FacebookRssXInstagramSoundCloud
Generic filters
Exact matches only

ALiEM AIR Series | Endocrine Module (2026)

ALiEM U

 

Welcome to the AIR ENDOCRINE Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to endocrine emergencies in the Emergency Department. 11 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 6 AIR and 5 Honorable Mentions. We recommend programs give 5.5 hours of III credit for this module.

 

AIR Stamp of Approval and Honorable Mentions

 

In an effort to truly emphasize the highest quality posts, we have 2 subsets of recommended resources. The AIR stamp of approval is awarded only to posts scoring above a strict scoring cut-off of ≥30 points (out of 35 total), based on our scoring instrument. The other subset is for “Honorable Mention” posts. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score.

 

Take the Endocrine Module at ALiEMU

 

Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a free, 1-time login account.

 

Highlighted Quality Posts: Endocrine 2025

 

SiteArticleAuthorDateLabel
EMCritHyperosmolar hyperglycemic state (HHS)Dr. Josh FarkasJune 1, 2024

AIR

EMCritHypokalemiaDr. Josh FarkasJuly 4, 2024AIR
EMCritHyperkalemiaDr. Josh FarkasNovember 5, 2024AIR
EMCritHyperkalemiaDr. Josh FarkasJuly 4, 2024AIR
EMCritHyponatremiaDr. Josh FarkasJuly 4, 2024AIR
EM OttawaThese are the Roids you are looking for – Steroids in the EdDr. Naman AroraJanuary 9, 2025AIR
EMCrit

Hypernatremia and dehydration in the ICU

Dr. Josh FarkasJuly 5, 2024AIR
Rebel EMHyperkalemiaDr. Anand SwaminathanJune 26, 2024HR
EM DocsAlcohol WithdrawalDr. Kyler OsborneDecember 18, 2024HR
St Emlyns BlogGLP-1A tocxicity: What do emergency clinicians need to know about drugs like ozempic and wegovy?Dr. Gregory YatesNovember 24, 2024HR
UMEM PearlsEuglycemic DKA Pitfalls and PearlsDr. Cody CouperusAugust 20, 2024HR

 

(AIR = Approved Instructional Resource; HM = Honorable Mention)

 

If you have any questions or comments on the AIR series, or this AIR module, please contact us!

Reference

    1. Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. Ann Emerg Med. 2023;82(1):55-65. doi:10.1016/j.annemergmed.2023.02.011, PMID 36967275

 

 

By |2026-03-15T17:43:30-07:00Mar 15, 2026|Approved Instructional Resources (AIR series), Endocrine-Metabolic|
Read More

SAEM Clinical Images Series: Green Foot

The patient is a 59-year-old male with a history of prior DVT, atrial fibrillation, HTN, alcohol use and COPD who presents to the Emergency Department with chest pain, dyspnea, and left lower extremity swelling and pain. He had a prior hospital admission two weeks ago for leg swelling and cellulitis. He was previously prescribed oral gentamicin and topical mupirocin for concerns of foot infection, which he has been compliant with taking. He has been working long hours as a construction worker, but knows of no chemical exposure to his feet and denies walking barefoot. He has had no fever and denies any other complaints at this time.

 

Vitals: BP 151/69; HR 93; R 18; T 97.7°F; O2 sat 95% room air.

General: No acute distress.

Respiratory: Mild wheezes bilaterally.

Extremities: Mild bilateral lower extremity swelling, worse on left compared to right. Left foot discolored as shown in the image – when asked, the patient states the discoloration started initially on the great toenail and progressed to the sole of the foot.

CBC: WBC: 10.2; Hgb: 12.7

Na: 130

ESR: 6

CRP: 0.8

CXR: Mild pulmonary edema.

Foot X-ray: No acute findings, old Lisfranc injury.

Ultrasound: Negative for DVT.

The patient has Green Foot Syndrome.

Pseudomonas aeruginosa

Green foot syndrome is a rarely diagnosed Pseudomonas aeruginosa infection secondary to chronic skin moisture of the feet, identified from the greenish discoloration of skin. The green discoloration is due to pyocyanin and pyoverdine, giving the skin a bluish-green color. Symptoms can also include pruritus, pain, malodor, and paresthesias. Our patient was admitted to the hospital with dermatology consultation, who recommended vinegar soaks, gentamicin cream, and 0.3% ciprofloxacin solution. Other case studies have reported successful treatment by removing the inciting agent and keeping skin dry, acidic soaks such as benzoyl peroxide, and/or oral fluoroquinolones. Green foot syndrome has been reported in soldiers wearing combat boots for long hours and in patients during prolonged cast use. The moist environment of damp skin in boots provides an ideal environment for P. aeruginosa to grow. Our patient often wore construction boots with 2 pairs of socks for long hours at work, which made him susceptible to this infection.

