RESUMO
For patients presenting with suspected diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) understanding of the etiology and pathophysiology will ensure optimal emergency management. Morbidity and mortality is most often due to the underlying precipitating cause, which may include infection, infarction/ischemia, noncompliance with insulin therapy, pregnancy, and dietary indiscretion. Current guidelines are based primarily on expert opinion and consensus statements, but more recent evidence suggests that recommendations related to arterial blood gas, insulin bolus, and IV fluid replacement should be re-evaluated. This issue presents an approach to DKA and HHS management based on current evidence, with a simplified pathway for emergency department management.
Assuntos
Hidratação/métodos , Hiperglicemia/fisiopatologia , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus/tratamento farmacológico , Cetoacidose Diabética/tratamento farmacológico , Cetoacidose Diabética/fisiopatologia , Humanos , Hiperglicemia/tratamento farmacológico , Coma Hiperglicêmico Hiperosmolar não Cetótico/tratamento farmacológico , Coma Hiperglicêmico Hiperosmolar não Cetótico/fisiopatologia , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêuticoRESUMO
We present an illustrative case of a 24-year old male who developed cardiovascular and multi-organ system toxicity after inhaling a keyboard dust cleaner containing a halogenated hydrocarbon. In the field, the patient demonstrated neurotoxic effects in addition to electrocardiographic changes concerning for toxic myocarditis. We discuss the types of hydrocarbons, methods of abuse, and toxic effects of their inhalation including "sudden sniffing death" from myocardial sensitization.
