ObjectivesDiabetes is a debilitating disease that affects the way the body uses or produces insulin. Research evaluating the usefulness in screening patients admitted to a clinical decision unit (CDU) from the emergency department (ED) has been limited.MethodsA retrospective chart review of patients admitted to a CDU from the ED was performed. Patients included were > 18-year-old who were observed in the CDU, had blood glucose drawn greater than eight hours after admission, and who had not been previously diagnosed with diabetes. Age, sex, and fasting glucose level were collected. The analysis was done to evaluate the percentage of patients undiagnosed and at risk for diabetes mellitus by assessing fasting blood glucose the morning after admission.ResultsStudy revealed that 27.8% of the patients analyzed in this study had fasting blood glucose levels meeting or exceeding the diagnostic threshold of 126 mg/dL and could potentially have undiagnosed diabetes.ConclusionScreening patients admitted to a CDU from the emergency department identified that 27.8% had fasting plasma glucose levels ≥ 126 mg/dL. Consideration should be made to obtain a fasting blood glucose level in those without a previous diagnosis of diabetes who are observed overnight in a CDU.
An unresponsive patient with COVID-19 infection should prompt immediate evaluation with consideration of a vast differential diagnosis entailing a multitude of diagnostic and therapeutic interventions in the emergency department. We report a case of an unresponsive 41-year-old female with COVID-19 infection and a history of rheumatoid arthritis who presented to the emergency department with bilateral carotid artery dissections and left internal carotid artery thrombus that extended into the middle cerebral artery. This case calls into question if COVID-19 is coincidentally or causally associated with acute vascular and thromboembolic disease.
Seizures can result in profound elevations of serum lactate. A paucity of investigation into whether lactate levels in these patients is associated with increased mortality. We sought to evaluate the significance in patients presenting with a seizure and elevated lactate.
Methods
This is a retrospective study involving patients presenting to the Emergency Department (ED) with a diagnosis of seizure from September 1st, 2016 until March 31st, 2018. Those with normal serum lactate (< 2mmol/L) were compared with patients that had an elevated serum lactate (> 2mmol/L).
Results
Patients with normal serum lactate levels had a significantly longer length of stay in the ED (60 minutes p = 0.04) when compared to those with elevated serum lactate levels. Additionally, a higher percentage of patients with elevated serum lactate received intravenous fluids in the ED (54.69% vs. 35.4%, P=0.01). There was no significant difference in other measured variables.
Conclusion
This study illustrates that serum lactate levels do not directly correlate with indicators of disease severity or outcomes when elevated secondary to seizure. However, patients with normal serum lactate levels had a longer length of stay in the ED.
Keywords: Lactate, Lactic Acid, Seizure, Epilepsy, Length of Stay
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