Take-Home Points

  • When patients present with lower extremity complaints, always carefully assess the feet; this patient’s initial complaint was not skin discoloration.

  • Pseudomonas aeruginosa infections can cause a greenish discoloration to feet chronically kept in moist conditions, such as frequent and extended shoe or cast use.

  • García-Martínez FJ, López-Martín I, Castellanos-González M, Segurado-Rodríguez MA. Green foot ulcers. Enferm Infecc Microbiol Clin. 2017 Oct;35(8):536-537. English, Spanish. doi: 10.1016/j.eimc.2015.10.010. Epub 2015 Nov 26. PMID: 26627144.
  • Spernovasilis N, Psichogiou M, Poulakou G. Skin manifestations of Pseudomonas aeruginosa infections. Curr Opin Infect Dis. 2021 Apr 1;34(2):72-79. doi: 10.1097/QCO.0000000000000717. PMID: 33492004.
  • Wu DC, Chan WW, Metelitsa AI, Fiorillo L, Lin AN. Pseudomonas skin infection: clinical features, epidemiology, and management. Am J Clin Dermatol. 2011 Jun 1;12(3):157-69. doi: 10.2165/11539770-000000000-00000. PMID: 21469761.
  • Sloan B, Meffert JJ. “Boot foot” with pseudomonas colonization. J Am Acad Dermatol. 2005;52(6):1109-1110. doi:10.1016/j.jaad.2005.01.105
  • Park, Y., & Bae, J. (2013). Green foot syndrome: A case series of 14 patients from an armed forces hospital. Journal of the American Academy of Dermatology, 69(4), e198-e199. https://doi.org/10.1016/j.jaad.2013.05.012
  • Lee SH, Cho SB. Cast-related green foot syndrome. Clin Exp Dermatol. 2009;34(7):2008-2009. doi:10.1111/j.1365-2230.2009.03317.x
  • Macgregor DM. An unusual presentation of immersion foot. Br J Sports Med. 2004 Aug;38(4):E11. doi: 10.1136/bjsm.2003.007385. PMID: 15273204; PMCID: PMC1724852.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2025 SAEM Annual Meeting | Copyrighted by SAEM 2025 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.



By |2026-03-04T10:25:32-08:00Mar 13, 2026|Infectious Disease, SAEM Clinical Images|
Read More

SAEM Clinical Images Series: Connect the Dots

The patient is a 39-year-old female with past medical history of polysubstance use disorder and seizures who presents to the Emergency Department complaining of bilateral leg pain, primarily in her joints. She states that she was seen by her PCP today and was given a shot of Toradol, but she reports that her pain has continued to worsen to the point that she has difficulty ambulating. She states that two days ago she developed pruritic blisters on her feet and her feet began to swell. She reports the blisters have worsened and have spread to her hands and forearms as well as her calves and thighs. She denies ever having similar symptoms in the past. She reports some subjective fevers and chills as well as cough and congestion, but denies sore throat, chest pain, abdominal pain, vomiting, diarrhea, dysuria, vaginal bleeding, or vaginal discharge. She denies any recent travel and denies any animal exposure other than her mother’s dog but there are no fleas that she knows of. She denies any recent insect bites. She states that she has been sexually active with one male partner over the last six months and that she has tested negative for STIs in the last two months. She has no other complaints at this time.

 

Vitals: BP 121/77; HR 107; R 22; T 100.8°F; O2 sat 98% room air.

General: Appears mildly uncomfortable but no acute distress.

HEENT: Normal, no signs of pharyngitis.

Respiratory: Clear to auscultation bilaterally.

Cardiovascular: Tachycardia without murmur.

Abdomen: Non-tender, no masses.

Extremities: There are no signs of trauma. Full range of motion but complaints of joint pain with moving her legs and with walking.

Skin: Relevant findings as shown. Discrete, tender, erythematous macules and vesicles on the bilateral feet, calves, forearms and a singular vesicle of the right1st digit

Urinalysis: Small amount of bacteria

This patient has disseminated gonococcal infection.

