Dr Johnny Nie has dug up some recent articles of interest with brief summaries for your perusal.
Skeptics Guide to EM reviews a recent paper on fluid choice in mild dehydration secondary to pediatric gastroenteritis.
- half diluted apple juice performed better than standard electrolyte solution (like pedialyte) in treating mild dehydration in pediatric patients with gastroenteritis
R.E.B.E.L.E.M reviewed euglycemic DKA.
- Euglycemic DKA (DKA with glucose less than 20mmol) can happen in Type 1 and 2 DM patients, especially in those taking SGLT-2 inhibitors
- Do not rely on glucose alone to exclude DKA: Get VBG, anion gap, and Ketones
- Treat it just like regular DKA, aim to close AG.
- Most common symptom is vomitting, still only present in 37% of patients
- CPAP/BiPAP is life saving and intubation avoiding
- Strong benefit (NNT 4-10) demonstrated in COPD and CHF patients
- Avoid in patients with facial trauma, unprotected airway, vomitting
- Should be considered in asthmatic and neurodegenerative disorders. However evidence less strong.
- Make sure to get VBG to assess response/necessity for intubation