Capillary leak syndrome (CLS) is characterized by plasma extravasation into the interstitium with resultant hypotension, anasarca, hemoconcentration, and hypoalbuminemia in the absence of albuminuria. Initially reported in Clarkson’s disease (systemic capillary leak syndrome), CLS has been observed in multiple disease settings, the most common being sepsis. In oncology, CLS has been reported more often as a complication from therapy, and less often from malignancy. In this case study, we documented clinical manifestation, laboratory features, and radiological findings of CLS from rituximab therapy when employed in combination with a multi-agent chemotherapy regimen (EPOCH-R). Differentiating drug-induced CLS from sepsis, which presents with the same clinical features, is important in avoiding further exposure to rituximab, which could be fatal to the patient.

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Sixty two year old Caucasian man with past medical history of Hypertension, Coronary artery disease, Congestive Heart Failure (CHF) and Hypothyroidism secondary to radio-ablation of thyroid, presented to Emergency Room with complaints of shortness of breath and swelling of his neck for one day. Initial vitals on admission showed elevated BP (178/100 mm Hg) and pulse oximetry showed 92 % saturation with 2L O2 via nasal canula. Physical examination was normal except for increased neck circumference and pitting edema in both feet. Labs revealed elevated BNP at 2330 pg/ml (<125), elevated TSH at 13 uIU/ML (0.5 -5), with low T3 at 0.79 ng/ml (0.9 - 1.6). Rapid Group A streptococcal serology was negative. Patient had previous allergy to Angiotensin Converting Enzyme Inhibitor (ACEI) with lip swelling five years ago and has since been taking Angiotensin Receptor Blocker (ARB) - Losartan for Heart Failure with preserved ejection fraction (HFpEF) without any complaints, until this episode one day ago. Initial X-ray of the neck revealed epiglottic narrowing and subsequent CT scan showed uvular thickening. The uvular angioedema was likely worsened due to ARB, with possible contribution from exacerbation of diastolic heart failure and hypothyroidism. He was started on hydralazine and intravenous furosemide for CHF exacerbation in addition to continuing home medication of metoprolol and stopping Losartan. The dose of Levothyroxine was titrated for hypothyroidism. Patient was given intravenous dexamethasone, famotidine, and diphenhydramine in the hospital, with which the swelling subsided within a day and he felt symptomatically better. Oxygen was weaned off and saturation was 95 % on room air, BP was controlled at discharge. Losartan was hence stopped and he was sent home on steroid taper. Subsequent follow up at six months revealed that he did not develop any further episodes of angioedema subsequent to stopping Losartan. ARB is sometimes prescribed to patients having intolerance to ACEI. Previous reports suggest that patients who develop angioedema with ACEI, may also develop allergy with ARB, and is hence best avoided. This case illustrates that caution needs to be exercised in transitioning patients from ACEI to ARB, and that allergy may manifest as isolated uvular edema, especially in patients with multiple comorbidities.

Introduction Nearly 1 in 10 individuals in the US have Diabetes Mellitus [1]. One potential preventable complication is Diabetic Ketoacidosis (DKA). Urban and rural patients may have different mortality [2]. Better understanding of the risk factors for readmissions of DKA will allow the development and implementation of specific patient-centered interventions to decrease future readmissions. We determined the 30-day all-cause readmission rate for adults (age &gt;= 18) admitted with a principal diagnosis of DKA and compare the risk factors for urban and rural patients. Methods We utilized Agency of Healthcare Research and Quality’s (AHRQ) 2014 Nationwide Readmission Database to identify admissions with a principal diagnosis of DKA related ICD-9 diagnosis (250.10, 250.11, 250.12, and 250.13) associated with both Type 1 and Type 2 Diabetes Mellitus. Applicable admissions were all adults (age &gt;= 18) with an index hospitalization between January 1 to November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. The 2013 NCHS Urban-Rural Classification System was used to classify if originating from an urban or rural location. All-cause readmission within 30-days of DKA were analyzed. Predictors for readmission were determined using logistic regression model. Results A total of 65,249 patients met criteria for inclusion. Of which, there was 12,561 readmissions (19.25 %) within 30-days of the index admission. Patients originating from urban locations had a readmission rate of 19.36% compared to 18.56 % for patients from rural locations (p=0.07). Multivariate analysis showed patients from either rural or urban location each had a higher likelihood of readmission if their disposition was home health or AMA, younger age (&lt;65), female, Medicare as payer, LOS 7-14 days, absence of obesity, and presence of renal failure. In addition, disposition to short term hospital increased the odds for readmission from rural patients. Conclusion Almost 1 in 5 patients discharged with a principal diagnosis of DKA will be readmitted within 30 days. No difference was noted in rates of readmissions for patients originating from urban or rural locations. Risk factors are similar with further research needed to better understand the drivers of readmission. References: [1] CDC: National Diabetes Statistics Report (2017) [2] Ferdinand AO, et al. (2017). Diabetes-Related Hospital Mortality in Rural America: A Significant Cause for Concern. Policy Brief #3. Southwest Rural Health Research Center

Introduction: Nearly 1 in 10 individuals in the United States have Diabetes Mellitus [1]. One potential preventable complication is Diabetic Ketoacidosis (DKA). Better understanding of the risk factors for readmissions of DKA will allow the development and implementation of specific patient-centered interventions to decrease future readmissions. We sought out to determine the 30-day all-cause readmission rate for adults (age &gt; 18) admitted with DKA and the associated predictors of readmissions. Methods: We utilized Agency of Healthcare Research and Quality’s (AHRQ) Health Care Utilization Project’s (HCUP) 2014 Nationwide Readmission Database which includes 14.9 Million discharges across 22 states accounting for 51.2% of the total U.S. population and 49.3% of all U.S. hospitalizations to identify admissions with a DKA related ICD-9 diagnosis (250.10, 250.11, 250.12, and 250.13) associated with both Type 1 and Type 2 Diabetes Mellitus. Applicable admissions were all adults (age &gt; 18)with an index hospitalization between January 1 and November 30, 2014. Patients who died during index admission and those with missing covariates were excluded. All-cause readmission including DKA within 30-days of DKA were analyzed. Statistical analysis was completed with Stata 15 (StataCorp, College Station, TX) with p-values &lt; 0.05 considered statistically significant. A univariate and multivariate analysis of data collected was completed using both odds ratio and chi square test for significance. Predictors for readmission were determined using a multivariate logistic regression model following sequential step-wise elimination of covariates including demographics, comorbidities, hospital characteristics, length of stay (LOS) for index admission, and the modified Elixhauser Comorbidity Index. Results: A total of 66,896 patients met criteria for DKA related index admission. Of which, there was 12,954 (19.36%) all-cause readmissions within 30-days including 7,167 were again for DKA accounting for 55.32% of all readmissions. Multivariate analysis showed that the predictors of 30-day readmission were younger age, (with adults age &lt;35 the highest risk), female, disposition at discharge to short term hospital or home health or against medical advice), from a zip code with the lowest income quartile, Medicare as payer, lengthier LOS, presence of comorbidities, absence of obesity, and presence of renal failure. Conclusion: Almost 1 in 5 (19.36%) patients discharged after a DKA admission were readmitted within 30 days. Physician awareness and development of targeted interventions for individuals with risk factors and high-risk for readmissions may help decrease future morbidity and mortality. References: [1] CDC: National Diabetes Statistics Report (2017). https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. Abstracts presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.