Thyroid Storm – Spoon-Feed Version
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Thyroid storm is a high-risk, low-prevalence disease that mimics multiple other emergent diagnoses due to its most common features being fever, altered mental status, and cardiovascular dysfunction.Â
Endocrine
Can Clinical or Lab Variables Predict Dehydration Severity in Children with DKA?
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Most pediatric patients with diabetic ketoacidosis (DKA) have mild to moderate dehydration. Clinical and laboratory variables in isolation are not accurate predictors of rehydration needs.
Source
Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis. Ann Emerg Med. 2023 Apr 4;S0196-0644(23)00002-1. doi: 10.1016/j.annemergmed.2023.01.001. Online ahead of print.
New SQuID Game? SQ Insulin, DKA, and Length of Stay
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The use of a subcutaneous insulin protocol for mild-to-moderate diabetic ketoacidosis (DKA) resulted in significant reductions in ED LOS.
Source
The SQuID Protocol (Subcutaneous Insulin in Diabetic Ketoacidosis): Impacts on ED Operational Metrics. Acad Emerg Med. 2023 Feb 12. doi: 10.1111/acem.14685. Online ahead of print.
Thionamide Smackdown – PTU vs MMI for Thyroid Storm
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This comparative effectiveness study showed no significant difference in clinical outcomes or adverse effects when comparing use of propylthiouracil (PTU) and methimazole (MMI) for thyroid storm. This suggests both medications may be reasonable first-line treatment options for patients with thyroid storm.
Source
Comparison of Propylthiouracil vs Methimazole for Thyroid Storm in Critically Ill Patients. JAMA Netw Open. 2023 Apr 3;6(4):e238655. doi: 10.1001/jamanetworkopen.2023.8655.
Does Prehospital Intranasal Glucagon for Hypoglycemia Work?
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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.
DKA Fluid Choice, Dropping Sodium, and AMS – Is There Correlation?
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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.
Pediatric DKA – Spoon-Feed Version
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Managing pediatric DKA requires fluid, insulin, intense monitoring, and being ever watchful for cerebral edema. This covers best practices.
Can You Spot Euglycemic DKA From SGLT-2 Inhibitors?
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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
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.
Does Hyperglycemia at Discharge Matter?
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.