Spoon Feed
In this small study of hypoglycemic patients who received prehospital intranasal glucagon, 32% had substantial improvement, 30% had slight improvement, and 38% had no improvement. There was no clear patient characteristic that predicted response.
Source
Prehospital Intranasal Glucagon for Hypoglycemia. Prehosp Emerg Care. 2022 Mar 2;1-4. doi: 10.1080/10903127.2022.2045406. Online ahead of print.
Spoon Feed
In pediatric patients with DKA, a decline in serum sodium was associated with a higher starting sodium level, preexisting diabetes, and use of 0.45% saline. Patients with a drop in sodium during treatment did not have an associated increase in altered mental status.
Spoon Feed
Managing pediatric DKA requires fluid, insulin, intense monitoring, and being ever watchful for cerebral edema. This covers best practices.
Spoon Feed
Sodium-glucose cotransporter-2 (SGLT-2) inhibitors were associated with a threefold increased risk for diabetic ketoacidosis compared to another drug class in patients with type 2 diabetes.
Adrenal crisis is increasing in frequency and can masquerade as something as seemingly benign as gastroenteritis. Read this summary to update your knowledge on the diagnosis and management of acute adrenal insufficiency.
Lowering glucose prior to discharge may negatively impact ED length of stay (LOS) without short-term benefit for the patient, but this study wasn’t able to prove it.
There was a helpful JAMA Internal Medicine article on caring for transgender patients this past month. This will help us apply it in the ED.
Use of any LR in pediatric patients with DKA, as opposed to only NS, was associated with lower overall costs, similar length of stay, and markedly reduced incidence of cerebral edema in this retrospective study.
Neither the fluid rate (fast or slow) or type (NS vs 1/2NS) altered the risk of brain injury with decline in GCS <14 in children with DKA.
In patients with septic shock, those treated with hydrocortisone + fludrocortisone had a lower 90-day mortality compared to placebo (43% vs 49.1%, NNT 17). They also had significantly more vasopressor-free and organ-failure free days, in addition to having a shorter time to weaning from vasopressors and mechanical ventilation.
