The etiology of primary nocturnal enuresis remains somewhat controversial but may include genetic factors, decreased functional bladder capacity, increased diuresis at night, and constipation. Deep sleep and emotional illness usually play only a minimal
In evaluating recurrent childhood infections, the physician must keep in mind the rarity of true immunodeficiency and the frequency of atopy, day care, exposure to cigarette smoke and anatomic variations as predisposing factors in recurrent childhood il
Recent reviews of the effect of estrogen on the cardiovascular system suggest that long-term estrogen replacement therapy after menopause may prevent cardiovascular disease in women who are at risk. Short-term effects of estrogen on coronary vascular re
Chlamydia trachomatis and Trichomonas vaginalis are common sexually transmitted infections associated with adverse pregnancy outcome. Since patients are frequently asymptomatic, diagnosis on the basis of symptoms or physical findings is unreliable. If m
Acute cholecystitis is a common abdominal condition resulting from chemical or bacterial inflammation of the gallbladder. It is generally related to gallstones and subsequent unresolved obstruction. Early surgery is the treatment of choice because of th
Lindane has been the primary therapy for scabies for more than 30 years. However, because of neurotoxic side effects attributed to this drug, alternative drugs such as 5 percent permethrin have been used, particularly in the pediatric population where t
Clodronate is a second-generation bisphosphonate that has shown the ability to induce substantial gains in bone mineral density when administered in a cyclical regimen in patients with osteoporosis. Because progressive gains in calcium balance and bone
Diagnostic imaging of the spinal canal in the pediatric population is primarily performed to evaluate the presence of congenital malformations, trauma, neoplasms and inflammation. Although magnetic resonance imaging (MRI) is considered the diagnostic mo
Nearly one-half of all spinal injuries occur in motor vehicle accidents, with falls, sports injuries and assaults comprising the remainder. One-half of all spinal injuries occur in the cervical region, with associated risks of quadriplegia. Patients wit
Acetaminophen is believed to produce analgesia primarily through peripheral effects. It has become widely used for analgesia both under medical supervision arid as an over-the-counter agent. Codeine is believed to act mainly within the central nervous s
Date: August, 1991
Treatment of patients with altered mental status caused by hypoglycemia may be complicated by patient agitation and difficult intravenous access. The efficacy of glucagon has been established in patients refractory to exogenous dextrose. Vukmir and colleagues conducted a prospective clinical trial to evaluate the efficacy of glucagon in the prehospital treatment of hypoglycemic patients in whom intravenous access could not be obtained.
The study included 50 patients with hypoglycemia (blood glucose of 80 mg per dL [4.4 mmol per L] or less as determined by blood glucose test strip) and symptoms of decreased level of consciousness, syncope or seizure. All of the patients were evaluated by paramedics and were determined to have difficult intravenous line access. The patients ranged in age f rom four months to 97 years (mean age: 56.8 years). A history of diabetes was reported in 62 percent of the patients. Glucagon was administered in 1.0-mg doses in adults and 0.5-mg doses in children by intramuscular or subcutaneous routes. Pretreatment and post-treatment levels of serum glucose were measured. The level of consciousness of each patient was assessed by a quantitative measure (the Glasgow Coma Scale) and by a qualitative scale (3 = alert; 2 = responsive to verbal stimuli; 1 = responsive to painful stimuli; 0 = unresponsive).
Mean serum glucose levels were 33.2 mg per dL (1.8 mmol per L) before treatment and increased to 133.3 mg per dL (7.4 mmol per L) after treatment. Mean qualitative level of consciousness scores increased from 1.26 before treatment to 2.42 after treatment, and mean Glasgow Coma Scale scores increased from 9.00 before treatment to 13.04 after treatment. In the 41 patients (82 percent) who had increases in both of the scores, mean time until response was 8.8 minutes. Administration of glucagon resulted in an increase in glucose levels in 49 (98 percent) of the patients. Headache was reported in only two patients (4 percent).
The authors conclude that glucagon is safe and effective therapy in the management of hypoglycemia in the prehospital setting. Glucagon has a rapid onset of action with minimal side effects, and the deleterious effects of hyperglycemia are avoided. Annals of Emergency Medicine, April 1991, vol. 20, p. 375.)
COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group