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em@3am

EM@3AM: Hypoglycemia

A 27-year-old female with a history of insulin-dependent diabetes presents to the ED on a Friday evening somnolent and disoriented. Her coworkers report she started slurring her speech and became increasingly altered after they met at a bar after work.  Exam reveals a diaphoretic, obtunded female not oriented to person, place, or time. Her GCS is 11. What do you suspect as the diagnosis? What should your first order be?

EM Cases

EM Cases: Pediatric DKA

Learn the key historical and examination pearls to help pick up this sometimes elusive diagnosis, what the value of serum ketones are in the diagnosis of DKA, how to assess the severity of DKA to guide management, how to avoid the dreaded cerebral edema that all too often complicates DKA, how to best adjust fluids and insulin during treatment, which kids can go home, which kids can go to the floor and which kids need to be transferred to a Pediatric ICU.