Turkish Journal of Emergency Medicine最新文献

{"title":"Emergency practitioner-administered ultrasound nerve blocks in the emergency department: A retrospective analysis.","authors":"Suhrith Bhattaram, Varsha S Shinde, Ishan Lamba, Princy Panthoi Khumujam, Tanvi Snehal Desai","doi":"10.4103/tjem.tjem_41_24","DOIUrl":"10.4103/tjem.tjem_41_24","url":null,"abstract":"<p><strong>Objectives: </strong>In the realm of acute pain management within emergency departments (EDs), the prevalent reliance on systemic analgesics, notably opioids, presents challenges due to associated risks and suboptimal efficacy. The emerging alternative of ultrasound-guided nerve blocks (USGNBs) has shown promise in prospective studies. However, the safety and efficacy of USGNBs when performed by emergency medicine practitioners remain largely unexplored, necessitating this study to address the research gap. The primary objectives of this study were to assess the efficacy of Emergency physician-performed USGNBs and changes in patient-reported pain (pre- and postnerve block) at 15 and 30 min. In addition, the time taken to perform nerve blocks, type of nerve block, frequency, indications, procedure time, and complications were all studied.</p><p><strong>Methods: </strong>Conducted at a Tertiary Care Teaching Hospital in Pune, India, this single-center, retrospective observational study aimed to evaluate the effectiveness of USGNBs in the ED context. A retrospective analysis covered 274 emergency practitioner-performed USGNBs recorded from January 2022 to December 2023. Participants included consecutive ED patients consenting to nerve blocks, with practitioners utilizing bupivacaine (0.25%) and ropivacaine (0.25%) based on individual preferences. The study systematically recorded patient demographics, block types, indications, complications, and pre- and postpain scores on a Numerical Rating Scale.</p><p><strong>Results: </strong>The study demonstrated a significant reduction in pain scores post-USGNB, with an average decrease of 2.9 ± 1.08 at 15 min and 5.8 ± 1.39 at 30 min. Commonly performed blocks included the femoral nerve, fascia iliaca, and serratus anterior, with notable pain relief in fracture management cases. Procedural durations varied, ranging from 2 to 12 min, while four complications were reported, including diaphragmatic paresis and arterial punctures during interscalene nerve block and fascia iliac compartment blocks, respectively.</p><p><strong>Conclusion: </strong>This extensive study in an academic ED setting supports the proficiency of emergency practitioners in performing USGNBs. The findings emphasize the transformative potential of USGNBs in academic ED pain management, showcasing notable pain reduction and minimal complications. These results advocate for the integration of advanced pain relief techniques into emergency medicine training programs, contributing to a comprehensive approach to acute pain management.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"245-251"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected consequences: A case of ketamine-induced seizure in procedural sedation.","authors":"Adem Az, Yunus Doğan","doi":"10.4103/tjem.tjem_67_24","DOIUrl":"10.4103/tjem.tjem_67_24","url":null,"abstract":"<p><p>This case report describes a 32-year-old male who underwent ketamine procedural sedation and experienced a generalized tonic-clonic seizure. Despite its rapid onset and favorable tolerance profile, this case emphasizes the potential convulsive side effects of ketamine, which is commonly used for procedural sedation. While ketamine has shown promise in treating acute pain, refractory status epilepticus, and treatment-resistant depression and schizophrenia, it is associated with side effects such as hallucinations, visual disturbances, dizziness, nausea, and vomiting. The patient in this case received a carefully titrated dose of 40 mg of ketamine intravenously and underwent successful shoulder reduction while under sedation. However, within 60 s of receiving the ketamine, the patient experienced a 60-s seizure that was stopped with the administration of 5 mg of diazepam intravenously. The patient was hospitalized for further evaluation, including an electroencephalography (EEG) that showed no abnormalities. This case highlights the need for health-care professionals to be aware of the potential convulsive side effects of ketamine and to carefully monitor patients who receive ketamine sedation.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"259-261"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional outcome predictors and recanalization in cerebral venous thrombosis: A single-center cross-sectional study.","authors":"Rizwana Shahid, Azra Zafar","doi":"10.4103/tjem.tjem_65_24","DOIUrl":"10.4103/tjem.tjem_65_24","url":null,"abstract":"<p><strong>Objectives: </strong>Cerebral venous thrombosis (CVT) is a rare type of stroke. Functional outcome (FOC) in CVT can be affected by different factors, and recanalization is an important determinant. This study aimed to identify the FOC predictors including recanalization in patients with CVT.