Israel Medical Association Journal

Lactation ketoacidosis (LA) is a well-documented phenomenon in cows, known as bovine ketoacidosis. It occurs when there is a negative energy balance because of a high glucose demand for milk production. LA in humans is rare, although the first case was reported in 1982 [1] and several cases have been reported in recent years. In most cases, there is a recognizable precipitating factor, often fasting or consuming a low calorie or low carbohydrate diet. However, a case of recurrent LA with no apparent trigger has also been reported [1]. In most cases the patients were euglycemic on presentation; however, hypoglycemia had been reported [2]. In this study, we present a case of LA and hypoglycemia on presentation with an unexpected striking hyperglycemia after treatment with dextrose.

Background: Syncope is a common reason for emergency department (ED) visits; however, the decision to admit or discharge patients after a syncopal episode remains challenging for emergency physicians. Decision rules such as the Boston Syncope Criteria have been developed in an attempt to aid clinicians in identifying high-risk patients as well as those who can be safely discharged, but applying these rules to different populations remains unclear.

Objectives: To determine whether the Boston Syncope Criteria are valid for emergency department patients in Israel.

Methods: This retrospective cohort convenience sample included patients who visited a tertiary care hospital in Jerusalem from August 2018 to July 2019 with a primary diagnosis of syncope. Thirty-day follow-up was performed using a national health system database. The Boston Syncope Criteria were retrospectively applied to each patient to determine whether they were at high risk for an adverse outcome or critical intervention, versus low risk and could be discharged.

Results: A total of 198 patients fulfilled the inclusion criteria and completed follow-up. Of these, 21 patients had either an adverse outcome or critical intervention. The rule detected 20/21 with a sensitivity of 95%, a specificity of 66%, and a negative predictive value of 99%.

Conclusions: The Boston Syncope Criteria may be useful for physicians in other locations throughout the world to discharge low-risk syncope patients as well as identify those at risk of complications