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Context:Diabetic ketoacidosis (DKA) is one of the most serious complications of diabetes. It is characterized by a triad of increased total body ketone concentration, metabolic acidosis, and uncontrolled hyperglycemia. Hyperglycemia is a key diagnostic criterion of DKA; however, in some rare cases, normal glucose levels can be present.Case Reports:We describe two patients with type 1 diabetes mellitus (DM1); one who presented with a Bartholin's gland abscess and the other with acute pancreatitis. Both patients had maintained adequate hydration and continued to take their insulin without sufficient carbohydrate intake in the previous days prior to presentation. Despite their normal serum glucose levels upon presentation, they were found to have ketonemia and acidosis consistent with DKA. If only the serum glucose level was taken into consideration, while ignoring the rest of their biochemical profiles and failing to obtain ketone levels, the diagnoses would have been missed.Conclusion:Euglycemic DKA is usually seen in otherwise healthy patients with type 1 diabetes mellitus who have decreased carbohydrate intake in the presence of adequate hydration and a degree of insulin intake. Recognition of this entity by the emergency provider is crucial when patients with DM1 present with a picture of DKA, regardless of their blood sugar.

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Troponin level elevation, in hospitalized patients with HFpEF decompensation, was associated with higher short-, intermediate-, and long-term mortality.

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With the increasing use of various medications and supplements nowadays, the incidence of abnormal liver function tests and frank hepatic injury is has been increasing. Medications are now considered one of the most common causes of acute hepatic failure in the United States. Losartan was the first angiotensin 1 (AT1) receptor blocker approved by FDA for the treatment of arterial hypertension. It is a well-tolerated medication with few significant adverse effects. However, losartan-related hepatotoxicity has been reported rarely. We report a case of acute hepatic injury in an adult patient treated with losartan as a monotherapy for arterial hypertension.

Context:Eosinophilic myocarditis is a rare cause of myocarditis. It is manifested histopathologically by diffuse or focal myocardial inflammation with eosinophilic infiltration, often in association with peripheral blood eosinophilia. Patients infected with Human Immunodeficiency Virus (HIV), especially those with lower CD4 counts, can occasionally have hyperimmunoglobulinemia E (Hyper IgE) and eosinophilia.Case Report:We report a case of a 29-year-old patient with Acquired Immunodeficiency Syndrome (AIDS) who had a persistent elevation of eosinophil counts and elevated IgE levels for a year prior to admission. He was presented to our emergency department with chest pain and laboratory tests revealed peripheral blood eosinophilia and elevated troponins. Coronary angiogram showed nonobstructive coronary artery disease. He then underwent cardiac magnetic resonance imaging which was consistent with an infiltrative myocarditis. After being put on steroid therapy, his peripheral eosinophilia resolved and his cardiac symptoms improved.Conclusion:Our case highlights that eosinophilia and Hyper IgE in HIV patients has the potential to contribute to end-organ damage.

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