</p><p><strong>Methods: </strong>This retrospective study reviewed electronic charts of patients with CVT admitted to the King Fahd Hospital of the University, a teaching and referral hospital between January 2012 and March 2023. Demographic and other clinicoradiological characteristics were noted. Factors affecting FOC were investigated using the Chi-square test, odds ratios (ORs), and 95% confidence interval (CI).</p><p><strong>Results: </strong>Out of 64 patients, 78% achieved good FOC. Age was significantly higher in patients having poor FOC as compared to those having good FOC (<i>P</i> ≤ 0.001). Women had more likelihood to be functionally independent as compared to men (OR = 1.35, 95% CI = 1.01-1.80, <i>P</i> = 0.02). Altered consciousness (OR = 2.94, 95% CI = 1.23-6.99, <i>P</i> = 0.01), venous hemorrhagic infarction (OR = 3.26, 95% CI = 1.36-7.82, <i>P</i> = 0.008), and nonrecanalization (OR = 1.44, 95% CI = 0.97-2.14, <i>P</i> = 0.02) were significantly associated with poor FOC. Hereditary thrombophilia (OR = 0.60, 95% CI = 0.31-1.12, <i>P</i> = 0.03) and infections (OR = 0.59, 95% CI = 0.31-1.12, <i>P</i> = 0.01) were associated with less likelihood of good FOC. Age ≥50 years (<i>P</i> = 0.01) and illness of more than 1-month duration (<i>P</i> = 0.01) were associated with nonrecanalization.</p><p><strong>Conclusion: </strong>Older age, male sex, presence of venous hemorrhagic infarction, and nonrecanalization can predict poor FOC in CVT. The recanalization process can be affected by late presentation, and the plausible reason could be a delay in therapeutic anticoagulation. Further prospective and multicenter studies are needed to determine the predictors of FOC and to understand the process of recanalization in CVT.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"218-225"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of plasma alpha- and beta-synuclein levels in the diagnosis, severity, and functional outcome of acute ischemic stroke.","authors":"Özge Başak Fırtına, Ömer Salt, Mustafa Burak Sayhan, Ilker Dibirdik, Aykut Yucal","doi":"10.4103/tjem.tjem_17_24","DOIUrl":"10.4103/tjem.tjem_17_24","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to determine the role of plasma alpha- and beta-synuclein levels and other routine inflammatory parameters in the diagnosis, outcome, and mortality of acute ischemic stroke (AIS).</p><p><strong>Methods: </strong>In our study, serum alpha- and beta-synuclein levels and clinical data were prospectively evaluated in 93 subjects (43 controls and 50 AIS patients) admitted to the emergency department. The outcome status and prognostic classification were performed according to the modified Rankin Scale (mRS) scores on the 30^th day from hospital admission.</p><p><strong>Results: </strong>The mean age of the subjects was 70.6 ± 11 years. Thirty-eight percentage were female. Plasma α-synuclein levels in the AIS group (33.6 ± 8.5 ng/mL) were significantly higher than those in the control group (4.22 ± 2.1 ng/mL) (<i>P</i> < 0.001). Plasma β-synuclein levels in the AIS group (13.07 ± 2.7 ng/mL) were significantly higher than those in the control group (2.17 ± 1.4 ng/mL) (<i>P</i> < 0.001). There was no significant difference in alpha- and beta-synuclein levels between the subgroups formed according to the 30^th-day results of the patients using the mRS scores (<i>P</i> = 0.813 and 0.812, respectively).</p><p><strong>Conclusion: </strong>The serum alpha- and beta-synuclein concentrations of patients with AIS at admission were significantly higher than the healthy control group. At admission, serum alpha- and beta-synuclein levels do not have definitive clinically predictive value in predicting stroke progression and outcome in patients with AIS.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 4","pages":"238-244"},"PeriodicalIF":1.1,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11573173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Reversible Encephalopathy Syndrome (PRES) following blood transfusion in a polytrauma victim, an atypical occurrence.","authors":"Erum Shariff, Nehad Mahmoud Soltan","doi":"10.4103/tjem.tjem_30_24","DOIUrl":"10.4103/tjem.tjem_30_24","url":null,"abstract":"<p><p>Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological syndrome, clinically present by impaired consciousness, headache, visual disturbances, and seizures, and radiologically brain edema. Cases of PRES induced by blood transfusion are rarely documented. We report this case to increase the awareness of treating physicians for the possible complications of rapid blood transfusion. A 29-year-old man presented with polytrauma and was in hemorrhagic shock. He was transfused with multiple transfusions. Later, he was found to have quadriplegia with minimal movement of fingers in the left hand. His computed tomography showed cerebral edema in multiple cerebral regions. We propose that the etiology in this case is that rapid blood transfusion induced acute rise in hemoglobin which led to PRES. The influences of blood transfusion on blood flow, blood viscosity, and endothelial dysfunction lead to blood-brain barrier dysfunction, which can result in PRES.