Robert A Raschke

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Scholarly Contributions

Journals/Publications

• Gallo, T., Curry, S. C., & Raschke, R. A. (2021). Computerised risk scores to guide recognition and diagnosis in patients with possible heparin-induced thrombocytopenia. British journal of haematology, 192(1), 146-150.
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  The heparin-induced thrombocytopenia computerised risk (HIT-CR) score is designed to aid in the diagnosis of HIT. We sought to evaluate its potential clinical utility. In this retrospective cohort study, we collected HIT-CR scores on all inpatients receiving heparin over a 4-month period and performed chart reviews on the subset who independently underwent clinical diagnostic testing for HIT to identify patients with HIT. In all, 34 342 patients received heparin, 1744 had high-risk HIT-CR scores of ≥3 and 220 had the maximal risk score of 4. Only 6% of high-risk and 10% of maximal-risk patients underwent testing for HIT. Conversely, among all 317 patients who underwent independent testing for HIT, 67% had low-risk HIT-CR scores (
• Raschke, R. A., Agarwal, S., Rangan, P., Heise, C. W., & Curry, S. C. (2021). Discriminant Accuracy of the SOFA Score for Determining the Probable Mortality of Patients With COVID-19 Pneumonia Requiring Mechanical Ventilation. JAMA.
• Raschke, R. A., Curry, S. C., Glenn, T., Gutierrez, F., & Iyengar, S. (2020). A Bayesian analysis of strategies to rule out COVID19 using reverse transcriptase-polymerase chain reaction (RT-PCR). Archives of pathology & laboratory medicine.
• Gallo, T., Curry, S. C., Padilla-Jones, A., Heise, C. W., Ramos, K. S., Woosley, R. L., & Raschke, R. A. (2019). A computerized scoring system to improve assessment of heparin-induced thrombocytopenia risk. Journal of thrombosis and haemostasis : JTH, 17(2), 383-388.
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  Essentials Current risk scores for heparin-induced thrombocytopenia (HIT) are not computer-friendly. We compared a new computerized risk score with the 4Ts score in a large healthcare system. The computerized risk score agrees with the 4Ts score 85% of the time. The new score could potentially improve HIT diagnosis via incorporation into decision support. SUMMARY: Background (HIT) is an immune-mediated adverse drug event associated with life-threatening thrombotic complications. The 4Ts score is widely used to estimate the risk for HIT and guide diagnostic testing, but it is not easily amenable to computerized clinical decision support (CDS) implementation. Objectives Our main objective was to develop an HIT computerized risk (HIT-CR) scoring system that provides platelet count surveillance for timing and degree of thrombocytopenia to identify those for whom diagnostic testing should be considered. Our secondary objective was to evaluate clinical management and subsequent outcomes in those identified as being at risk for HIT. Methods We retrospectively analyzed data from a stratified sample of 150 inpatients treated with heparin to compare the performance of the HIT-CR scoring system with that of a clinically calculated 4Ts score. We took a 4Ts score of ≥ 4 as the gold standard to determine whether HIT diagnostic testing should be performed. Results The best cutoff point of the HIT-CR score was a score of 3, which yielded 85% raw agreement with the 4Ts score and a kappa of 0.69 (95% confidence interval 0.57-0.81). Ninety per cent of patients with 4Ts score of ≥ 4 failed to undergo conventionally recommended diagnostic testing; 38% of these experienced persistent, unexplained thrombocytopenia, and 4% suffered life-threatening thrombotic complications suggestive of undiagnosed HIT. Conclusion The HIT-CR scoring system is practical for computerized CDS, agrees well with the 4Ts score, and should be prospectively evaluated for its ability to identify patients who should be tested for HIT.
• Josey, K., Smith, M. L., Kayani, A. S., Young, G., Kasperski, M. D., Farrer, P., Gerkin, R., Theodorou, A., & Raschke, R. A. (2018). Hospitals with more-active participation in conducting standardized in-situ mock codes have improved survival after in-hospital cardiopulmonary arrest. Resuscitation, 133, 47-52.
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  The American Heart Association (AHA) and the Institute of Medicine have published a national "call-to-action" to improve survival from in-hospital cardiopulmonary arrest (IHCA). Our aim was to determine if more-active hospital participation in standardized in-situ mock code (ISMC) training is associated with increased IHCA survival.
