Clinical Diabetic Emergencies in the Urgent Care Setting Urgent message: Patients with glucose levels either too high or too low often require immediate, potentially life-saving interventions in the urgent care setting. These patients are often found to be diabetic. Allan F. Moore, MD, Nicolas Abourizk, MD, Jeffrey Collins, MD, MA Introduction iabetes is a common chronic disease affecting approximately 7% of the United States popula- tion. Of these individu- als, 17.5 million carry a diag- nosis of diabetes and over 6 million are undiagnosed. An estimated 54 million addi- tional Americans have pre- diabetes. In 2007, the total annual economic cost of diabetes care in the U.S. was estimated at $174 billion—with the major- ity of this cost being spent on urgent and emergent care and in-patient hospitalization. 1 © Jim Dowdalls / Photo Researchers, Inc. Unfortunately, due to a mul- tiple of factors (e.g., primary care and subspecialty access, insurance resources, the level of patient understanding about their condition), diabetes care is often fragmentary or insufficient. Hence, diabetic patients will continue to seek care in walk-in centers, and the likelihood of en- countering serious diabetic complications in urgent care will increase. Common glycemic emergencies seen in diabetic patients in the urgent care setting include diabetic ke- toacidosis (DKA), hyperglycemic hyperosmolar state D w w w. j u c m . c o m (HHS), and hypoglycemia. All three require immediate evaluation and treatment. This review will take a case-study approach to exem- plify the immediate triage, evaluation, and treatment of adult patients with glycemic perturbations. Case Studies: Patient 1 Presentation C.K. is a 19-year-old female who presents to the urgent care with her mother. She had been feeling weak and tired for several days but now, ac- cording to her mother, is not eating. She has been vomiting “on and off.” Her mother states “she’s not herself.” In triage, we find: Ⅲ oral temperature 102.4°F Ⅲ pulse 112 Ⅲ BP 84/50 mmHg The patient is ill-appearing and states her stomach hurts. A screening urine dip reveals: Ⅲ 3+ WBC Ⅲ 2+ RBC Ⅲ + nitrite JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | J u n e 2 0 0 8 11