Annals of emergency medicine
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An unusual case of intra-articular patellar dislocation is described in which the patella rotated simultaneously in both the horizontal and vertical axes. The dislocation was sustained without apparent trauma. Reduction could not be accomplished in the emergency department. Closed reduction was accomplished successfully under general anesthesia in the operating room.
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To assess the treatment of intentional insulin overdoses with intravenous (IV) glucose, we reviewed the records of 17 attempts in 15 patients seen during a ten-year period. The mean age of our patients was 29 +/- 9 years, and the mean overdose of insulin was 386 +/- 276 units. Eight patients were insulin-dependent diabetics and seven patients had no history of diabetes. ⋯ No patient sustained permanent complications from hypoglycemia. We conclude that prolonged, aggressive IV glucose infusion and serial monitoring of serum glucose levels is required in insulin overdoses. These patients may become hypoglycemic much later than predicted from the conventional duration of action of the various insulin preparations.