• Menon, N., Perez-Velez, C. M., Wheeler, J. A., Morris, M. F., Amabile, O. L., Tasset, M. R., & Raschke, R. A. (2018). Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season. Revista Brasileira de terapia intensiva, 29(3), 271-278.
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  This report aimed to describe the outcomes of the patients with severe H1N1 associated acute respiratory distress syndrome who were treated with extracorporeal membrane oxygenation therapy.
• Raschke, R. A., Gallo, T., Curry, S. C., Whiting, T., Padilla-Jones, A., Warkentin, T. E., & Puri, A. (2017). Clinical effectiveness of a Bayesian algorithm for the diagnosis and management of heparin-induced thrombocytopenia. Journal of thrombosis and haemostasis : JTH, 15(8), 1640-1645.
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  Essentials We previously published a diagnostic algorithm for heparin-induced thrombocytopenia (HIT). In this study, we validated the algorithm in an independent large healthcare system. The accuracy was 98%, sensitivity 82% and specificity 99%. The algorithm has potential to improve accuracy and efficiency in the diagnosis of HIT.
• Raschke, R. A., Gollihare, B., & Peirce, J. C. (2017). The effectiveness of implementing the weight-based heparin nomogram as a practice guideline. Archives of internal medicine, 156(15), 1645-9.
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  To determine the effectiveness of the nomogram in a community hospital that implemented it as a practice guideline.
• Raschke, R. A., Groves, R. H., Khurana, H. S., Nikhanj, N., Utter, E., Hartling, D., Stoffer, B., Nunn, K., Tryon, S., Bruner, M., Calleja, M., & Curry, S. C. (2017). A quality improvement project to improve the Medicare and Medicaid Services (CMS) sepsis bundle compliance rate in a large healthcare system. BMJ open quality, 6(2), e000080.
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  Sepsis is a leading cause of mortality and morbidity in hospitalised patients. The Centers for Medicare and Medicaid Services (CMS) mandated that US hospitals report sepsis bundle compliance rate as a quality process measure in October 2015. The specific aim of our study was to improve the CMS sepsis bundle compliance rate from 30% to 40% across 20 acute care hospitals in our healthcare system within 1 year. The study included all adult inpatients with sepsis sampled according to CMS specifications from October 2015 to September 2016. The CMS sepsis bundle compliance rate was tracked monthly using statistical process control charting. A baseline rate of 28.5% with 99% control limits was established. We implemented multiple interventions including computerised decision support systems (CDSSs) to increase compliance with the most commonly missing bundle elements. Compliance reached 42% (99% statistical process control limits 18.4%-38.6%) as CDSS was implemented system-wide, but this improvement was not sustained after CMS changed specifications of the outcome measure. Difficulties encountered elucidate shortcomings of our study methodology and of the CMS sepsis bundle compliance rate as a quality process measure.
• Heise, C. W., Skolnik, A. B., Raschke, R. A., Owen-Reece, H., & Graeme, K. A. (2016). Two Cases of Refractory Cardiogenic Shock Secondary to Bupropion Successfully Treated with Veno-Arterial Extracorporeal Membrane Oxygenation. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 12(3), 301-4.
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  Bupropion inhibits the uptake of dopamine and norepinephrine. Clinical effects in overdose include seizure, status epilepticus, tachycardia, arrhythmias, and cardiogenic shock. We report two cases of severe bupropion toxicity resulting in refractory cardiogenic shock, cardiac arrest, and repeated seizures treated successfully. Patients with cardiovascular failure related to poisoning may particularly benefit from extracorporeal membrane oxygenation (ECMO). These are the first cases of bupropion toxicity treated with veno-arterial EMCO (VA-ECMO) in which bupropion toxicity is supported by confirmatory testing. Both cases demonstrate the effectiveness of VA-ECMO in poisoned patients with severe cardiogenic shock or cardiopulmonary failure.
• Raschke, R. A., Curry, S. C., Warkentin, T. E., & Gerkin, R. D. (2013). Improving clinical interpretation of the anti-platelet factor 4/heparin enzyme-linked immunosorbent assay for the diagnosis of heparin-induced thrombocytopenia through the use of receiver operating characteristic analysis, stratum-specific likelihood ratios, and Bayes theorem. Chest, 144(4), 1269-1275.
