct a clinical prediction model for hospital admission.
Cardiac risk factors and risk scores vs cardiac computed tomography angiography: a prospective cohort study for triage of ED patients with acute chest pain Ethan J. Halpern, Jacob P. Deutsch, Maria M. Hannaway, Adrian T. Estepa, Anand S. Kenia, Kenneth J. Neuburger, David C. Levin
DOI: http://dx.doi.org/10.1016/j.ajem.2013.08.001
The American Journal of Emergency Medicine , Vol. 31 , Issue 10 ,
Published online: September 12 2013
x The objective of the study is to evaluate cardiac risk factors and risk scores for prediction of coronary artery disease (CAD) and adverse outcomes in an emergency department (ED) population judged to be at low to intermediate risk for acute coronary syndrome.
Identifying patients with cellulitis who are likely to require inpatient admission after a stay in an ED observation unit Kathryn A. Volz, Louisa Canham, Emily Kaplan, Leon D. Sanchez, Nathan I. Shapiro, Shamai A. Grossman
DOI: http://dx.doi.org/10.1016/j.ajem.2012.09.005
The American Journal of Emergency Medicine , Vol. 31 , Issue 2 ,
Published online: November 19 2012
x Emergency department observation units (EDOU) are often used for patients with cellulitis to provide intravenous antibiotics followed by a transition to an oral regimen for discharge. Because institutional regulations typically limit EDOU stays to 24 hours, patients lacking a clinical response within this period will often be subsequently admitted to the hospital for further treatment.
Is there a potential role for echocardiography in adult patients with CAP? Birdal Yıldırım, Funda Sungur Biteker, Özcan Başaran, Ömer Doğan Alataş, Ethem Acar, Hamdi Sözen, Volkan Doğan, Halil Beydilli, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2015.06.036
The American Journal of Emergency Medicine , Vol. 33 , Issue 11 ,
Published online: June 18 2015
x The role of echocardiography in adult patients with community-acquired pneumonia (CAP) has not been tested in a clinical trial. The aim of the study was to assess the cardiac changes secondary to CAP by echocardiography and to find out the correlation between echocardiographic findings and the severity of CAP.
Resource utilization and health care charges associated with the most frequent ED users Cory Ondler, G.G. Hegde, Jestin N. Carlson
DOI: http://dx.doi.org/10.1016/j.ajem.2014.07.013
The American Journal of Emergency Medicine , Vol. 32 , Issue 10 ,
Published online: July 29 2014
x Emergency department (ED) visits have continued to rise, and frequent ED users account for up to 8% of all ED visits. Reducing visits by frequent ED users may be one way to help reduce health care costs. We hypothesize that frequent users have unique ED utilization patterns resulting in differences in health care charges.
Association of blood glucose at admission with outcomes in patients treated with therapeutic hypothermia after cardiac arrest Soo Hyun Kim, Seung Pill Choi, Kyu Nam Park, Seung Joon Lee, Kyung Won Lee, Tae O. Jeong, Chun Song Youn, for the Korean Hypothermia Network Investigators
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.004
The American Journal of Emergency Medicine , Vol. 32 , Issue 8 ,
Published online: May 12 2014
x It is well known that hyperglycemia is associated with poor outcomes in critically ill patients. We investigated the association between blood glucose level at admission and the outcomes of patients treated with therapeutic hypothermia (TH) after cardiac arrest.
Are there symptom differences in patients with coronary artery disease presenting to the ED ultimately diagnosed with or without ACS? Michele M. Pelter, Barbara Riegel, Sharon McKinley, Debra K. Moser, Lynn V. Doering, Hendrika Meischke, Patricia Davidson, Heather Baker, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.03.002
The American Journal of Emergency Medicine , Vol. 30 , Issue 9 ,
Published online: May 25 2012
x Symptoms are compared among patients with coronary artery disease (CAD) admitted to the emergency department with or without acute coronary syndrome (ACS). Sex and age are also assessed.
