The American journal of emergency medicine
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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. ⋯ It was concluded that stress and counter-regulatory hormones released during anaphylaxis, as well as the treatment with epinephrine and glucocorticoids, precipitated DKA in this patient despite ongoing insulin and fluid therapy. Type 1 diabetic patients experiencing anaphylaxis may require prolonged periods of observation and measurement of serial blood glucose and urine ketones.
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The degradation of epinephrine in USP injectable cartridges was investigated under different heating conditions. Epinephrine (EPI) and EPI sulfonic acid (EPI-SA) levels in 1:10,000 (0.1 mg/mL) EPI injectable solutions subjected to either cyclical (65 degrees C for 8 hr/d for 4 to 12 weeks) or constant (65 degrees C for 7 days) heating were determined using high-pressure liquid chromatography with diode array and electrochemical detection. ⋯ In laboratory-prepared solutions, the degradation of EPI and the formation of EPI-SA was found to be dependent on sodium metabisulfite concentration and the duration of cyclical heating. These results indicate that the thermal stability of EPI and the formation of EPI-SA depends on the method of heat exposure and the amount of bisulfite present in the solution.
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An overdose of the beta-blocking agent metoprolol is presented in which the patient remained asymptomatic despite blood levels that were more than 25 times that reported to be the upper limit of therapeutic. This case emphasizes the need to diagnose beta-blocker toxicity on clinical grounds, not on blood levels that correlate poorly with the severity of symptoms. Furthermore, the question is raised as to whether patients are at any subsequent risk for morbidity, if they have not demonstrated signs or symptoms within 4 hours of ingestion.
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This study determined the biological consequence of temperature induced epinephrine degradation. Two different epinephrine preparations (1:1,000 and 1:10,000) were exposed to either cold (5 degrees C) or hot (70 degrees C) temperature. The exposure occurred for 8-hour periods each day in 4-, 8-, and 12-week intervals. ⋯ No change was noted from control in either epinephrine concentration when exposed to cold temperatures. In conclusion, epinephrine (1:10,000) deteriorates in the presence of elevated temperature and should be protected from high temperatures when carried by EMS providers. The degradation products may possess biological activity.
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Comment Letter Case Reports
CPAP as adjunctive treatment of severe pulmonary edema in patients with ESRD.