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  Heparin-induced thrombocytopenia (HIT) is diagnosed using clinical criteria and detection of platelet-activating anti-platelet factor 4/heparin (anti-PF4/H) antibodies, usually through a surrogate enzyme-linked immunosorbent assay (ELISA). The high false-positive rate (FPR) of this ELISA prompted us to reexamine its interpretation.
• Raschke, R. A., & Garcia-Orr, R. (2011). Hemophagocytic lymphohistiocytosis: a potentially underrecognized association with systemic inflammatory response syndrome, severe sepsis, and septic shock in adults. Chest, 140(4), 933-938.
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  Hemophagocytic lymphohistiocytosis (HLH) was originally described as a genetic disorder of immune regulation, presenting in neonates with protracted fever, hepatosplenomegaly, and cytopenia. A secondary form of HLH, triggered by serious infections, was subsequently described in adults.
• Raschke, R. A., Gerkin, R. D., Curry, S. C., & Baratz, D. M. (2010). Operating characteristics of pulmonary capillary wedge pressure for pulmonary arterial hypertension. Chest, 137(3), 740.
• Raschke, R. A., Curry, S. C., Rempe, S., Gerkin, R., Little, E., Manch, R., Wong, M., Ramos, A., & Leibowitz, A. I. (2008). Results of a protocol for the management of patients with fulminant liver failure. Critical care medicine, 36(8), 2244-8.
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  To assess the safety and efficacy of a protocol to support management of intracerebral pressure in patients with fulminant liver failure (FLF).
• Warkentin, T. E., Sheppard, J. I., Raschke, R., & Greinacher, A. (2007). Performance characteristics of a rapid assay for anti-PF4/heparin antibodies: the particle immunofiltration assay. Journal of thrombosis and haemostasis : JTH, 5(11), 2308-10.
• Hirsh, J., & Raschke, R. (2004). Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest, 126(3 Suppl), 188S-203S.
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  This article about unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) is part of the Seventh American College of Chest Physicians Conference on Antithrombotic and Thrombolytic Therapy: Evidence-Based Guidelines. UFH is a heterogeneous mixture of glycosaminoglycans that bind to antithrombin via a pentasaccharide, catalyzing the inactivation of thrombin and other clotting factors. UFH also binds endothelial cells, platelet factor 4, and platelets, leading to rather unpredictable pharmacokinetic and pharmacodynamic properties. Variability in activated partial thromboplastin time (aPTT) reagents necessitates site-specific validation of the aPTT therapeutic range in order to properly monitor UFH therapy. Lack of validation has been an oversight in many clinical trials comparing UFH to LMWH. In patients with apparent heparin resistance, anti-factor Xa monitoring may be superior to measurement of aPTT. LMWHs lack the nonspecific binding affinities of UFH, and, as a result, LMWH preparations have more predictable pharmacokinetic and pharmacodynamic properties. LMWHs have replaced UFH for most clinical indications for the following reasons: (1) these properties allow LMWHs to be administered subcutaneously, once daily without laboratory monitoring; and (2) the evidence from clinical trials that LMWH is as least as effective as and is safer than UFH. Several clinical issues regarding the use of LMWHs remain unanswered. These relate to the need for monitoring with an anti-factor Xa assay in patients with severe obesity or renal insufficiency. The therapeutic range for anti-factor Xa activity depends on the dosing interval. Anti-factor Xa monitoring is prudent when administering weight-based doses of LMWH to patients who weigh > 150 kg. It has been determined that UFH infusion is preferable to LMWH injection in patients with creatinine clearance of < 25 mL/min, until further data on therapeutic dosing of LMWHs in renal failure have been published. However, when administered in low doses prophylactically, LMWH is safe for therapy in patients with renal failure. Protamine may help to reverse bleeding related to LWMH, although anti-factor Xa activity is not fully normalized by protamine. The synthetic pentasaccharide fondaparinux is a promising new antithrombotic agent for the prevention and treatment of venous thromboembolism.
• Raschke, R., Hirsh, J., & Guidry, J. R. (2003). Suboptimal monitoring and dosing of unfractionated heparin in comparative studies with low-molecular-weight heparin. Annals of internal medicine, 138(9), 720-3.
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  Site-specific validation of the activated partial thromboplastin time (aPTT) therapeutic range is required to ensure administration of the optimal dose of unfractionated heparin. Therapeutic ranges of 1.5 to 2.5 times the control value are subtherapeutic for most modern aPTT reagents.