Diabetic ketoacidosis in toddler with a diaper rash Mark D. Williams, Don Sallee, Matthew Robinson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.01.018
The American Journal of Emergency Medicine , Vol. 26 , Issue 7 ,
Published in issue: September 2008
x The term diabetes does not denote a single disease entity but rather a clinical syndrome. Fundamental to all types of diabetes is impairment of insulin secretion by the pancreatic beta cells. Diabetes is divided into (1) diabetes associated with certain syndromes or conditions, (2) gestational diabetes, (3) non–insulin-dependent diabetes or type 2 diabetes, and (4) insulin-dependent diabetes (IDDM) or type 1 diabetes. The impairment of insulin secretion seen in diabetes is due to progressive loss of pancreatic beta-cell function secondary to an autoimmune-mediated process.
Gas gangrene, diabetes, and cholecystitis Gabriel Mayer, Rodney Kang
DOI: http://dx.doi.org/10.1016/0735-6757(85)90011-7
The American Journal of Emergency Medicine , Vol. 3 , Issue 1 ,
Published in issue: January 1985
Diabetic ketoacidosis with alkalemia David Jerrard, Jeahan Hanna
DOI: http://dx.doi.org/10.1053/ajem.2001.27167
The American Journal of Emergency Medicine , Vol. 19 , Issue 6 ,
Published in issue: October 2001
x —A common complication of diabetes mellitus is ketoacidosis which results from the accumulation of acetoacetic and B-Hydroxybutyric acids. A less often seen and recognized metabolic alteration is diabetic ketoacidosis with alkalemia This disorder is a mixed acid-base disorder in which diabetic ketoacidosis exists alongside a state of metabolic alkalosis. Blood pH will be determined by which disorder predominates. Diuretic use, vomiting, alkali ingestion, and hypercortisolism have all been implicated as causes of this disorder.
Role of autonomic disturbances in the development of accidental hypothermia in diabetic patients : Aibiki M, Ogura S, Shirakawa Y, Uefufi T, Honda K, Yokono A, Yokono S, Oguli K. Jpn J Acute Med 1987;11:1935–1939
DOI: http://dx.doi.org/10.1016/0735-6757(88)90168-4
The American Journal of Emergency Medicine , Vol. 6 , Issue 4 ,
Published in issue: July 1988
Diabetic mastopathy Zara Cooper, Mary Pat McKay
DOI: http://dx.doi.org/10.1016/j.ajem.2004.07.007
The American Journal of Emergency Medicine , Vol. 22 , Issue 6 ,
Published in issue: October 2004
Bedside ultrasound for the detection of diabetic myonecrosis Arun Nagdev, Michael Murphy, Craig Sisson
DOI: http://dx.doi.org/10.1016/j.ajem.2008.02.017
The American Journal of Emergency Medicine , Vol. 26 , Issue 8 ,
Published in issue: October 2008
x Diabetic myonecrosis is an uncommon complication of diabetes mellitus. There are fewer than 50 cases reported in the general medical literature. Patients classically complain of the abrupt onset of diffuse anterior thigh pain with no signs of overlying infection or signs of systemic toxicity. Because of the difficulty in diagnosis, most patients endure multiple medical visits until appropriate imaging modalities are obtained. Currently, magnetic resonance imaging (MRI) or tissue biopsy is considered the gold standard for diagnosis.
Presentation and symptom predictors of coronary heart disease in patients with and without diabetes Marjorie Funk, Janice B. Naum, Kerry A. Milner, Deborah Chyun
DOI: http://dx.doi.org/10.1053/ajem.2001.27135
The American Journal of Emergency Medicine , Vol. 19 , Issue 6 ,
Published in issue: October 2001
x The aims of this prospective, observational study were to compare: (1) symptom presentation of coronary heart disease (CHD) between patients with and without diabetes and (2) symptom predictors of CHD in patients with and without diabetes. We directly observed 528 patients with symptoms suggestive of CHD as they presented to the ED of a 900-bed cardiac referral center in the northeastern United States. There were no significant differences in symptom presentation of CHD between patients with and without diabetes, although patients with diabetes were slightly more likely to present with shortness of breath (P =.056).
