Case Presentation: A 26-year-old male with a history of schizophrenia presented with generalized abdominal pain and altered mental status. He has a history of multiple psychiatric admissions, specifically seven times in the past two years, and long-term antipsychotic usage. Most recently, he was discharged on clozapine, divaloproex, and trazodone. Initial physical exam was notable for [...]

Case Presentation: A 46-year-old male with Type 2 DM presented with 2 weeks of malaise, 3 days of cough, dyspnea, and fatigue. His wife noted his breath smelt different over the last 2 weeks. He had a thyroidectomy for multinodular goiter 2 weeks prior and started a ketogenic, intermittent fasting diet after. Medications include empagliflozin [...]

Background: Diabetic Ketoacidosis (DK)A at our center has historically been managed in the intensive care unit (ICU) utilizing low-dose insulin infusion. According to the American Diabetes Association (ADA) and a 2016 Cochrane review, cases of mild to moderate DKA can be safely managed on general medical floors utilizing subcutaneous short-acting insulin. Prior studies have demonstrated [...]

Case Presentation: A 55-year-old man with a history of homelessness, poorly controlled type 2 diabetes treated with insulin and complicated by recurrent diabetic ketoacidosis (DKA), peripheral vascular disease and neuropathy with foot ulcers, severe autonomic neuropathy with postural hypotension and recurrent syncope treated chronically with midodrine and fludrocortisone, and chronic heart failure with mid-range ejection [...]

Case Presentation: TS is a 58 year-old male with a past medical history of prediabetes, pulmonary embolism, and stage II colon cancer treated via hemicolectomy in 2016 who presented to the hospital with dyspnea and altered mental status. On exam, he was febrile to 38.6 degrees Celsius. His abdomen was distended and diffusely tender to [...]

Case Presentation: A 60 year old female with small cell cancer, type 2 diabetes on an insulin pump and empagliflozin, and recently diagnosed pulmonary embolus (PE) on apixaban presents to the hospital with intractable nausea with vomiting and symptomatic tachycardia. This patient presented 1 month prior with dyspnea and tachycardia and was found to have [...]

Case Presentation: This is a case of a 72-year-old male with Stage III metastatic melanoma. The patient was started on combination immunotherapy with ipilimumab and nivolumab three months prior. He completed three cycles of treatment. He presented to the emergency department with complaints of fatigue and lethargy. Initial assessment of vitals showed hypotension, BP 95/61 [...]

Background: Glycemic control is crucial in the intensive care setting to reduce morbidity and adverse outcomes.1 The debate over methods for achieving this control highlights the risks of hypoglycemia and unclear management parameters.2 Continuous glucose monitoring software, like Glucommander, helps manage blood sugar safely and prevents hypoglycemic events.3,4 Generally, maintaining euglycemia with insulin improves outcomes [...]

Background: Sodium-glucose transport protein 2 inhibitors (SGLT-2i) are antidiabetic drugs that have shown to aid in all-cause/cardiovascular mortality along with progression of renal disease. ​Though SGLT2i have many benefits, there are many instances where these medications need to be held or discontinued; preoperatively (72h-92h prior to surgery), hypotension, reduced oral intake, decrease in eGFR, urinary [...]

Case Presentation: A 43 year-old man presented with one day of diffuse joint pains and fevers. He had new onset severe joint pains and stiffness of the neck, shoulders, elbows, wrists, fingers, hips, knees, and ankles. He used a continuous subcutaneous insulin infusion device to manage type 1 diabetes. He recently had a small bowel [...]