Diabetes Mellitus en el servicio de urgencias: manejo de las complicaciones agudas en adultos / Diabetes Mellitus in the emergency room: handling acute complications in adults

La Diabetes Mellitus (DM) es una enfermedad de alta prevalencia, reconocida como un problema de salud pública, debido a sus altas tasas de morbilidad y mortalidad asociadas. Diferentes estudios han documentado que la falta de adherencia al tratamiento, constituye uno de los principales factores desencadenantes para las descompensaciones agudas en el paciente diabético. Dentro del espectro de dichas alteraciones se encuentran las crisis hiperglicémicas agudas, las cuales se han dicotomizado en dos entidades clínicas: la Cetoacidosis Diabética (CAD) y el Estado Hiperglicémico Hiperosmolar (EHH), que constituyen complicaciones metabólicas potencialmente fatales en el corto plazo y de las cuales pueden encontrarse cuadros superpuestos. Se han establecido criterios diagnósticos específicos buscando realizar un diagnóstico diferencial acertado, que permita un tratamiento idóneo; sin embargo, las tasas de morbilidad y mortalidad siguen siendo considerables. Por su parte, la Hipoglicemia también constituye una emergencia médica que, de no ser tratada oportunamente, puede ocasionar daño neurológico permanente e incluso la muerte. De lo anterior se deduce la importancia de que existan guías claras de manejo de estas alteraciones en todos los centros y servicios donde se preste atención médica de urgencias. Se siguen realizando investigaciones en busca de nuevas estrategias diagnósticas y terapéuticas que permitan un manejo más integral de la DM y sus complicaciones, en aras de mejorar la calidad de vida de los pacientes...

Diabetes Mellitus (DM) is a high prevalence disease, recognized as a public health problem because of its high morbidity and mortality rates. Some studies have expose that the lack of adherence to treatment is one of the main triggers for acute complications in diabetic patients. Those complications are the acute hyperglycemic crises, which are two clinical entities: Diabetic Ketoacidosis (DKA) and the Hyperglycemic Hyperosmolar State (HHS), which are potentially fatal metabolic complications in the short term and which can be found overlapping. They have established some specific diagnostic criteria in order to perform a correct differential diagnosis, which allows proper treatment, however, morbidity and mortality remain significantly high. Hypoglycemia is also a medical emergency, which if not treated on time, can cause permanent neurological damage and even death. That’s why it is important to create clear guidelines to treat these complications, in all services, in order to provide emergency medical care. New researchs have been developed to find new diagnostic and therapeutic’s strategies would allow a more integrated management of the DM and its complications, for the sake of improving patients’ life quality...

Envenenamiento ofídico / Snake poisoning

Snake bites are prevalent and related to different activities in the area of tropical regions.Since October 2004, The “Ministerio de Protección Social” from Colombia has declared itas an event of mandatory notification.Recent data has facilitated the understanding of the mechanism of action of different venoms.The local toxicity, hemorrhage, renal damage and hipotensive effects of the Botrhopic venomhas been described. As well as the Lachesis’s vagal neurotoxicity, the Chrotalis’ muscularneuraltoxicity, and the Elapidae’s palsy effect. These snakes genders are responsible of 99 percentof snake bites in Colombia, with Bathrops causing 90-95 percent of cases. The better understandingof the toxicity and the body’s response have lead to the publication of management guidesincluding the classification of the bites, according to clinical presentation and laboratoryworkup (specially coagulation studies). This has also leaded the development of protocolsregarding the administration of the neutralizing serum, depending on different presentations,being this the only effective treatment in the case of a systemic envenomation. For these reasonsthe national availability of the serum must be warranted, as well as its administration, inspite of the early allergic reactions. The Whole Blood Clotting Test, which has been certifiednationally in the “Dirección Seccional de Salud de Antioquia” guidelines is also described.This test is a good alternative to guide the management in rural areas. Some recent dataabout the role of the mastocites in the immune response against the venom is also described,opening new ways to treatment investigations.