Babesiosis in the Emergency Department: A Case Report.

BACKGROUND: Babesiosis, a tick-borne illness spread by Ixodes scapularis, is an emerging infectious disease in the Northeastern and upper Midwestern United States. Infection can present as a flu-like illness with anemia, thrombocytopenia, and jaundice. This disease can even be fatal in the immunocompromised or highly infected patient. Co-infection with other tick-borne illnesses is common, and prompt treatment with antiprotozoal agents and antibiotics is indicated to prevent adverse outcomes. CASE REPORT: We describe a patient who presented to the emergency department with flu-like symptoms, but had history concerning for environmental exposure to babesiosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early detection is important to prevent severe sequalae of the disease. This is a disease that can imitate a viral syndrome but should be considered in the differential for a patient with a concerning history.

Case Report: Antifreeze Ingestion and Urine Fluorescence.

This case report presents a patient with ethylene glycol intoxication from antifreeze ingestion. Ethylene glycol is an active ingredient in antifreeze, traditionally causing an anion gap metabolic acidosis with a high osmolality gap. In our emergency department, serum ethylene glycol is a send-out test requiring hours for a result. The patient presented here had an initial acidotic venous blood gas with an elevated serum osmolality and osmolality gap, and a normal anion gap. Quick bedside analysis of the patient's urine using ultraviolet fluorescence gave supportive evidence for the ingested substance while the serum ethylene glycol level was still pending. The patient was promptly treated with fomepizole, pyridoxine, thiamine, and sodium bicarbonate. Several hours after admission, the ethylene glycol level had resulted as 636 mg/dL. Due to the quick initiation of treatment, the patient had no complications or signs of end-organ damage during admission. Topics: Ethylene glycol, fomepizole, toxicology, ultraviolet fluorescence.