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.
A case report of emphysematous pyelonephritis secondary to ureteral obstruction in a non-diabetic patient Nicole Suzanne Vetere, James Monti, Deborah Gutman
DOI: http://dx.doi.org/10.1016/j.ajem.2006.02.018
The American Journal of Emergency Medicine , Vol. 24 , Issue 6 ,
Published in issue: October 2006
x A 74-year-old woman was brought to the emergency department after being found by her niece on the floor of her apartment, confused and incontinent of urine and stool. According to her niece, the patient had been complaining of flank pain for several days. The patient's medical history included hypertension; gastric cancer status post resection, radiation, and chemotherapy 3 years prior; and pulmonary embolus. She did not have a history of diabetes mellitus.
Survival after prolonged resuscitation from cardiac arrest due to diabetic ketoacidosis using extracorporeal life support Toru Hifumi, Nobuaki Kiriu, Hiroshi Kato, Junichi Inoue, Yuichi Koido
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.041
The American Journal of Emergency Medicine , Vol. 31 , Issue 5 ,
Published online: March 4 2013
x Management of cardiac arrest due to severe diabetic ketoacidosis (DKA) using bicarbonate therapy and extracorporeal life support (ECLS) remains controversial. We report a case of a 24-year-old man with insulin-dependent type 1 diabetes mellitus who survived without any neurologic complications after prolonged ECLS (including fluid resuscitation and insulin but no aggressive bicarbonate) for cardiac arrest due to severe DKA. In post-DKA cardiac arrest, insulin and fluid resuscitation is the mainstay of treatment, but ECLS should be considered when prolonged cardiac arrest is expected.
Pseudonormoglycemia in diabetic ketoacidosis with elevated triglycerides Mark J. Rumbak, Thomas A. Hughes, Abbas E. Kitabchi
DOI: http://dx.doi.org/10.1016/0735-6757(91)90019-G
The American Journal of Emergency Medicine , Vol. 9 , Issue 1 ,
Published in issue: January 1991
x A 24-year-old newly diagnosed male patient with diabetes presented with diabetic ketoacidosis (DKA) (pH 7.16, HCO3 6.0) and extreme hypertriglyceridemia (239.35 mmol/L). The diagnosis of DKA was delayed because of the apparent depression of the true serum glucose (to 11 mmol/L). He was treated with intravenous (IV) insulin and rehydration, which normalized his pH, HCO3 , and triglyceride levels. To the authors' knowledge, this is both the highest triglyceride level recorded and the first report of a high triglyceride level as the apparent cause of a factitiously low glucose level.
Prognostic determinants of community-acquired bloodstream infection in type 2 diabetic patients in ED Chia-Hung Yo, Meng-Tse Gabriel Lee, Weng-Tein Gi, Shy-Shin Chang, Kuang-Chau Tsai, Shyr-Chyr Chen, Chien-Chang Lee
DOI: http://dx.doi.org/10.1016/j.ajem.2014.08.071
The American Journal of Emergency Medicine , Vol. 32 , Issue 12 ,
Published online: August 29 2014
x The objective of the study is to describe the epidemiology and outcome of community-acquired bloodstream infection (BSI) in type 2 diabetic patients in emergency department (ED).
An unusual presentation of emphysematous cystitis John Weddle, Beth Brunton, David R Rittenhouse
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90170-X
The American Journal of Emergency Medicine , Vol. 16 , Issue 7 ,
Published in issue: November 1998
x Emphysematous cystitis is a rare disorder most commonly seen in women and associated with urinary tract infections and poorly controlled diabetes mellitus. We report the case of a 76-year-old woman who presented with diarrhea and abdominal discomfort, and emphysematous cystitis was revealed on the abdominal X-ray series. This case is unique in that the patient had no evidence of urinary tract infection, diabetes, or recent instrumentation. As the patient was treated for emphysematous cystitis (bladder irrigation and intravenous antibiotics), the diarrhea rapidly resolved and the radiographic abnormalities of the emphysematous cystitis also resolved.