Disseminated gonococcal infection (DGI) is a serious complication of untreated gonorrhea, potentially leading to severe complications such as septic arthritis, pustular skin lesions, tenosynovitis, and in rare cases, endocarditis or meningitis. DGI is characterized by fevers, polyarticular joint pain, and skin lesions. The diagnosis of disseminated gonorrhea should be considered in any patient presenting with polyarticular joint pain or swelling in the setting of petechial or pustular skin lesions, especially in high risk populations. The skin lesions of disseminated gonorrhea most commonly appear on the distal extremities, and may involve the palms and soles. Patients may also present with acute septic arthritis without an obvious source. Patients with gonoccocal bacteremia may show signs of perihepatitis, meningitis, endocarditis, or osteomyelitis. Disseminated gonococcal infection results from the hematogenous spread of N gonorrhoeae, and typically develops within 3 weeks of primary mucosal infection. Patients with disseminated gonoccocal infection should be admitted for intravenous antibiotics (ceftriaxone). Any sexual partners should be treated as well.

Take-Home Points

  • Consider disseminated gonorrhea when you have a patient with polyarticular joint pain/swelling with pustular skin lesions.

  • Complications of DGI may be severe; admission and aggressive treatment with intravenous antibiotics is warranted.

  • Tang et al. Characterizing the rise of disseminated gonococcal infections in California, July 2020-July 2021. Clin Infect Dis. January 2023;76(2):194-200.
  • Wang CH, Lu CW. Images of the month 2: Disseminated gonococcal infection presenting as the arthritis-dermatitis syndrome. Clin Med (Lond). 2019 Jul;19(4):340-341. doi: 10.7861/clinmedicine.19-4-340. PMID: 31308120; PMCID: PMC6752240.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2025 SAEM Annual Meeting | Copyrighted by SAEM 2025 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.



By |2026-03-04T10:20:27-08:00Mar 9, 2026|Infectious Disease, SAEM Clinical Images|
Read More

SAEM Clinical Images Series: Modern Pirate

ecchymosis

The patient is a 72-year-old male with multiple medical problems who presents to the Emergency Department complaining of dyspnea on exertion. The patient also complains of bruising that has developed on his right leg. He states that he previously had a similar episode for which she was admitted to the hospital and had warfarin discontinued due to thrombocytopenia. He also reports that he has been unable to eat or drink much lately due to gum swelling and tenderness, and states that when he begins chewing he feels as though his teeth are going to fall out. When asked about his usual diet, the patient states that he primarily eats raisin bran crunch and grits and that he does not really eat fruits or vegetables. He denies any chest pain, abdominal pain, nausea, vomiting, diarrhea, bloody stools, or any other complaints.

 

Vitals: All vital signs are normal.
General: Pleasantly interactive in no acute distress.
HEENT: Key findings are shown in the image provided.
Respiratory: Clear to auscultation, no increased work of breathing.
Extremities/Skin: Diffuse ecchymosis and petechiae are present. Bruising to the right foot and ankle as shown. Bilateral legs with significant petechiae diffusely. Hair as shown.

CBC: WBC 10.4 Hgb 7.8 Plt 98,000

RBC Morphology abnormal- Moderate Anisocytosis, Slight Poikilocytes
Moderate Polychromasia, Slight Elliptocytes, Slight Hyopchromia

CMP: Albumin 2.5, Total Protein 5.4

This patient has scurvy.

Vitamin C deficiency

Scurvy results in multiple symptoms including gingivitis with bleeding, periodontal disease, loss of dentition, mucocutaneous petechiae, ecchymosis, hyperkeratosis, and corkscrew hairs. Scurvy is due to Vitamin C deficiency and resultant impaired collagen biosynthesis. Petechiae, ecchymosis, follicular hyperkeratosis, perifollicular hemorrhages, corkscrew hairs, gingival bleeding, arthralgias, skin discoloration, impaired wound healing, koilonychias, and splinter hemorrhages may all be seen in patients with scurvy. These findings are primarily derived from inability to synthesize collagen due to lack of ascorbic acid, which is used as an electron donor to catalyze proline and lysine into hydroxyproline and hydroxylysine. Ascorbic acid also prevents epigenetic DNA hypermethylation, which is essential in the synthesis of certain collagen types.

Take-Home Points

  • A thorough dietary history can help identify patients at risk for vitamin deficiencies and other diagnoses caused by malnutrition.
  • Scurvy is caused by Vitamin C deficiency and results in impaired collagen synthesis, leading to multiple potential abnormal physical exam findings such as gingivitis with bleeding, severe periodontal disease, loss of dentition, mucocutaneous petechiae, ecchymosis, hyperkeratosis, and corkscrew hairs.

