Harefuah
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Opioids are considered a cornerstone in the treatment of cancer and non-cancer pain. The World Health Organization considers a country's morphine consumption to be an important indicator of the quality of pain control. There is little or no use of opioids in nearly half of the countries in the world. ⋯ During the 5 year period evaluated, there is a growing trend in use of opioids at CHS in Israel. This trend may be an indication of the improvement in treatment of chronic pain.
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Ketoacidosis is a serious complication of diabetes mellitus, especially type 1, and its secondary consequences account for a large proportion of diabetes-related hospitalizations and mortality in children with type 1 diabetes. Our understanding of the pathophysiology of ketoacidosis has increased considerably, together with methods and means of management. Nevertheless, its incidence has remained constant in most parts of the western world, as has the incidence of cerebral edema, the main cause of death due to ketoacidosis. ⋯ Although studies of the risk factors for the development of cerebral edema in this setting have yielded discrepant findings, there is a wide consensus regarding ketoacidosis treatment. The accepted protocol consists of slow rehydration with isoosmotic fluids, without bicarbonate solution except in rare cases, with continuous attention to glucose, sodium and potassium levels and the patient's neurological state. The aim of this survey is to present guidelines for the treatment of diabetic ketoacidosis (DKA) in children and to recommend preventive measures.
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We report the clinical and radiographic findings of a female patient who presented to the emergency room in acute distress due to a subluxated globe. The patient had a 10 year history of poorly controlled Grave's disease and associated orbitopathy. ⋯ To the best of our knowledge, this case is the first documented report of this unusual event occurring in a patient with significant involvement of the extraocular muscles which caused a resultant crowding of the orbital apex, disturbance to venous outflow and severe orbital congestion. In conclusion, acute globe subluxation may rarely happen in "myogenic" (type II) thyroid orbitopathy.
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Ketoacidosis is a common condition in patients with new onset type 1 diabetes and remains a major reason for hospitalization of those with established disease. The major cause of mortality in ketoacidosis is cerebral edema. Although rarely diagnosed on a clinical basis, cerebral edema may have subtle manifestations and is probably under-diagnosed. Novel insights into the underlying pathophysiology of cerebral edema associated with ketoacidosis may help us treat this life threatening condition and prevent the low, yet significant, mortality associated with it.