Diabetic ketoacidosis and infection: Leukocyte count and differential as early predictors of serious infection Corey M Slovis, Virginia G.C Mork, Randall J Slovis, Raymond P Bain
DOI: http://dx.doi.org/10.1016/0735-6757(87)90280-4
The American Journal of Emergency Medicine , Vol. 5 , Issue 1 ,
Published in issue: January 1987
x The records of 153 patients who presented to an emergency department with diabetic ketoacidosis were reviewed to determine whether any admission evaluation laboratory data could serve as a predictor of occult or coexisting infection. Ten patients with admission radiographs already demonstrating active infection (pneumonia or tuberculosis) and two patients with wet gangrene of an extremity were not included in subsequent statistical analysis, as their infections were diagnosed on initial evaluation.
Prescriber beware: report of adverse effect of sodium-glucose cotransporter 2 inhibitor use in a patient with contraindication Reginald St Hilaire, Heather Costello
DOI: http://dx.doi.org/10.1016/j.ajem.2014.09.039
The American Journal of Emergency Medicine , Vol. 33 , Issue 4 ,
Published online: October 2 2014
x Diabetic ketoacidosis (DKA) is well recognized as an endocrine emergency. Diabetic ketoacidosis more commonly occurs in patients with type I diabetes secondary to the absence of endogenous insulin and their general predilection toward ketone production. Emergency medicine physicians are well trained in the prompt recognition and initiation of appropriate treatment needed to stop the rapidly progressive cycle of acidosis and dehydration before it becomes fatal. Traditionally, diagnostic criteria include hyperglycemia (>
Rate and prediction of infection in children with diabetic ketoacidosis Robert G. Flood, Vincent W. Chiang
DOI: http://dx.doi.org/10.1053/ajem.2001.24473
The American Journal of Emergency Medicine , Vol. 19 , Issue 4 ,
Published in issue: July 2001
x The purpose of this retrospective cohort study was to determine the rate and prediction of infection in children, ≤ 21 years, with diabetic ketoacidosis (DKA). Over a 6-year period, 247 admissions were identified. There were 171 (69%) with no infection, 44 (17.8%) with presumed viral infection, and 32 (12.9%) with bacterial infection. The mean WBC for all patients was 17,519 ( ± 9,582). 118 (50%) had leukocytosis as defined by a WBC ≥15,000/mm3. WBC, differential, leukocytosis, as well as sex, temperature and new onset diabetes, were not significant predictors (P >.05) of bacterial infection.
Gender differences in reported symptoms for acute myocardial infarction: Impact on prehospital delay time interval Hendrika Meischke, Mary Pat Larsen, Mickey S Eisenberg
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90128-0
The American Journal of Emergency Medicine , Vol. 16 , Issue 4 ,
Published in issue: July 1998
x A retrospective observational study using database registry of consecutive patients admitted to 16 King County hospital Coronary Care Units (CCU) was conducted to assess gender differences in symptom presentation for acute myocardial infarction (AMI) and investigate how symptom presentation relates to prehospital delay time interval from acute symptom onset to emergency department (ED) presentation. Between January 1991 and February 1993, 4,497 patients were admitted to the CCUs with diagnosed AMI.
Survival after prolonged resuscitation from cardiac arrest in a case of severe diabetic ketoacidosis Huei-Tsair Chen, Jiann-Ruey Ong, Shih-Wen Hung, Li-Wei Lin, Chee-Fah Chong
DOI: http://dx.doi.org/10.1016/j.ajem.2006.01.011
The American Journal of Emergency Medicine , Vol. 24 , Issue 5 ,
Published in issue: September 2006
x The use of bicarbonate in the management of diabetic ketoacidosis (DKA) remains controversial. Previous studies have shown that the use of bicarbonate in patients with severe DKA is not associated with better outcomes [1-3]. However, the use of bicarbonate therapy in patients with complicated DKA has not been addressed adequately, and the dogmatic use of bicarbonate continues in such cases [4].
