Warning over diabetic ketoacidosis after man’s death
GPs are being told to consider diabetic ketoacidosis after a man died less than 24 hours after presenting to his doctor. According to the Victorian Coroner’s report, a 29-year-old man visited his GP complaining of increased urination, thirst and difficulty sleeping. He had a fever of 38.6C with high blood pressure and the GP prescribed cephalexin antibiotics for a urinary tract infection. A urine sample was taken and sent to pathology, as well as requests for blood tests; however, the patient was found dead in his home at 9pm the following day. The pathology report dated the day after testing found ketones and glucose in the urine sample. The coroner found that the patient died from diabetic ketoacidosis. Post mortem toxicological analysis showed a glucose concentration of 45mmol/L, combined with raised acetone levels in the blood and vitreous. The coroner recommended the RACGP provide a clinical update to GPs to highlight the importance of recognising hyperglycaemia and ketosis in adult diabetic patients. RACGP President Dr Frank R Jones said: “The RACGP will certainly review and respond to the coroner’s recommendations regarding diabetic ketoacidosis (DKA) as published in the findings into the death of (the patient) and will communicate a clinical update to members. Read more at doctorportal.

Link found between childhood wheezing and lung disease
A LONG-term study has found children who wheeze could be at risk of developing lung disease later in life. British researchers found almost 60% of children who started wheezing in infancy and continued to age 10 were still affected at age 18 and had significantly impaired lung function. Patients were recruited at birth in 1989 (n=1456) and were studied at the ages of 1, 2, 4, 10 and 18. A wheeze recording took place at each visit. According to Dr Claire Hodgekiss, a clinical fellow in asthma and allergy based at the David Hide Asthma and Allergy Research Centre in England, “using our large group of long-term research patients, we’ve discovered wheeze can transcend adolescence into young adulthood and cause airway disease at 18 years, which is a new finding”. Persistent wheezers had worse lung function compared to those who hadn’t wheezed at all in the first decade of their life. The study found 62% of persistent wheezers had more than one common allergic disease including eczema, hay fever or asthma. The current smoking rate of persistent wheezers at age 18 was also almost double that of non-wheezers (44.4% v 24%). Read more at doctorportal.

Homelessness, Aboriginality are contributing factors to ED attendance
A study published today in the MJA has found that frequent attenders to the emergency department (ED) of a remote Northern Territory hospital were more likely to be homeless and/or Indigenous, with alcohol and rainy weather also possibly playing a role. The researchers conducted a non-matched case–control study that included all adult patients who presented to Katherine Hospital ED between 1 January and 31 December, 2012. Cases were defined as frequent attenders without a chronic health condition if they presented to the ED on six or more occasions during the study period; controls were patients who presented on only one occasion. Frequent attenders had a 2-year mortality rate of 7.3% (6.8 times the national average), compared with 2.8% for controls, although this difference was not statistically significant. “Evidence-based strategies that redress homelessness and alcohol-related harm among Aboriginal people in Australia’s north are an imperative,” the authors concluded.

A rare cause of intrathoracic mass
A snapshot published in the MJA today highlighted the case of a 47-year-old woman who presented complaining of cough and dyspnoea. Corrective surgery for scimitar syndrome had been performed 4 years earlier, with relocation of the draining scimitar vein to the left atrium via right thoracotomy. A computed tomography scan of the chest revealed right middle lobe pneumonia and a cephalad malposition of the right kidney in a diaphragmatic hernia, giving an intrathoracic appearance. The patient had normal renal function according to biochemistry results. Malpositioning of the kidneys and renal ectopia are rare causes of intrathoracic mass and should be considered in the differential diagnosis. See the image here.

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