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 white blood cell (WBC) count and neutrophil count are commonly used in clinical decision making. It has been established that parenterally administered beta-adrenergic agents will increase the values of both of these measurements as a result of demargination. The purpose of this study was to evaluate whether the same phenomenon occurs when the beta-adrenergic agent albuterol is administered by inhalation. ⋯ Three patients did not get neutrophil counts recorded. All results are noted as the mean +/- one standard deviation. The WBC count (in 1,000) before (mean, 10.33 +/- 3.48) and after (mean, 10.66 +/- 4.02) albuterol were compared using the two-tailed paired t test.(ABSTRACT TRUNCATED AT 250 WORDS)
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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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The objective of this study was to evaluate the overall impact of serum amylase determinations in the initial management of patients presenting to the pediatric emergency department (ED) with the acute onset of abdominal pain or trauma. All cases of patients younger than 18 years of age who presented to the pediatric ED for whom a serum amylase value was determined during an 18-month period were reviewed. Data were collected retrospectively, including serum amylase concentration, age, gender, presenting complaint, discharge/admission status, diagnosis, and discharge plans or inpatient management to evaluate the impact of serum amylase determinations. ⋯ Of the 12 patients with elevated amylase levels sent for abdominal pain or trauma, only 2 had their clinical management affected by the serum amylase concentration. In both cases, the patient presented with subacute abdominal pain related to significant abdominal trauma that had occurred 2 to 3 weeks earlier. Both patients showed evidence of pancreatic insult with diagnostic imaging studies.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Subarachnoid hemorrhage: atypical presentation associated with rapidly changing cardiac arrhythmias.
Subarachnoid hemorrhage (SAH) typically presents with sudden onset of severe headache and is often associated with cardiac arrhythmias. The case of a patient with SAH in whom typical presenting signs and symptoms were absent is presented. This case was characterized by rapidly changing arrhythmias observed in the prehospital setting. The diversity and rapid evolution of arrhythmias can be attributed to the autonomic and electrolyte imbalances that often accompany SAH.