Diagnostic Performance of Point-of-Care High-Sensitivity Troponin in the Exclusion of Non-ST-Elevation Myocardial Infarction in the Emergency Department.

BACKGROUND: This study evaluates the diagnostic performance of high-sensitivity troponin using point-of-care testing (POCT) devices compared with main laboratory measurements for ruling out non-ST-elevation myocardial infarction (NSTEMI) in emergency department (ED) patients presenting with non-traumatic chest pain. METHODS: This multicenter, observational, prospective, non-interventional study was conducted in two Spanish hospitals from 1 June to 31 December 2023 and included adult patients presenting with non-traumatic chest pain admitted to the ED. High-sensitivity troponin levels were measured using both the Siemens Atellica® VTLi POCT device and main laboratory testing, with data collected on analytical results and measurement times. RESULTS: Of the 201 patients who met the inclusion criteria, a significant correlation was observed between the POCT and laboratory assays. The area under the curve (AUC) of the ROC curve was consistently greater than 0.9, indicating a high diagnostic accuracy for ruling out NSTEMI. In addition, measurement times were significantly reduced using POCT compared to the core laboratory. CONCLUSION: These results suggest that high-sensitivity troponin POCT devices offer comparable diagnostic performance to traditional laboratory methods for the diagnosis of NSTEMI in the emergency department, potentially speeding up clinical decisions and optimizing resource utilization.

Diabetic Euglycemic Ketoacidosis Induced by Oral Antidiabetics Type SGLT2i.

Euglycemic diabetic ketoacidosis (euglycemic DKA) is a serious complication of diabetes, which can occur in some patients treated with oral antidiabetics called sodium-glucose co-transporter 2 inhibitors (SGLT2i). This group of drugs works by increasing renal excretion of sodium and glucose, thereby lowering blood glucose levels. Euglycemic DKA is characterized by having blood glucose levels in the normal range, usually below 200 mg/dL (11 mmol/L), which complicates early diagnosis. We present the case of a 67-year-old patient with type 2 diabetes mellitus, treated with metformin and empagliflozin, who was admitted to the Intensive Care Unit in a coma with severe ketoacidotic decompensation.

Hepatotoxicity with cholestatic pattern secondary to enoxaparin treatment.

Objectives: Treatment with low-molecular-weight heparins is very common in clinical practice. Exceptionally, some patients develop hepatitis within a few days of starting treatment, and rapid discontinuation of the drug is decisive to avoid chronification. Case presentation: These episodes usually present themselves only with elevated transaminases. We describe the case of a patient who presented a cholestatic pattern, which is very uncommon with this type of drug. Conclusions: Hepatitis secondary to heparin therapy is an underdiagnosed entity. The laboratory plays a fundamental role in its diagnosis, given that it initially presents itself without a clear clinical profile.