Just the Facts: Diagnosis and treatment of diabetic ketoacidosis in the emergency department

CJEM ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 19-22
Author(s):  
Justin W. Yan ◽  
Tamara Spaic ◽  
Selina Liu

A 21-year-old male with known type 1 diabetes mellitus presented to the emergency department (ED) with two days of vomiting, polyuria, and polydipsia after several days of viral upper respiratory tract infection symptoms. Since his symptom onset, his home capillary blood glucose readings have been higher than usual. On the day of presentation, his glucometer read “high,” and he could not tolerate oral fluids. On examination, his pulse was 110 beats/minute, and his respiratory rate was 24 breaths/minute. He was afebrile, and the remaining vital signs were normal. Other than dry mucous membranes, his cardiopulmonary, abdominal, and neurologic exams were unremarkable. Venous blood gas demonstrated a pH of 7.25 mm Hg, pCO2 of 31 mm Hg, HCO3 of 13 mm Hg, anion gap of 18 mmol/L, and laboratory blood glucose of 40 mmol/L, as well as serum ketones measuring “large.”

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 644-647
Author(s):  
Nicholas J. Connors ◽  
Robert S. Hoffman ◽  
Sophie Gosselin

A 54-year-old woman prepares dinner around 8:00 pm that includes mushrooms that she picked from her yard. The next morning, around 8:00 am, the woman (patient), her daughter, and son-in-law all develop abdominal cramps, violent vomiting, and diarrhea. They present to the emergency department and are admitted for dehydration and intractable vomiting with a presumed diagnosis of food poisoning. Twenty-four hours later, they appear well with stable vital signs and improved symptoms. Four hours later, 36 hours post-ingestion, the patient becomes lethargic. A venous blood gas reveals pH, 7.1; PCO2, 16 mmHg; and her AST was 3140 units/L with an ALT of 4260 units/L and an INR of 3.7.


Author(s):  
M. V. Bidevkina ◽  
M. I. Golubeva ◽  
A. V. Limantsev ◽  
I. N. Razumnaya ◽  
T. N. Potapova ◽  
...  

Sodium lauryl sulfate is the most common surfactant used in the production of detergents, chloroprene rubber, plastics, artificial furs and in pharmaceutical industry. Sodium lauryl sulfate is a moderately hazardous substance when introduced into the stomach (DL50 for white mice and rats is in the range of 2086-2700 mg/kg), has a pronounced local irritant effect on the skin and mucous membranes of the eyes, has a skin-resorptive, sensitizing and pronounced cumulative effects. The threshold for acute inhalation action is set at 15,3 mg/m3 for changes in the function of the nervous system and irritating effects on the mucous membranes of the upper respiratory tract (an increase in the total number of cells in the nasal flushes).Recommended for approval tentative safe exposure level of sodium lauryl sulfate in the air of the working area is 0.2+ mg/m3 (aerosol).


Author(s):  
Larissa May ◽  
Grant Tatro ◽  
Eduard Poltavskiy ◽  
Benjamin Mooso ◽  
Simson Hon ◽  
...  

Abstract Background Acute upper respiratory tract infections are a common cause of Emergency Department (ED) visits and often result in unnecessary antibiotic treatment.  Methods We conducted a randomized clinical trial to evaluate the impact of a rapid, multi-pathogen respiratory panel (RP) test versus usual care (control). Patients were eligible if they were ≥12 months old, had symptoms of upper respiratory infection or influenza like illness, and were not on antibiotics. The primary outcome was antibiotic prescription; secondary outcomes included antiviral prescription, disposition, and length of stay (ClinicalTrials.gov# NCT02957136). Results Of 191 patients enrolled, 93 (49%) received RP testing; 98 (51%) received usual care. Fifty-three (57%) RP and 7 (7%) control patients had a virus detected and reported during the ED visit (p=0.0001). Twenty (22%) RP patients and 33 (34%) usual care patients received antibiotics during the ED visit (-12% [95% CI -25%, 0.4%]; p=0.06/0.08); 9 RP patients received antibiotics despite having a virus detected. The magnitude of antibiotic reduction was greater in children (-19%) versus adults (-9%; post-hoc analysis). There was no difference in antiviral use, length of stay, or disposition. Conclusions Rapid RP testing was associated with a trend towards decreased antibiotic use, suggesting a potential benefit from more rapid viral tests in the ED. Future studies should determine if specific groups are more likely to benefit from testing and evaluate relative cost and effectiveness of broad testing, focused testing, and a combined diagnostic and antimicrobial stewardship approach.


2019 ◽  
Vol 98 (9) ◽  
pp. 1015-1020
Author(s):  
G. G. Gimranova ◽  
Lyaylya M. Masyagutova ◽  
L. G. Gizatullina

Introduction. The working conditions of workers in oil-producing industries do not exclude the negative impact of a harmful biological factor of the working environment. The combined effect of harmful and dangerous factors (noise, vibration, a complex of chemicals of varying intensity), adverse climatic and geographical conditions in the process of oil production lead to violations of the structural and functional state of the body and increase the risk of disease caused by opportunistic microorganisms. Material and methods. To study the effect of working conditions of workers engaged in oil extraction on the qualitative and quantitative composition of the microorganism, an investigation of skin microbiota and microbiocenosis of the upper respiratory tract mucosa was carried out. Using the method of skin prints from the inner surface of the forearm on a plate with blood agar allowed, along with the total number of microorganisms, to determine the presence of hemolytic forms on the surface and in deep layers of the skin of oil workers. Estimate the influence of working conditions on the microbiocenosis of the upper respiratory tract and mucosal anti-infective resistance of the mucous membrane analyzed the species composition of the microbiota of the nasal mucosa and pharynx in workers, directly and indirectly engaged in oil production. Results. Studies show in workers directly involved in oil extraction, the number of microorganisms of the skin is significantly higher than that of healthy people in average by 2.0-3.6 times on the surface and 1.7-3.7 times in the deep layers. For machinists, these differences achieve 2.5-4.0 and 1.2-4.0 times, respectively, and for engineering and technical workers, 1.4-2.3 on the skin surface and 1.2-2.5 in the deep layers. For drillers, drillers’ assistants, operators, the presence of conditionally pathogenic microorganisms of 3-5 or more components on the nasal and pharyngeal polymicrobial associations is typical, and for engineers, engineers and technicians from 2-4, less often 5 components. Conclusion. The impact of occupational factors affecting workers in the process of oil extraction, contributes to the development of microbiocenosis lesions of the skin and mucous membranes. On the surface of the skin and mucous membranes of the upper respiratory tract there are a wide variety and specific structure of the microflora, specific to each of the studied groups in the workers examined.


2011 ◽  
Vol 18 (10) ◽  
pp. 1105-1108 ◽  
Author(s):  
Michael Menchine ◽  
Marc A. Probst ◽  
Chad Agy ◽  
Dianne Bach ◽  
Sanjay Arora

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