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 3","pages":"180-184"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11299845/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing commercial versus low-cost gelatinous phantoms for ultrasound-guided needle tracking: A randomized crossover trial, among emergency medicine residents.","authors":"Prawal Shrimal, Nirmal Thakur, Bharath Gopinath, Prakash Ranjan Mishra, Ranjan Rajalekshmi, Sanjeev Bhoi, Praveen Aggarwal, Nayer Jamshed, Ashish Datt Upadhyay","doi":"10.4103/tjem.tjem_206_23","DOIUrl":"10.4103/tjem.tjem_206_23","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this study was to devise a low-cost indigenous gelatin-based vascular phantom and to compare this newly constructed phantom with a commercially available phantom.</p><p><strong>Methods: </strong>This was a randomized crossover study conducted at a tertiary care hospital of India. The aim of the study was to develop a prototype low-cost gelatin-based vascular phantom and compare it with a commercially available phantom. Gelatin, psyllium husk, corn starch, antiseptic liquid, food-coloring agent, latex balloons, and metallic containers were used to prepare the gelatin phantom. The newly prepared gelatin model was labeled \"Model A\" and the commercially available gelatin model was labeled \"Model B.\" Emergency medicine residents (<i>n</i> = 34) who routinely perform ultrasound (USG)-guided invasive procedures were asked to demonstrate USG-guided in-plane and out-of-plane approach of needle-tracking in both the models and fill out a questionnaire on a Likert scale (1-5). An independent supervisor assessed the image quality.</p><p><strong>Results: </strong>The cost of our phantom was USD 6-8 (vs. USD 1000-1200 for commercial phantom). The participants rated the ease of performance and tissue resemblance as 4 (interquartile range [IQR]: 4-5) for both the models \"A\" and \"B.\" The supervisor rated the overall performance as 4 (IQR: 3-4) for both the models. In all the parameters assessed, model A was noninferior to model B.</p><p><strong>Conclusion: </strong>The indigenously developed vascular phantom was noninferior to the commercially available phantom in terms of tissue resemblance and overall performance. The cost involved was a fraction of that incurred with the currently available commercial model. The authors feel that gelatin-based models can be easily prepared in resource-constraint settings which may be used for USG-guided training and medical education in low- and middle-income countries.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 2","pages":"103-110"},"PeriodicalIF":0.9,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11100574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family opinions on resuscitation and participation in end-of-life care in the emergency department: A cross-sectional study.","authors":"Ugur Akman, Aynur Koyuncu","doi":"10.4103/tjem.tjem_164_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_164_23","url":null,"abstract":"<p><strong>Objective: </strong>The study looked into emergency department family members' (FMs) views on being present during resuscitation and contributing to end-of-life care.</p><p><strong>Methods: </strong>A cross-sectional study with 467 FM volunteers of mildly injured or ill patients was conducted at a research hospital between October 2021 and May 2022. Data were collected using a questionnaire administered by a clinical psychologist. The analysis employed SPSS 22.0 with a significance threshold of <i>P</i> < 0.05. The study was conducted according to the STROBE criteria. Statistical significance was set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>The mean FMs' age was 34.3 ± 10.43; 64.2% were male, 62.1% were married, and 76.9% had nuclear families. About 61% wanted the option of being present during resuscitation, with 47.5% desiring participation in both resuscitation and end-of-life care. Significant differences were observed in opinions based on education, work status, and resuscitation training (<i>P</i> = 0.015, <i>P</i> = 0.001, <i>P</i> = 0.002).</p><p><strong>Conclusion: </strong>Many FMs sought the choice to be present during resuscitation, and nearly half preferred participation in both resuscitation and end-of-life care.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"48-54"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of high-dose methylprednisolone in Zargar Grade IIB corrosive esophageal burns: A randomized control study.","authors":"Irtiqa Sheikh, Nayer Jamshed, Akhil Neseem, Praveen Aggarwal, Saurabh Kedia, Maroof Ahmad Khan, Chandan J Das, Ankit Kumar Sahu","doi":"10.4103/tjem.tjem_134_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_134_23","url":null,"abstract":"<p><strong>Objective: </strong>The objective of the study is to test the efficacy of high-dose methylprednisolone in the prevention of esophageal stricture after corrosive ingestion.</p><p><strong>Methods: </strong>This study was a single-center, randomized controlled single-blinded study. Simple randomization was done with 15 adult patients (>18 years) in each arm, who presented with a history of corrosive ingestion within the past 24 h and had esophageal injury of Zargar Grade IIB on endoscopy. Intravenous methylprednisolone 1 g/day for 3 days was given to the intervention arm while 100 mL of normal saline was given as placebo in control arm. Follow-up to diagnose esophageal stricture was done at 8 weeks.