  • Gandhi M, Elfeky O, Ertugrul H, Chela HK, Daglilar E. Scurvy: Rediscovering a Forgotten Disease. Diseases. 2023 May 26;11(2):78. doi: 10.3390/diseases11020078. PMID: 37366866; PMCID: PMC10296835.
  • Léger D. Scurvy: reemergence of nutritional deficiencies. Can Fam Physician. 2008 Oct;54(10):1403-6. PMID: 18854467; PMCID: PMC2567249.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2025 SAEM Annual Meeting | Copyrighted by SAEM 2025 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

By |2026-02-19T12:33:13-08:00Feb 23, 2026|SAEM Clinical Images, Uncategorized|
Read More

SAEM Clinical Images Series: A Mucous Membrane Mystery

eye

The patient is a healthy 14-year-old male without past medical history who presents to the Emergency Department with oral lesions, eye swelling, intermittent fevers, and pain with urination. Over the past 10 days he has been seen by his PCP and at an outside ED for a cough, sore throat, fevers, and oral pain. Three days ago he was seen by his PCP, had a positive rapid strep test, and was started on amoxicillin. His oral lesions and lip swelling have been progressively worsening over the past 2 days. Monospot testing was also performed yesterday and is negative. Today he was seen again by his PCP for new pain with urination and was sent to the ED for concern for Kawasaki disease. The patient has had decreased oral intact due to his pain, but otherwise has no other complaints.

 

Vitals: BP 124/88 HR 112 R 28 T 100.2 F O2sat 94% room air.
HEENT: Relevant findings are shown in the images provided. Tonsillar exudate is present. No meningismus. Voice is normal.
Respiratory: Coarse breath sounds with diffuse wheezing.
Cardiovascular: Tachycardic, no murmurs, no rubs.
Skin: No rash. Negative Nikolsky sign. No palmar desquamation.
Lymph: Cervical lymphadenopathy is present
Genitourinary: See image provided.

CBC, CMP, Urinalysis: negative

COVID/Flu/RSV: negative

Mycoplasma NAAT: positive.

CRP: 13.5 mg/L

ESR: 48 mm/Hr

This child has RIME (reactive infections mucocutaneous eruption), a rare post-infectious cause of mucositis in children and adolescents.

Mycoplasma pneumoniae

Prolonged fevers and illnesses are frequent reasons for pediatric ED visits. Children and adolescents can be more prone than adults to a variety of immune-mediated and other inflammatory reactions such as Kawasaki disease, serum sickness like reactions, erythema or urticaria multiforme, SJS/TEN, MISC, among others. RIME is a relatively recently described post-infectious condition characterized by mucositis in at least two mucus membranes, with or without an area of cutaneous eruption. It was previously called mycoplasma-induced rash and mucositis (MIRM), and mycoplasma is the most common trigger, though the designation RIME implies that other common infectious agents (covid, influenza, and other viral and bacterial pathogens) have been identified as causal agents. Management is supportive, including treatment of the underlying illness (in this case, treatment of mycoplasma). Corticosteroids and other immunomodulatory agents may be used in more severe cases.

Take-Home Points

  • RIME is a reaction primarily involving mucosal surfaces that is often associated with Mycoplasma pneumoniae infections in pediatric populations.
  • Treatment of RIME involves treating Mycoplasma pneumoniae with azithromycin and supportive care including hydration and appropriate consultations for wound management as needed.

  • Lofgren D, Lenkeit C. Mycoplasma Pneumoniae-Induced Rash and Mucositis: A Systematic Review of the Literature. Spartan Med Res J. 2021 Aug 30;6(2):25284. doi: 10.51894/001c.25284. PMID: 34532621; PMCID: PMC8405277.
  • Meyer Sauteur PM, Theiler M, Buettcher M, Seiler M, Weibel L, Berger C. Frequency and Clinical Presentation of Mucocutaneous Disease Due to Mycoplasma pneumoniae Infection in Children With Community-Acquired Pneumonia. JAMA Dermatol. 2020 Feb 1;156(2):144-150. doi: 10.1001/jamadermatol.2019.3602. PMID: 31851288; PMCID: PMC6990853.
  • Rehmus, W. E., Phillips, J., & Flegel, L. (2023). In Pediatric Dermatology (pp. 274–274). essay, UBC LIBRARY. Retrieved January 6, 2025,.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2025 SAEM Annual Meeting | Copyrighted by SAEM 2025 – all rights reserved. View other cases from this Clinical Image Series on ALiEM.

By |2026-02-06T12:12:18-08:00Feb 20, 2026|SAEM Clinical Images, Uncategorized|
Read More
Go to Top