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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Hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood, has the potential to progress to a life-threatening illness. Its incidence in North America is increasing. ⋯ This case exemplifies what appears initially as gastroenteritis but, ultimately, becomes the final diagnosis of HUS. A case is presented to provide additional education to ensure the E coli O157:H7 infection is considered in the differential diagnosis of persons who present with bloody diarrhea.
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Unintentional aspiration of medication capsules is a rare event. A case report of a neurologically impaired 23-year-old woman who aspirated a 50-mg nortriptyline capsule is presented. This resulted in progressive respiratory distress necessitating ventilatory support. Bronchoscopy showed severe airway inflammation and edema.
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Cyclic antidepressant (CA) overdose can produce life-threatening seizures, hypotension, and dysrhythmias. It accounts for up to half of all overdose-related adult intensive care unit admissions and is the leading cause of death from drug overdose in patients arriving at the emergency department alive. Several factors contribute to the significant morbidity and mortality associated with CA overdose. ⋯ Finally, and of greatest significance for the clinician, the presenting signs and symptoms of CA overdose may be missed by the physician, even in cases of severe toxicity. Therefore, CAs must be considered early in any case of suspected overdose, and all such cases should be managed as potentially fatal ones. The following case demonstrates the current approach to the patient with significant CA toxicity.
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The overcrowding of emergency departments (EDs) with inpatients results in an increased average inpatient length of stay; therefore, overcrowded hospitals have increased costs per patient. All admissions through the ED to our institution for 1988, 1989, and 1990 were reviewed. These admissions were analyzed based on whether they had spent less than 1 day or more than 1 day in the ED, after they had been admitted to the hospital and were waiting for a bed assignment. ⋯ In 1989, 32% of admissions via the ED remained in the ED for more than 1 day and had a 13% increase in total hospital length of stay. In 1990, 25% of admissions via the ED spent more than 1 day in the ED and had a 10% increase in total hospital length of stay. Inpatients who remained in the ED after admission had a greater average length of stay than those who were promptly transferred to inpatient units.(ABSTRACT TRUNCATED AT 250 WORDS)