Insulin does MANY things in the body, but the role we care about in the Emergency Department is glucose regulation. Insulin allows cells to take up glucose from the blood stream, inhibits liver glucose production, increases glycogen storage, and increases lipid production. When insulin is not present, such as in patients with Type 1 diabetes mellitus (DM), all of the opposite effects occur.
The first recording from Little Patients, Big Medicine: the Pediatric Emergency Medicine (PEM) Podcast. This is an exciting interview with Dr. Halden Scott, a PEM physician at Children’s Hospital Colorado, about the use of lactate measurement in pediatric sepsis. Dr. Scott is one of the premier pediatric sepsis researchers, with a specific focus on the use of lactate measurement in the ED. We talk about the Sepsis-3 definitions and whether pediatrics will eventually follow them, Dr. Scott’s previous work on lactate use in the pediatric ED, and her new article published in March of 2017 on the association between elevated lactate in the ED and 30-day mortality in children. 1–6
Just as in adults, pediatric sepsis is a complex topic with continued research. In the United States, there are an estimated 75,000 cases per year of pediatric severe sepsis with an in-hospital mortality of 5-10%.1,2 This is one of the deadliest conditions treated in children. In addition, after the Rory Staunton case, New York State passed regulations requiring all hospitals to have pediatric specific recognition, treatment, and data reporting systems. Several other states have adopted, or are considering, similar requirements. Thus it is critical that emergency physicians understand at least the basics of pediatric sepsis management.