1/3. Hypoketotic hypoglycemic coma in a 21-month-old child.We present the case of a 21-month-old child with hypoketotic hypoglycemic coma. The differential diagnosis initially included metabolic causes versus a toxicologic emergency (unripe ackee fruit poisoning). Using information obtained from the emergency department, the diagnosis was confirmed as the late-onset form of glutaric acidemia type II. This case illustrates the importance of emergency physicians in the diagnosis and management of children with inborn errors of metabolism.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/3. Profound hyperglycemia and metabolic acidosis after verapamil overdose.verapamil, a potent calcium antagonist, possesses varied systemic effects, including smooth muscle relaxation leading to both peripheral and coronary artery vasodilation, slowed atrioventricular nodal conduction and decreased insulin release from the pancreatic B cells. Reports concerning the effects of acute intoxication with verapamil are scarce. A case is presented of a 22 year old woman who developed profound hyperglycemia and metabolic acidosis after the inadvertent overdose of thirty 80 mg tablets (2,400 mg) of verapamil. This case illustrates the need for physicians to be aware of verapamil's inhibitory effects on insulin release and to exercise special care when prescribing verapamil in patients with preexisting diabetes mellitus.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/3. Transient erythroblastopenia of childhood presenting with shock and metabolic acidosis.Transient erythroblastopenia of childhood is usually a benign, self-limiting underproduction of red blood cells that often goes undetected clinically. The patient presented here, however, required crystalloid boluses and red blood cell transfusion for treatment of shock and metabolic acidosis in the emergency department. The emergency physician must be alert to the patient presenting with severe anemia and procure extra pretransfusion blood samples for anemia studies when transfusion appears imminent. The need for red blood cell transfusion in such a patient must be expeditiously recognized and, when the need exists, transfusions should be started as quickly as possible.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |