Emergency medicine clinics of North America
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Ethanol intoxication and ethanol use are associated with a variety of metabolic derangements encountered in the Emergency Department. In this article, the authors discuss alcohol intoxication and its treatment, dispel the myth that alcohol intoxication is associated with hypoglycemia, comment on electrolyte derangements and their management, review alcoholic ketoacidosis, and end with a section on alcoholic encephalopathy.
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Emerg. Med. Clin. North Am. · May 2014
ReviewCurrent Diagnosis and Treatment of Hyperglycemic Emergencies.
Diabetic ketoacidosis and hyperosmolar hyperglycemic state are the most feared complications of uncontrolled diabetes seen in emergency medicine. The treatment of both conditions must be tailored to individual patients and relies on aggressive fluid resuscitation, insulin replacement, and electrolyte management. ⋯ Improved understanding of the underlying pathophysiology and application of evidence-based guidelines have significantly improved prognosis and decreased mortality. The purpose of this article is to review the diagnosis, presentation, and emergency department management of diabetic ketoacidosis and hyperosmolar hyperglycemic state with an emphasis on current management and treatment guidelines.
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Emerg. Med. Clin. North Am. · May 2014
ReviewNeonatal Endocrine Emergencies: A Primer for the Emergency Physician.
The resuscitation principles of securing the airway and stabilizing hemodynamics remain the same in any neonatal emergency. However, stabilizing endocrine disorders may prove especially challenging. ⋯ Implementing routine screening tests worldwide and improving the accuracy of present tests remains the challenge for healthcare providers. With further study of these disorders and best treatment practices we can provide neonates presenting to the emergency department with the best possible outcomes.
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Although the altered mental status is a common presentation in the emergency department, altered mental status caused by endocrine emergencies is rare. The altered patient could have an endocrine cause that can quickly improve with appropriate diagnosis and interventions. When dealing with limited information and an obtunded patient, it is important to have a broad differential diagnosis, pick up on the physical examination findings, and evaluate laboratory abnormalities that could suggest an underlying endocrine emergency. This article outlines the findings and provides a description of altered patients with endocrine emergencies to facilitate the diagnosis and treatment in the emergency department.
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Dysnatremias occur simultaneously with disorders in water balance. The first priority is to correct dehydration; once the patient is euvolemic, the sodium level can be reassessed. ⋯ In stable patients with either hyponatremia or hypernatremia, the clinician should aim for correction over 24 to 48 hours, with the maximal change in serum sodium between 8 to 12 mEq/L over the first 24 hours. This rate of correction decreases the chances of cerebral edema or osmotic demyelination syndrome.