J Emerg Med
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Mycobacterium tuberculosis (TB) infection remains a serious problem in many underdeveloped countries. TB is largely perceived as a disease affecting the pulmonary system, yet despite declining cases of pulmonary TB in the United States (US), extrapulmonary infections are being reported at an increasing proportion of total TB cases. Moreover, due to the insidious nature of extrapulmonary TB (EPTB), it may not be readily recognized by emergency physicians, as it masquerades as more commonly encountered infectious or inflammatory processes. ⋯ Loss of vision may be a presenting complaint for active tuberculosis infection.
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Intentional insulin glargine overdose is rarely reported in the literature, but usually results in prolonged hypoglycemia requiring intensive care unit admission. ⋯ Prolonged hypoglycemia often occurs after large overdoses of insulin glargine due to a depot effect at the site of injection. Octreotide is a potential adjunctive treatment to dextrose in patients with a functioning pancreas.
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Records of patients discharged from the Emergency Department (ED) who return within 72 h and are admitted are often reviewed for potential quality issues. ⋯ Poor care on the initial visit or any poor outcome upon returning in 72-h return admissions is relatively rare in the ED. Reporting 72-h return admissions without chart review may not be a good way to measure clinical quality.
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Intentional massive sodium chloride ingestions are rare occurrences and are often fatal. ⋯ Emergency physicians should consider rapidly lowering serum sodium with hypotonic intravenous fluids as a potential management strategy for acute severe hypernatremia secondary to massive salt ingestion.