Can J Emerg Med
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In the emergency department (ED), the typical manifestation of impaired glucose homeostasis seen in patients with severe bacterial infections is hyperglycemia. Severe hypoglycemia is generally not a presenting feature of sepsis in children in the emergency setting, and thus may lead to delayed diagnosis and management. We present a case of a 14-year-old boy who attended the ED with constitutional symptoms and severe hypoglycemia as the initial presentation of overwhelming meningococcal sepsis and discuss the impairment of glucose homeostasis in patients with sepsis.
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In the medical community there is a widely held belief that epinephrine should not be used with lidocaine when attempting a digital block because it will cause tissue gangrene. This belief is reinforced by several of the more prominent emergency textbooks, but a review of the medical literature fails to reveal a sound basis for this dogma.