Rectal glucose administration cannot be used to treat hypoglycemia

Managing collapsed or seriously ill participants of ultra-endurance events in remote environments

Increasing participation in ultramarathons and other ultra-endurance events amplifies the potential for serious medical issues during and immediately following these competitions. Since these events are often located in remote settings where access may be extremely limited; the diagnostic capabilities, treatment options, and expectations of medical care may differ from those of urban events. This work outlines a process for assessment and treatment of athletes presenting for medical attention in remote environments, with a focus on potentially serious conditions such as major trauma, acute coronary syndrome, exertional heat stroke, hypothermia, hypoglycemia, exercise-associated hyponatremic encephalopathy, severe dehydration, altitude illness, envenomation, anaphylaxis, and bronchospasm. A list of suggested medical supplies is provided and discussed. But, given that diagnostic and treatment options may be extremely limited in remote settings, it is important for medical providers to understand how to assess and manage the most common serious medical issues with limited resources, and to be prepared to make presumptive diagnoses when necessary.

Dextrose is absorbed by rectum in hypoglycemic rats

The objective of this study was to determine the efficacy of the rectal administration of dextrose in raising the serum glucose in a hypoglycemic rat model. A randomized, prospective, controlled experimental study was performed using 18-h fasted, acutely anesthetized Harlan Sprague-Dawley rats made hypoglycemic by the intravenous infusion of insulin at 3 U/kg/h for 2 h. At 1 h into the infusion, study rats received 1, 2, or 3 g/kg of 50% dextrose solution infused into the rectum using a balloon tipped catheter. Control animals received an equivolume, equi-osmolar (as compared to the 3 g/kg dose) amount of polyethylene glycol (PEG)-400 by rectum. Blood glucose (BG) measurements were made using blood obtained from the portal vein and a femoral artery. Intravenous insulin administered at 3 U/kg/h consistently produced BG levels 60% of baseline at 60 min and 80% of baseline at 120 min. BG levels in portal and arterial circulation increased after rectal dextrose. In general, portal venous values were greater than arterial after rectal dextrose. The greatest increase was seen 30 min after dextrose by rectum in animals receiving 3 g/kg. A 50% dextrose administered by rectum in hypoglycemic rats is absorbed in quantities sufficient to raise BG in the arterial and portal circulation.

Toxic emergencies of endocrine and metabolic therapeutic agents

Treatment recommendations for insulin, sulfonylurea, and thyroid hormone poisoning are widely divergent. Recent research data indicates a standard approach to management of these poisonings. Clinical practice may now incorporate recent findings.