Commonly seen in the emergency department, diabetic ketoacidosis is a potentially lethal sequela of uncontrolled diabetes mellitus. In the adult population, a rare complication of diabetic ketoacidosis is cerebral edema. This case report discusses a 26-year-old male with new onset diabetes mellitus who developed cerebral edema leading to death.
Calcium channel blocker overdoses are often fatal despite standard treatment. Methylene blue is a novel adjunct that should be considered in refractory cases. Currently accepted therapeutic modalities include intravenous fl uids, calcium, vasopressors and high-dose insulin euglycemic therapy, however shock may persist despite these treatment options. [1] Methylene blue has been utilized in sepsis, shock after cardiac surgery and other non-poisoning causes of shock. However, there are only ten human case reports and one animal study regarding its utility. The case reports describe its use in shock caused by quetiapine, valsartan and dihydropyridine calcium channel blockers, and measure the outcomes of hemodynamics and mortality. The animal study used a rat-model with thirty subjects treated with a lethal dose of amlodipine, followed by methylene blue or normal saline. Results revealed an increase in heart rate, mean arterial pressure (MAP) and median survival time in those treated with methylene blue. [2] E x pe r t c o n s e n s u s r e c o m m e n d a t i o n s f o r t h e management of calcium channel blocker poisoning in adults were recently assembled and did not recommend the use of methylene blue as first-line treatment, given that the experience was limited to a small number of case reports. [1] However, with additional case reports attesting to its effi cacy, there may be a role for methylene blue in the treatment of drug-induced vasodilatory shock. We present a case where methylene blue was administered to a patient suffering from refractory vasodilatory shock following toxic ingestion of amlodipine, resulting in subsequent hemodynamic improvement.
Ketamine is used widely in emergency departments for a variety of purposes, including procedural sedation and pain management. A major benefit of using ketamine is the rapid onset and lack of respiratory depression. The known side effects include emergence reactions, hallucinations, hypertension, dizziness, nausea, and vomiting. Recent studies have shown the benefit of ketamine for refractory status epilepticus; however, this application of the drug is still being studied. We present a case where ketamine likely induced a seizure in a patient on whom it was used as a single agent in procedural sedation. Seizure is not a known side effect of ketamine in patients without a seizure history. Given the eagerness over additional uses for ketamine, this novel case of a seizure following procedural sedation with ketamine should be of interest to emergency providers.
Isolated dissection of the superior mesenteric artery is a novel disease often presenting with vague signs and symptoms. Although the disease entity is rare, the potential for morbidity and mortality is high. This is a case report of a healthy 58-year-old male presenting with diffuse persistent abdominal pain. Diagnosed on computed tomography, this patient’s condition was managed conservatively with anticoagulants.
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