D50 vs D10 for Severe Hypoglycemia in the Emergency Department

Think back to your last severely hypoglycemic and lethargic patient presenting to the ED. What was the first treatment modality that came to mind? The initial knee-jerk reaction might be to reach for that big blue box of D50 if the patient has IV access. After all, top priority is to reverse hypoglycemia as fast as possible. But in the midst of stabilizing the patient, how often do we consider the potential aftermath of concentrated glucose?

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By Adam Spaulding, PharmD BCPS|2020-09-17T08:57:06-07:00Dec 31, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical)|

Can Permanent Marker Leach into IV Infusion Bags?

You are resuscitating a hypotensive patient with severe sepsis and have just hung your 4th liter of crystalloid. On the fluid bags, you wrote the numbers 1 through 4 in permanent marker to help keep track of your resuscitation. As you finish placing your central line the charge nurse enters the room. He informs you that according to the Institute for Safe Medical Practices (ISMP), writing directly on IV bags with permanent marker is not recommended due to concerns that the ink will leach into the bag and potentially cause harm to your patient.^1–4

This situation raises several questions:

Should we write on IV bags in permanent marker?
Is there a possibility of ink diffusing through polyvinylchloride (PVC) bags?
If so, is there potential harm to the patient?

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By Jeremy Bair, PharmD, BCPS|2019-02-19T18:22:53-08:00Nov 24, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Tox & Medications|

Why Henderson and Hasselbalch Belong in the ED

If you’re like me, you learned and then promptly forgot the Henderson Hasselbalch equation (HH eq) in medical school.¹ After all, in clinical rotations it was never invoked, and our patients seemed to have fared well without it. So why bring up the topic now?

Medicine is changing. The ubiquitous nature of computing allows a level of sophistication exponentially greater than before. To a large extent we’re freed from much of the onerous work of rote memorization. In the ideal, that should free us to be more thoughtful about the way we approach our work and to have a deeper understanding of health and disease. Going forward, medicine will become increasingly computational. With that in mind, I’ll make three points about the HH eq.

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By Frank Ruiz, MD|2016-11-28T17:27:51-08:00Nov 19, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical)|

Mythbusting the Banana Bag

We’re all pretty familiar with the banana bag: intravenous (IV) fluids with the addition of thiamine, folic acid, multivitamins, and sometimes magnesium. Banana bags are commonly utilized in patients at risk for alcohol withdrawal symptoms or those who present to the emergency department (ED) acutely intoxicated.

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By Meghan Groth, PharmD, BCPS|2019-04-05T17:18:28-07:00Nov 5, 2014|Endocrine-Metabolic, Expert Peer Reviewed (Clinical), Pre Publication Critique (Clinical), Tox & Medications|

AIR Series: Endocrinology Module 2014

Welcome to the third ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our readers for the reading and learning they are already doing online, we have created an Individual Interactive Instruction (III) opportunity utilizing FOAM resources for U.S. Emergency Medicine residents. For each module, the board curates and scores a list of blogs and podcasts. A quiz is available to complete after each module to obtain residency conference credit. Once completed, your name and institution will be logged into our privatedatabase, which participating residency program directors can access to provide proof of completion.

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By Andrew Grock, MD|2017-03-05T14:18:40-08:00Oct 1, 2014|Approved Instructional Resources (AIR series), Endocrine-Metabolic|

Antidiabetic Medications: Hypoglycemic Potential in Overdose

With several new diabetes medications available, it is important to know which ones are likely to cause hypoglycemia after overdose. Based on mechanism of action and reported cases, the likelihood of hypoglycemia after overdose is listed below by drug class. ¹

Keep in mind that other drugs can interact with antidiabetic medications resulting in hypoglycemia. The following table applies only to single agent ingestion/administration.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2016-11-11T19:22:28-08:00Sep 16, 2014|Endocrine-Metabolic, Tox & Medications|

Article: Hypotonic maintenance IV fluids in pediatrics

A 6-month-old male presents to the emergency department with diarrhea and vomiting. Despite antiemetic therapy, the the child is unable to tolerate oral intake in the ED and so you opt to admit him to the hospital for IV fluids. The pediatric hospitalist requests that you write maintenance fluids prior to admission to the floor. Utilizing the 4-2-1 rule you calculate maintenance needs and choose D5 ½NS as your fluid. This is what you had been taught to utilize in children. It seems appropriate… but is it?

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By William Paolo, MD|2016-11-11T19:19:57-08:00Apr 9, 2014|Endocrine-Metabolic, Pediatrics|

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