Journal Club

Journal Club Summaries 2/23/2017

Journal Summary #1

Annals of Emergency Medicine 11/2016

Jeremiah S. Hinson, MD, PhD; Michael R. Ehmann, MD, MPH, MS; Derek M. Fine, MD; Elliot K. Fishman, MD, FACR; Matthew F. Toerper, BS; Richard E. Rothman, MD, PhD; Eili Y. Klein, MS, PhDRisk of Acute Kidney Injury After Intravenous Contrast Media Administration

By Stefan Meyering, DO

Main points

Contrast administration was not associated with increased incidence of acute kidney injury (contrast-induced nephropathy criteria odds ratio 0.96, 95% confidence interval 0.85 to 1.08; and Acute Kidney Injury Network/Kidney Disease Improving Global Outcomes criteria odds ratio 1.00, 95% confidence interval 0.87 to 1.16). The baseline sCr and GFR in the contrast-exposed group was lower and showed better renal function than the non-contrast group contributing to bias. Administration of intravenous crystalloids was associated with a lower probability of developing acute kidney injury although the study’s main outcome displayed the frequency of later acute kidney injury in 7,201 patients undergoing contrast-enhanced CT, 5,499 undergoing unenhanced CT, and 5,234 with no imaging did not differ (10.2% to 10.9%)

Bottom Line

This study suggests fear of triggering acute kidney injury after intravenous contrast during ED CT is disproportionate to objective data.

Journal Summary #2

Canadian Journal of Emergency Medicine

Arora, Sanjay, Marc A. Probst, Laura Andrews, Marissa Camilion, Answer Grock, Gregory Hayward, and Michael Menchine. “A Randomized, Controlled Trial Of Oral versus Intravenous Fluids for Lowering Blood Glucose in Emergency Department Patients with Hyperglycemia.” Cjem 16.03 (2014): 214-19. Web.

By Jane Shmelkov, DO

Main points

This was a prospective, non blinded, randomized controlled trial comparing the efficacy and safety of oral vs IV hydration for reducing blood glucose in patients with hyperglycemia. The trial was conducted at Los Angeles County Medical Center at the University of Southern California with over 170,000 annual visits. Over a course of 43 days, a total of 115 patients were approached but only 48 (74%) were eligible and agreed to participated in the study. 25 of those patients were randomized into the IVF administratio arm and 23 into the PO arm. Over the course of 2 hours both groups received a maximum of 2L fluids with moderate decrease in blood glucose, a difference between the groups of -0.6 mmol/L (10 mg/dl). Limitations of the study include small sample size, concern for selection bias as 26% were unable to be consented for the trial, lack of blinding introduces potential bias, no control as in “no treatment arm”, no measurement of serum electrolyte concentrations, no time/cost analysis, no definitive calculations of how much water was taken in orally by the PO arm and how much IVF was administered over the 2 hours

Bottom Line

There is little change in overall decrease of blood glucose regardless if you use IV hydration or PO hydration.

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