</p><p><strong>Results: </strong>Thirty patients (15 in each arm) were recruited for the study. As per the intention to treat analysis, 33% and 46.6% developed stricture in the intervention and control arm, respectively (relative risk [RR] = 0.714; 95% confidence interval 0.29-1.75; <i>P</i> = 0.462). 40% patients in control group and 7.7% in intervention group had undergone feeding jejunostomy, which was statistically significant with a p-value of 0.048. Airway injury showed significant clinical improvement in the intervention arm but the difference was nonsignificant statistically (<i>P</i> = 0.674). There was no increased incidence of hypertension, hyperglycemia, hyponatremia, hyperkalemia, or infections in intervention arm.</p><p><strong>Conclusion: </strong>Methylprednisolone does not help in the prevention of stricture formation in corrosive esophageal injury, but it significantly reduces the requirement of feeding jejunostomy and has a beneficial role in treating airway injury.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"20-26"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ratio of oxygen saturation index for predicting high-flow nasal cannula outcomes in emergency department for COVID-19 patients with severe hypoxemia: A retrospective study.","authors":"Cynthia Karam, Ahmad Oseili, Fadia M Shebbo, Mohamad Fakih, Mohamad F El-Khatib","doi":"10.4103/tjem.tjem_159_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_159_23","url":null,"abstract":"<p><strong>Objectives: </strong>High-flow nasal cannula (HFNC) oxygen therapy has been used as an initial ventilatory support for coronavirus disease 2019 (COVID-19) patients with mixed levels of acute hypoxemic respiratory failure (AHRF). However, the effectiveness of HFNC when used as initial ventilatory support in COVID-19 patients with severe AHRF exclusively is not well documented. Ratio of oxygen saturation (ROX) index (ROX = [SpO₂/fraction of inspired oxygen]/respiratory rate) was shown to predict the outcome of HFNC in intensive care unit patients. Our study aimed to evaluate the utility of the ROX index for predicting HFNC therapy success/failure in COVID-19 patients with severe AHRF when HFNC is used as the first line of ventilatory support.</p><p><strong>Methods: </strong>Retrospective study in 67 COVID-19 patients with severe AHRF receiving HFNC in the emergency department at a tertiary care academic medical center. ROX index was determined at 0, 2, 6, 12, and 24 h of HFNC onset. The need to escalate to noninvasive or invasive ventilatory support was documented. The receiver operating characteristic curves were performed and areas under the curves (AUCs) were calculated to evaluate the accuracy of ROX index for differentiating between patients who will succeed or fail HFNC therapy.</p><p><strong>Results: </strong>HFNC therapy was successful in 19 patients (28.1%) and failed in 48 patients (71.6%). ROX index after 6 h of HFNC initiation had the best predictive capacity for the outcome of HFNC therapy (AUC = 0.78). ROX index >4.4 at 6 h of HFNC onset was significantly associated with HFNC success/failure.</p><p><strong>Conclusion: </strong>ROX index at 6 h after initiating HFNC therapy in COVID-19 patients with severe AHRF has a good predictive capacity for HFNC success/failure.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"41-47"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re-emergence of a forgotten diabetes complication: Euglycemic diabetic ketoacidosis.","authors":"Murat Dagdeviren, Tolga Akkan, Derun Taner Ertugrul","doi":"10.4103/tjem.tjem_110_23","DOIUrl":"https://doi.org/10.4103/tjem.tjem_110_23","url":null,"abstract":"<p><p>Diabetic ketoacidosis (DKA) is the most common emergency complication of diabetes. Euglycemic DKA (EDKA), on the other hand, has been known for many years but is a rare and under-recognized condition and constitutes a very small proportion of DKA cases. However, in recent years, an increase in the incidence of EDKA has been observed with the widespread use of sodium-glucose co-transporter 2 inhibitors, which have proven benefits in the treatment of diabetes mellitus and its cardiorenal complications, heart failure, and chronic kidney disease. Unlike classical DKA, these patients without significant hyperglycemia can easily be missed in emergency departments. EDKA should be kept in mind in patients with diabetes presenting with DKA but with a blood glucose level <250 mg/dL. The diagnostic and therapeutic approach after clinical suspicion in these patients is similar to classical DKA and is briefly summarized in this review. The most important point in treatment is that these patients are normoglycemic but have a significant insulin deficiency (relative or absolute). Therefore, insulin is the mainstay of the treatment and should be given together with dextrose solutions to avoid hypoglycemia.</p>","PeriodicalId":46536,"journal":{"name":"Turkish Journal of Emergency Medicine","volume":"24 1","pages":"1-7"},"PeriodicalIF":0.9,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10852133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}