Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low-to middle-income country

BACKGROUND: Timely identifi cation of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care(POC) testing is being increasingly utilized in the emergency department(ED). We examined the accuracy and timesaving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED patients.METHODS: A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fi ngertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation(ICC) and Bland and Altman plots.RESULTS: Forty-three septic patients were included in the study. The fingertip POC & whole blood POC lactate measurements each correlated tightly with the reference method(ICC=0.93 & ICC=0.92, respectively). Similarly at 6 hours, the fingertip POC & whole blood POC lactate measurements demonstrated satisfactory correlation with the reference method(ICC=0.95 & ICC=0.97, respectively).CONCLUSION: Fingertip POC lactate measurement is an accurate method to determine lactate levels in septic ED patients.KEY WORDS: Sepsis; Point of care; Lactate; Emergency department;

Euglycemia despite a sodium glucose co-transporter 2 inhibitor overdose

Dear editor,Sodium glucose co-transporter 2 inhibitors(SGLT2I)reduce the majority of reabsorption of glucose in the proximal tubules,which reduces blood glucose levels by allowing excretion of excess glucose in the urine.[1]By inhibiting glucose reabsorption,they increase the osmotic pressure of urine resulting in diuresis which can cause a reduction of blood pressure.[2]Fortunately,as these drugs are not directly implicated in altering glucose metabolism or causing insulin secretion,SGLT2I monotherapy does not result in severe hypoglycemia.

Community emergency medicine:Benefits and challenges of screening for elder abuse in the emergency department of a developing country

As people live longer and fewer babies are born,the elderly became the fastest and largest growing population of the world,expected to increase further from 86 million in 2005 to 394 million in 2050 worldwide.Older patients represent a large bulk of the population arriving in emergency departments(EDs)all over the world.^([1])They use hospitals more frequently than younger patients。