Potassium status should be evaluated also when diabetic ketoacidosis is complicated by heart failure Oscar M.P. Jolobe
DOI: http://dx.doi.org/10.1016/j.ajem.2011.05.004
The American Journal of Emergency Medicine , Vol. 29 , Issue 8 ,
Published online: June 13 2011
x The prevalence of hypokalemia quoted in the recent study [1] may not necessarily be a reflection of the state of affairs when diabetic ketoacidosis (DKA) coexists with hypervolemia attributable to heart failure. Documentation of potassium status in all body compartments is relevant to the management of these patients because unlike their hypovolemic counterparts who can tolerate the large volumes of intravenous fluids required to deliver appropriate doses of potassium replacement therapy [2], patients with DKA with coexisting heart failure and, hence, hypervolaemia incur the risk of worsening of heart failure with such treatment.
Cerebral edema in an adult patient with diabetic ketoacidosis Katherine M. Hiller, Stephen J. Wolf
DOI: http://dx.doi.org/10.1016/j.ajem.2005.02.009
The American Journal of Emergency Medicine , Vol. 23 , Issue 3 ,
Published in issue: May 2005
x A 31-year-old man without prior medical history presented to the emergency department with 2 days of nausea, vomiting, dyspnea, and abdominal pain. The patient was in moderate respiratory distress with Kussmaul's breathing. He was tachycardic but was not febrile, hypotensive, or hypoxemic. Physical examination was unremarkable except for evidence of dehydration and the abnormal breathing pattern. He was alert and oriented with a normal neurological examination.
Simultaneous presentation of thyroid storm and diabetic ketoacidosis Hsin-Ling Lee, Eugene Yu, How-Ran Guo
DOI: http://dx.doi.org/10.1053/ajem.2001.28043
The American Journal of Emergency Medicine , Vol. 19 , Issue 7 ,
Published in issue: November 2001
x —Thyroid storm and diabetic ketoacidosis (DKA) are both endocrine emergencies. The combination of diabetes mellitus (DM) with thyrotoxicosis is well known, and one condition usually precedes the other1,2 but the coexistence of DKA and thyrotoxic crisis is rare.3,4 We report a case of thyroid storm in a woman, previously diagnosed with hyperthyroidism, who also presented with DKA.
Anaphylaxis-induced diabetic ketoacidosis Gregory Greenbaum, John D. Riley
DOI: http://dx.doi.org/10.1016/0735-6757(94)90152-X
The American Journal of Emergency Medicine , Vol. 12 , Issue 3 ,
Published in issue: May 1994
x Allergic reactions and complications of diabetes mellitus are commonly seen in emergency departments and primary care settings. Although stress is a known contributor to the development of diabetic ketoacidosis (DKA), anaphylaxis-induced DKA has not previously been described. The case of a type 1 diabetic woman who presented with anaphylaxis secondary to seafood ingestion and subsequently developed DKA is reported. It was concluded that stress and counter-regulatory hormones released during anaphylaxis, as well as the treatment with epinephrine and glucocorticolds, precipitated DKA in this patient despite ongoing insulin and fluid therapy.
Effects of diabetes on the ED presentation of acute intermittent porphyria Huan-Wen Chen, Deng-Huang Su, Tzuu-Shuh Jou, Jia-Horng Kao
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.003
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x Whether diabetes could prevent attacks of acute intermittent porphyria (AIP) remains incompletely understood. Lithner described 16 AIP patients who had complete remission of AIP attacks after onset of diabetes [1]; however, a correlation between blood glucose level and frequency/severity of AIP attacks was not mentioned. Can AIP be excluded in a diabetic patient who visits ED for severe abdominal pain? AIP is a very rare hereditary metabolic disorder in Taiwan; herein, we reported a patient who had diabetes antedated AIP.