• Hirsh, J., Warkentin, T. E., Shaughnessy, S. G., Anand, S. S., Halperin, J. L., Raschke, R., Granger, C., Ohman, E. M., & Dalen, J. E. (2001). Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing, monitoring, efficacy, and safety. Chest, 119(1 Suppl), 64S-94S.
• Raschke, R. A., Guidry, J. R., & Foley, M. R. (2000). Apparent heparin resistance from elevated factor VIII during pregnancy. Obstetrics and gynecology, 96(5 Pt 2), 804-6.
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  Heparin resistance is the need for more than 35,000 units of heparin per 24 hours to achieve therapeutic activated partial thromboplastin time (APTT) values. Elevated factor VIII can cause apparent heparin resistance by suppressing the APTT result without inhibiting the antithrombotic effect of heparin.
• Tanen, D. A., Graeme, K. A., & Raschke, R. (1999). Severe lung injury after exposure to chloramine gas from household cleaners. The New England journal of medicine, 341(11), 848-9.
• Wallace, K. L., Curry, S. C., LoVecchio, F., & Raschke, R. A. (1999). Effect of magnesium hydroxide on iron absorption after ferrous sulfate. Annals of emergency medicine, 34(5), 685-7.
• Hirsh, J., Warkentin, T. E., Raschke, R., Granger, C., Ohman, E. M., & Dalen, J. E. (1998). Heparin and low-molecular-weight heparin: mechanisms of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest, 114(5 Suppl), 489S-510S.
• Jung, D., Griffy, K., Dorr, A., Raschke, R., Tarnowski, T. L., Hulse, J., & Kates, R. E. (1998). Effect of high-dose oral ganciclovir on didanosine disposition in human immunodeficiency virus (HIV)-positive patients. Journal of clinical pharmacology, 38(11), 1057-62.
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  This study was designed to investigate the interaction between high-dose oral ganciclovir (6,000 mg/day) and didanosine at steady state in patients who were seropositive for human immunodeficiency virus (HIV) and cytomegalovirus (CMV) infection. The study was conducted as an open-label, randomized, three-period crossover study. Patients received (in random order) multiple oral doses of didanosine 200 mg every 12 hours alone, ganciclovir 2,000 mg every 8 hours alone, and ganciclovir 2,000 mg every 8 hours in combination with didanosine 200 mg every 12 hours. Blood and urine samples for determinations of drug concentrations were obtained on day 3 of each dose regimen. When ganciclovir was administered either before or 2 hours after didanosine, the mean increases in maximum concentration (Cmax), area under the concentration-time curve (AUC0-12), and percent excreted in urine of didanosine were 58.6% and 87.3%, 87.3% and 124%, and 100% and 153%, respectively. There were no statistically significant effects of didanosine on the steady-state pharmacokinetics of ganciclovir in the presence of didanosine, irrespective of sequence of administration. There were no significant changes in renal clearance of didanosine, suggesting that the mechanism for the interaction does not involve competition for active renal tubular secretion. The mechanism responsible for increased didanosine concentrations and percent excreted in urine during concurrent ganciclovir therapy may be a result of increased bioavailability of didanosine. However, the mechanism appears to be saturated at oral ganciclovir doses of 3 g/day.
• Raschke, R. A., Gollihare, B., Wunderlich, T. A., Guidry, J. R., Leibowitz, A. I., Peirce, J. C., Lemelson, L., Heisler, M. A., & Susong, C. (1998). A computer alert system to prevent injury from adverse drug events: development and evaluation in a community teaching hospital. JAMA, 280(15), 1317-20.
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  Adverse drug events (ADEs) are the most common type of iatrogenic injury occurring in hospitalized patients. Errors leading to ADEs are often due to restricted availability of information at the time of physician order writing.
• Wallace, K. L., Curry, S. C., LoVecchio, F., & Raschke, R. A. (1998). Effect of magnesium hydroxide on iron absorption following simulated mild iron overdose in human subjects. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 5(10), 961-5.
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  To determine the effect of oral magnesium hydroxide [Mg(OH)2] on iron absorption after simulated iron overdose in human subjects.
