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Diabetic and endocrine emergencies
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  • Published on:
    Treatment of Acute Adrenal Crisis.

    Adrenal crisis is a medical emergency. If suspected treatment should be started as soon as possible. Every emergency physician should be familiar with adrenocortical insufficiency—a potentially life-threatening entity. The initial diagnosis and decision to treat are presumptive and are based on history, physical examination, and, occasionally, laboratory findings. Delay in treatment while attempting to confirm this diag...

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    Conflict of Interest:
    None declared.
  • Published on:
    Use of empirical hydrocortisone in suspected adrenal crisis

    Editor,

    In their helpful review article, Kearney and Dang advocate giving hydrocortisone to suspected adrenal crisis pending ACTH stimulation testing. Many authorities suggest the use of dexamethasone prior to testing as it does not interfere with cortisol assay (eg. Webb et al 1999, Shenker et al 2001). Can the authors justify their postponement of confirmatory tests?

    Yours sincerely

    Mark...

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    Conflict of Interest:
    None declared.
  • Published on:
    Comments to Diabetic and endocrine emergencies
    Dear Editor,

    In the recent review "Diabetic and endocrine emergencies (1) several important issues have been omitted or incompletely explained.

    1. On p 79, the authors write "In DKA, the severe deficiency in insulin and increased counter-regulatory hormones lead to increased lipolysis and production of ketone bodies and resulting metabolic acidosis. It is...
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    Conflict of Interest:
    None declared.
  • Published on:
    the possible role of acidosis-related capillary permeability in adult respiratory distress syndrome

    Dear Editor,

    Although adult respiratory distress syndrome (ARDS) is a complication common to both ketotic and non-ketotic diabetic decompensation (1), being arguably attributable to the development of adverse osmotic gradients which generate pulmonary oedema (2), the fact that ARDS is much commoner in diabetic ketoacidosis (DKA) than in hyperosmolar non-ketotic (HONK) diabetic decompensation (3)(4)(5) suggests that th...

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    Conflict of Interest:
    None declared.