International Journal of Emergency Medicine最新文献

Background: Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, is increasingly used for obesity treatment, including in individuals without diabetes. Starvation ketoacidosis is a rare but serious complication associated with reduced caloric intake and enhanced ketogenesis. Reports of tirzepatide-associated starvation ketoacidosis in non-diabetic patients remain limited, and none have been reported in East Asian populations.

Case presentation: A 21-year-old Japanese woman with obesity initiated weekly subcutaneous tirzepatide (2.5 mg/week) for weight loss while practicing carbohydrate restriction. After the fifth injection, she developed persistent nausea and vomiting, leading to markedly reduced oral intake. She presented to the emergency department with hypoglycemia (68 mg/dL) and severe high-anion gap metabolic acidosis (pH 7.22, bicarbonate 10 mmol/L, anion gap 22.6 mmol/L). Urinalysis revealed ketonuria, and serum ketone levels were markedly elevated. She had lost 21 kg one month after the initiation of tirzepatide. No infection, toxin exposure, or alternative metabolic disorder was identified. Starvation ketoacidosis was diagnosed. Treatment with intravenous glucose-containing fluids resulted in rapid resolution of metabolic acidosis within 12 h without insulin therapy.

Conclusions: This case demonstrates that tirzepatide can precipitate starvation ketoacidosis in non-diabetic individuals, particularly when gastrointestinal adverse effects or dietary restriction lead to caloric deprivation. As the first reported case in an East Asian patient, it highlights the need for emergency physicians to consider starvation ketoacidosis in patients using tirzepatide for weight loss who present with vomiting, poor intake, or rapid weight loss. Early recognition and appropriate metabolic assessment are essential, and in patients with preserved endogenous insulin secretion, prompt glucose administration may allow rapid recovery without need for insulin therapy.

Background: The use of Whole-Body Computed Tomography (WBCT) is becoming the standard of care for trauma patients as a first approach in the emergency setting. Radiation exposure is one of its major drawbacks. The use of a low-dose WBCT may be the answer to reduce radiation exposure. However, few studies have investigated the impact in clinical practice. This scoping review collected the available evidence comparing dose-reduction strategies in WBCT with the standard of care protocol.

Methods: This study is a scoping review of technical data, the use and effects of low-dose CT in injured patients. Electronic searches were performed using Ovid Medline, Cochrane CENTRAL, Embase, LILACS, Scielo, WPRIM from the date of inception to 5 March 2024. Unpublished trials were identified by searching trial registers, clinicaltrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), the Cochrane central register of Controlled Trials, conference abstracts and theses.

Results: Twenty-two articles were included, mostly observational and retrospective. Only one prospective randomised trial was reported. The methods used to reduce the dose were the use of an iterative reconstruction technique in 6 studies, a split bolus technique in 8 studies, a different arm positioning in 4 studies, and a single-pass continuous whole-body acquisition technique in 3 studies. The image quality of the low-dose protocols was generally similar or inferior, but the diagnostic capacity remained the same. The lowest effective dose achieved in the different studies for effective dose was 4.8 mSv for a protocol combining iterative reconstruction with a split-bolus.

Conclusion: Across studies, a consistent trend of dose reduction was observed with all strategies, with larger reductions reported for split-bolus protocols. However, direct comparisons were limited by heterogeneity in study designs, scan protocols, and reporting measures of effect, precluding definitive conclusions about the relative superiority of any single approach. Image quality did not seem to be affected by dose reduction. However, there was an increase in missed diagnoses of arterial injury. Direct comparisons were limited by heterogeneity in study designs, scan protocols, and reporting measures of effect, precluding definitive conclusions about the relative superiority of any single approach.