Background: Choosing Wisely recommends against testing for amylase in the diagnosis and management of acute pancreatitis; however, national CMS data shows over $19 million in charges for amylase laboratory testing per year. Our hospital spent over $341,000 on roughly 38,000 amylase orders in the past year. Purpose: We developed a quality improvement project to reduce [...]

Background: Decades-old clinical data and practice guidelines support the use of lipase over amylase in the workup and management of acute pancreatitis. Yet, laboratory testing for amylase continues to cost the Center for Medicare and Medicaid Services more than $19 million in largely avoidable charges each year. Previously hypothesized drivers of overutilization of amylase testing [...]

Case Presentation: A 21-year-old previously healthy man presented to an outside hospital with one day of confusion without any other localizing symptoms. He reported taking a supplement called Synergy, an androgen receptor modulator, for six months, and doxylamine, a first generation anti-histamine, for one-two days. He denied alcohol consumption or other substances. Initial vital signs [...]

Case Presentation: – Patient is a 61-year-old female diagnosed with Ornithine Transcarbamylase Deficiency (OTCD) several years ago with hospitalizations for three seizure episodes since diagnosis. These seizures had been triggered by pregnancy, steroids and once due to non-compliance with OTCD medications, respectively. – She got diagnosed with Type 2 Diabetes Mellitus more recently in October [...]