The American journal of emergency medicine
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Although patient comfort is a frequent rationale for antipyretic therapy, there have been few systematic studies of relationships between temperature and comfort. In this study, adult outpatients with febrile illnesses were asked to complete a symptom diary at multiple time points at which temperature was recorded. Temperature readings showed modest correlation (0.316) with scores of "feeling better or worse" and moderate correlation (0.586) with aggregate symptom scores. ⋯ Direction of temperature change was not significantly associated with overall subjective score of "feeling better or worse" although aggregate symptom scores were slightly higher with rising than falling temperature. These findings suggest that temperature is a partial determinant of morbidity in minor febrile illnesses but contribution of temperature change to well being may be small. Further study is needed to determine the appropriate priority of temperature reduction in symptomatic therapy.
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A 32-year-old man presented to the emergency department (ED) with seizures 6 hours after a lumbar myelogram with iopamidol (Isovue-M 200, Squibb, Princeton, NJ). Seizures are a rare complication after myelography with the current nonionic contrast agents and have not been previously reported in the emergency medicine literature. Emergency physicians should be aware of this potential complication because outpatient myelograms are frequently performed, and these patients may present to the ED after seizures.
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Various treatment strategies are currently used in the management of acute pyelonephritis, with some patients being treated as inpatients and others as outpatients. To better describe the clinical course of patients with this condition and the management strategies of physicians treating these patients, a retrospective cohort study of febrile nonpregnant women presenting to the emergency department with clinical evidence of acute pyelonephritis was conducted. Acute pyelonephritis was defined as infected urine (> or = 7 white blood cells/high-power field and/or urine culture with > or = 10(4) colony-forming units [CFU]/mL) and fewer (> or = 37.8 degrees C) without other source. ⋯ Nine (12%) of the 75 returned because of symptoms of acute pyelonephritis, with 8 returning within 1 day of the initial visit. Seven of those returning were admitted. All responded to additional antibiotic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Allergic reactions and complications of diabetes mellitus are commonly seen in emergency departments and primary care settings. Although stress is a known contributor to the development of diabetic ketoacidosis (DKA), anaphylaxis-induced DKA has not previously been described. ⋯ It was concluded that stress and counter-regulatory hormones released during anaphylaxis, as well as the treatment with epinephrine and glucocorticoids, precipitated DKA in this patient despite ongoing insulin and fluid therapy. Type 1 diabetic patients experiencing anaphylaxis may require prolonged periods of observation and measurement of serial blood glucose and urine ketones.
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Hemolytic uremic syndrome (HUS), the most common cause of acute renal failure in childhood, has the potential to progress to a life-threatening illness. Its incidence in North America is increasing. ⋯ This case exemplifies what appears initially as gastroenteritis but, ultimately, becomes the final diagnosis of HUS. A case is presented to provide additional education to ensure the E coli O157:H7 infection is considered in the differential diagnosis of persons who present with bloody diarrhea.