ABSTRACT
Since the start of the 21st Century, the use of opioids for pain management in primary care has increased along with a concomitant rise in opioid associated deaths. The use of opioids is associated with risks of addiction, respiratory depression, sedation, and death. There is no checklist available in electronic medical records to guide safe prescribing of non-opioid pain management options prior to opioids in primary care. Our quality improvement project pilot study aimed to reduce unnecessary opioid prescribing in an urban academic internal medicine clinic by incorporating a checklist of five first-line non-opioid therapy suggestions into electronic medical records. Following its implementation, opioid prescribing dropped by an average of 38.4 percent per month.
Subject(s)
Analgesics, Opioid , Electronic Health Records , Humans , Analgesics, Opioid/adverse effects , Pilot Projects , Practice Patterns, Physicians' , Drug Prescriptions , Primary Health CareABSTRACT
Diabetic ketoacidosis is defined as hyperglycemia >250 mg/dL with metabolic acidosis of arterial pH <7.3, serum bicarbonate <18 mEq/L with positive urine and serum ketones and an anion gap >10. Euglycemic ketoacidosis has been reported in patients with type 2 diabetes and in patients with type 1 diabetes. However, as a surgical complication, euglycemic ketoacidosis has not been reported. We report 2 cases from 2 teaching tertiary care centers of patients with type 2 diabetes who developed high-gap ketoacidosis in an intensive care unit while recovering from emergent abdominal surgery. Both patients developed altered mental status, metabolic acidosis with a bicarbonate level as low as 14 mEq/L, and an anion gap > 18, without hyperglycemia. Both patients had ß-hydroxybutyrate levels > 5 mmol/L.
