Der Anaesthesist
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Patient blood management (PBM) is a multidisciplinary evidence-based treatment model. Aims are to provide treatment of pre-existing or recently occureed deficits in blood volume and of substances that are important for erythropoiesis in patients, as well as the targeted administration of cellular and non-cellular blood products within reasonable and scientifically proven limits. The overall goal is therefore a safe therapy and complication-free course of the disease. PBM follows a strategy based on three pillars, which encompasses the aspects of optimization of anemia and hemoglobin, the handling of bleeding and the use of patient-related resources.
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In Germany it is required by law that basically every type of physician needs to be capable of executing a correct external post-mortem examination of a corpse. In recent years, numerous investigations on external post-mortem examinations repeatedly reported systematic mistakes and erroneous procedures in various clinical and medicolegal case groups. Accordingly, the completion of death certificates is frequently performed incorrectly. As one of the typical unnatural death cases, decedents dying from fatal head trauma (FHT) represent a special autopsy case group, which is expected to be correctly recognized during the primary external post-mortem examination because the external injuries are mostly obvious. ⋯ Despite the fact that FHT should be a cause of death that is comparably easy to identify during external post-mortem examination, more than one third of the cases were not sufficiently recognized. Therefore, special attention must still be paid to certain case constellations during the external post-mortem examination. Typical examples of such cases are burned bodies, cases of advanced putrefaction and falls.
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Case Reports
[Severe SGLT-2 inhibitor-induced euglycemic ketoacidosis-a rare but serious complication].
Ketoacidosis induced by sodium-glucose cotransporter‑2 inhibitors (SGLT-2i) is rare. If it occurs, it is a serious clinical condition which requires immediate and correct treatment. At the moment, the occurrence of a ketoacidotic crisis necessitates permanent removal of the SGLT-2i from the patient's medication. ⋯ The tendency towards the undesirable effects of the medication in stressful situations is impressive. Currently, SGLT-2i are recognized as established oral antidiabetics and are becoming more popular. Clinicians should be aware of and alert to the diagnosis of ketoacidosis with normal blood glucose measurements in diabetic patients showing unspecific symptoms under administration of SGLT-2i.