Venoarterial extracorporeal membrane oxygenation resuscitation in diabetic ketoacidosis with hypothermic cardiocirculatory instability Lin Ming-hsien, Ko Wen-Je, Shih Shyang-rong, Wang Chih-hsien
DOI: http://dx.doi.org/10.1016/j.ajem.2010.11.003
The American Journal of Emergency Medicine , Vol. 30 , Issue 1 ,
Published online: December 27 2010
x Diabetic ketoacidosis with hypothermia is underrecognized, and the mortality rate is high at between 30% and 60%. The cause of hypothermia in diabetic ketoacidosis patients is speculative and has multiple factors. Insulin deficit is the most important factor that leads to a lack of substrate for cellular heat production [4]. Water depletion and low environment temperature may also be contributing factors, especially in patients with a severe diabetic coma. Hypothermia may also aggravate uncontrolled diabetes mellitus and complicate treatment because insulin secretion is impaired and exogenous administered insulin is less effective at low temperatures.
Takotsubo cardiomyopathy associated with sepsis in type 2 diabetes mellitusSawako Ohigashi-Suzuki, Yasushi Saito, Ichiro Tatsuno
DOI: http://dx.doi.org/10.1016/j.ajem.2006.11.003
The American Journal of Emergency Medicine , Vol. 25 , Issue 2 ,
Published in issue: February 2007
x Takotsubo cardiomyopathy (TC)—ampullar cardiomyopathy—is a novel cardiac syndrome that has acute onset of chest pain, electrocardiographic change, and minimal elevation of cardiac enzymes resembling acute myocardial infarction without any evidence of myocardial ischemia or injury. Its characteristic image in angiography is a transient left ventricular (LV) apical ballooning having the appearance of takotsubo , Japanese for octopus trap [1-3]. We report here a rare case of a 69-year-old woman with type 2 diabetes mellitus (DM) who exhibited myocardial depression with the typical wall motion abnormality seen in TC during a period of sepsis.
Focal neurological deficits with delayed resolution in a seven-year-old boy with insulin-dependent diabetes Paul J. Allegretti, Meta Carroll
DOI: http://dx.doi.org/10.1053/ajem.2002.35507
The American Journal of Emergency Medicine , Vol. 20 , Issue 6 ,
Published in issue: October 2002
x —A 7 year old boy with diabetes mellitus presented to the emergency department (ED) after he arose from bed in the morning and fell. His parents tried to help him, but he could not stand on his own. His right side appeared weak. The boy's mother said he was feeling normal the night before. His finger stick glucose had been running “high” the past 2 days for which extra insulin had been administered. His blood sugar was down to 179 mg/dL before going to bed. The fire department obtained a rapid glucose of 77mg/dL.
Managing combined critical hypothermia, diabetic ketoacidosis and cocaine intoxication noninvasively Miriam Freundt, Adel Obaji, John K. Hix
DOI: http://dx.doi.org/10.1016/j.ajem.2013.10.042
The American Journal of Emergency Medicine , Vol. 32 , Issue 4 ,
Published online: November 4 2013
x Severe hypothermia with a core temperature below 28°C is critical especially in patients with diabetic ketoacidosis (DKA) and carries a high risk of mortality. Our case of a 52-year-old woman presenting with DKA, pH of 6.9, potassium of 7.6 mEq/L, and body temperature of 26°C demonstrates that conservative management can be safe and successful. We used an established cardiac arrest rewarming phase protocol modified to active warming with the Meditherm 3 Machine and the facility-used rigorous DKA protocol to successfully and safely achieve rewarming without hemodialysis or extracorporeal maneuvers.
Spurious laboratory values in diabetic ketoacidosis and hyperlipidemia Elizabeth S. Kaminska, Ghassem Pourmotabbed
DOI: http://dx.doi.org/10.1016/0735-6757(93)90066-K
The American Journal of Emergency Medicine , Vol. 11 , Issue 1 ,
Published in issue: January 1993
Serum glucose changes after administration of 50% dextrose solution: Pre- and in-hospital calculations Paul M. Adler
DOI: http://dx.doi.org/10.1016/S0735-6757(86)80004-3
The American Journal of Emergency Medicine , Vol. 4 , Issue 6 ,
Published in issue: November 1986
x A prospective clinical trial was conducted to estimate the rise in serum glucose level after an intravenous bolus of 50 ml of 50% dextrose solution (D-50) in the emergency department setting. Fifty one subjects with altered levels of consciousness were studied. Of these, 23 patients were known diabetics, and 28 were not diabetic. The change in glucose level for the total study group ranged from a low of 37 mg/dl to a high of 370 mg/dl, with a mean of 166 ± 77 mg/dl. The mean for the diabetic and non-diabetic groups were 177 ± 80 mg/dl and 154 ± 75 mg/dl.
