J Emerg Med
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Idiopathic ketotic hypoglycemia (IKH) is an important cause of emergent hypoglycemia among children. We present a case series of 24 patients with IKH in an effort to provide a current clinical description of this disorder. Secondly, we provide a crude lower-bound estimate of the incidence of IKH in an Emergency Department (ED) setting. ⋯ In our series, patients with IKH presented initially before 5 years of age with symptomatic hypoglycemia during the morning hours after a moderate fast. These patients were found to have ketonuria with symptoms resolving after glucose administration. Patients with IKH were more likely to be Caucasian, male gender, and have a low body weight.
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Previously thought to be extremely rare, renal artery aneurysms are now being found more commonly as incidental findings during the evaluation of refractory hypertension. Symptoms related to the aneurysm are uncommon and rupture occurs infrequently, but with devastating consequences. Factors predisposing to rupture include pregnancy, polyarteritis nodosa, and lack of aneurysmal calcification. ⋯ We report a case of ruptured renal artery aneurysm that presented with sudden onset of abdominal pain but no significant findings on physical examination. The patient's size precluded the detection of a pulsatile abdominal mass or the ability to obtain an abdominal angiogram. Computed tomography scan with contrast revealed the correct diagnosis, and successful treatment was initiated.
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Case Reports
Fluid-filled bowel mimicking hemoperitoneum: a false-positive finding during sonographic evaluation for trauma.
This case report describes a patient who presented to the Emergency Department (ED) after a high-speed motor vehicle crash (MVC), whose initial ultrasound examination was interpreted as being positive for fluid in Morison's pouch. Subsequent ultrasound examinations and computed tomography scans further delineated this finding to be fluid-filled bowel juxtaposed between the liver and right kidney. With greater implementation of ED ultrasound, it is important to identify entities that cause false-positive and false-negative examinations.
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Randomized Controlled Trial Comparative Study Clinical Trial
Levalbuterol is as effective as racemic albuterol in lowering serum potassium.
Albuterol is an effective treatment for hyperkalemia through beta-adrenergic induction of potassium (K+) uptake. Levalbuterol, the R-enantiomer of racemic albuterol, is used for the treatment of asthma and 0.63 mg of levalbuterol has the same therapeutic efficacy as 2.5 mg of albuterol but with a decreased adverse effects profile. We hypothesized that levalbuterol can reduce serum K+ levels similarly to albuterol when used in equipotent doses. ⋯ At 30 and 60 min after treatment, both albuterol and levalbuterol groups had significantly lower K+ values compared to placebo. No significant difference occurred between the albuterol and levalbuterol groups. Levalbuterol caused fewer reported adverse effects compared to albuterol.