The American journal of emergency medicine
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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.
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This is a report of a 4-year-old Hispanic boy who presented with skin changes to the lips and oral cavity, a generalized rash, edema of hands and feet, and peeling of the periungual areas of the fingers as well as to the groin and perianal areas. Fourteen days earlier, his 19-month-old brother was diagnosed and treated for Kawasaki disease. Upon laboratory investigation, our patient was found to have an elevated sedimentation rate, C-reactive protein, and serum γ-glutamyl transferase. Infectious disease and cardiology consultations subsequently diagnosed and treated our patient for incomplete Kawasaki disease.
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Case Reports
Ischemic stroke presenting as fluctuating focal weakness in an otherwise healthy young man.
A 32-year-old man presented to our emergency department (ED) with no complaints after paramedics responded to a fall. Medics noted left-sided weakness on scene. ⋯ An acute middle cerebral artery ischemic stroke was diagnosed, and tissue plasminogen activator was administered. Despite a fluctuating course of symptoms, our patient ultimately achieved a complete recovery.
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Bee stings are commonly encountered worldwide. Various manifestations after a bee sting have been described. Local reactions are common. ⋯ Rarely, vasculitis, serum sickness, neuritis, and encephalitis have been described, which generally develop days to weeks after a sting. We report a case of a 35-year-old man who developed neurologic deficit 6 hours after a bee sting, which was confirmed to be left parietooccipital infarction on magnetic resonance imaging scan. We report this case due to its rarity.
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Case Reports
Worsening Wenckebach after calcium gluconate injection: not uncommon but frequently missed diagnosis.
The objective of the study is to demonstrate a common etiology of hyperkalemia and illustrate a potential iatrogenic errors in treatment.