Hyperglycemia in ED patients with no history of diabetes Louise A. Prince, Elliot Rodriquez, James Campagna, Lawrence Brown, Daisy Fischer, William D. Grant
DOI: http://dx.doi.org/10.1016/j.ajem.2007.08.009
The American Journal of Emergency Medicine , Vol. 26 , Issue 5 ,
Published in issue: June 2008
x The purpose of this study was to determine the prevalence of incidentally discovered hyperglycemia in patients with non–glucose-related complaints and to consider the potential care implications.
Acute hematemesis confusing the diagnosis of diabetic ketoacidosis in an infant Samar K. Bhowmick, Sean L. Murphy
DOI: http://dx.doi.org/10.1016/0735-6757(89)90192-7
The American Journal of Emergency Medicine , Vol. 7 , Issue 3 ,
Published in issue: May 1989
Primary gas-containing mediastinal abscess in a diabetic patient Tze-Yu Lee, Sheung-Fat Ko, Yu-Fan Cheng, Yung-Liang Wang, Wen-Yen Chien
DOI: http://dx.doi.org/10.1016/0735-6757(95)90131-0
The American Journal of Emergency Medicine , Vol. 13 , Issue 4 ,
Published in issue: July 1995
x A case of primary gas-containing mediastinal abscess is reported. Mediastinal widening was seen on the chest radiograph of a diabetic patient who presented with nonspecific symptoms of shortness of breath and abdominal pain of 3 days' duration. The diagnosis of primary gas-containing mediastinal abscess was established by the characteristic findings of computed tomography and exclusion of all the etiological possibilities. The patient was treated by closed chest tube drainage and antibiotic therapy with an uneventful outcome.
Seizures in a diabetic patient on monoamine oxidase inhibitors M Albareda, C Udina, A Escartín, R Corcoy
DOI: http://dx.doi.org/10.1016/S0735-6757(99)90035-9
The American Journal of Emergency Medicine , Vol. 17 , Issue 1 ,
Published in issue: January 1999
Poor glycemic control in diabetic patients seeking care in the ED Gary Josephsen, Robert Rusnak
DOI: http://dx.doi.org/10.1016/j.ajem.2006.02.019
The American Journal of Emergency Medicine , Vol. 24 , Issue 6 ,
Published in issue: October 2006
x We hypothesized that diabetic patients in the emergency department (ED) have poorer glycemic control than patients seeking care at primary care clinics. A convenience sample of hemoglobin A1c (HbA1c) values was gathered retrospectively from the ED, Endocrinology, and Family Medicine Clinics. Results were divided into controlled, poorly controlled, and extremely poorly controlled. The only differing pattern of patients (*P < .01) was in the extremely poorly controlled group consisting of 36% of the ED patients (confidence interval [CI], 29.23-42.69; n = 74) vs 18% of the Endocrinology patients (CI, 13.76-22.53; n = 56) and 19% of the Family Medicine patients (CI, 15.98-22.75; n = 105).
Bilateral emphysematous pyelonephritis Terrance P McHugh, Suzanne E Albanna, Nathaniel J Stewart
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90038-9
The American Journal of Emergency Medicine , Vol. 16 , Issue 2 ,
Published in issue: March 1998
x In any diabetic patient being diagnosed or treated for pyelonephritis, it is important to exclude the diagnosis of emphysematous pyelonephritis, which carries a high mortality rate. The authors present an illustrative case of emphysematous pyelonephritis treated with antibiotics and emergency nephrectomy. The signs, symptoms, pathophysiology, diagnosis, and treatment of emphysematous pyelonephritis are discussed.