• Curry, S. C., Carlton, M. W., & Raschke, R. A. (1997). Prevention of fetal and maternal cyanide toxicity from nitroprusside with coinfusion of sodium thiosulfate in gravid ewes. Anesthesia and analgesia, 84(5), 1121-6.
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  Coadministration of sodium thiosulfate with sodium nitroprusside (SNP) to children and adults prevents increases in cyanide concentrations during anesthesia or long-term SNP infusions. We wondered whether maternally administered sodium thiosulfate would prevent increases in fetal red cell cyanide concentrations in gravid ewes receiving SNP infusions. Under anesthesia, the fetal head was delivered through a lateral hysterotomy for catheterization of the jugular vein; the fetus was left in utero. Six control ewes near term received SNP at 25 micrograms.kg-1.min-1 for 4 h. Norepinephrine was used to maintain maternal mean arterial pressure at 80% baseline values. Six experimental ewes received the same treatment except that sodium thiosulfate was infused with SNP (1 g sodium thiosulfate per 100 mg SNP). Serial red cell cyanide concentrations in ewes and fetuses were followed. One control fetal death resulted from abruptio placenta, and this ewe and fetus were excluded from analysis. An additional control ewe and fetus died from apparent cyanide poisoning late during the course of the experiment. While control ewes and fetuses suffered progressive increases in red cell cyanide concentrations into the toxic range, experimental ewes and fetuses never developed toxic red cell cyanide levels (ewes P < .003, fetuses P < .004). These data, if applicable to humans, suggest that coadministration of sodium thiosulfate with SNP to pregnant women at doses currently in use for nonpregnant patients will prevent fetal, as well as maternal, cyanide toxicity.
• Curry, S. C., Connor, D. A., Clark, R. F., Holland, D., Carrol, L., & Raschke, R. (1996). The effect of hypertonic sodium bicarbonate on QRS duration in rats poisoned with chloroquine. Journal of toxicology. Clinical toxicology, 34(1), 73-6.
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  To determine efficacy of hypertonic sodium bicarbonate in narrowing QRS prolongation produced by chloroquine.
• Raschke, R., Raupp, J., Göttmann, D., & Husfeldt, K. J. (1996). [Aortitis and development of an aneurysm after PTA of distal aortic stenosis]. VASA. Zeitschrift fur Gefasskrankheiten, 25(3), 287-91.
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  A 43-year-old woman was admitted with peripheral arterial occlusive disease (PAD), pelvis-type. The angiography showed a high-grade stenosis of the aortal bifurcation. A percutaneous transluminal angioplasty (PTA) in "kissing-balloon-technique" was performed. After 7 days the patient developed a sepsis with distinct back-pain. The ultrasound-B-scan and CT-scan of the abdomen showed the development of an infrarenal aortic aneurysm during a period of 29 days. Bacterial infection of the aorta was considered to be the reason of development of the aneurysm occurred. Immediate antibiotic therapy got the patient afebrile after 14 days. We implanted an aortobiiliacal Dacron graft 2 weeks later. The follow-up time was without complications except for two thrombotic occlusions of the graft after 4 and 19 months. Thrombectomy was carried out in both cases without complications.
• Reilly, B. M., & Raschke, R. A. (1996). New method to predict patients' intravenous heparin dose requirements. Journal of general internal medicine, 11(3), 168-73.
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  To predict intravenous heparin dose requirements of patients treated for thromboembolic disorders.
• Hirsh, J., Raschke, R., Warkentin, T. E., Dalen, J. E., Deykin, D., & Poller, L. (1995). Heparin: mechanism of action, pharmacokinetics, dosing considerations, monitoring, efficacy, and safety. Chest, 108(4 Suppl), 258S-275S.
• Raschke, R. A., & Reilly, B. (1995). Methods for standardizing intravenous heparin therapy. Archives of internal medicine, 155(1), 117.
• Curry, S. C., Connor, D. A., & Raschke, R. A. (1994). Effect of the cyanide antidote hydroxocobalamin on commonly ordered serum chemistry studies. Annals of emergency medicine, 24(1), 65-7.
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  Concentrated aqueous solutions of hydroxocobalamin (OHCob) are given intravenously for the treatment of cyanide poisoning. Because OHCob solutions are intensely red and have peak light absorptions at 352 nm and 525 nm, we investigated whether the presence of OHCob in serum would interfere with various automated, colorimetric chemistry measurements.
• Raschke, R., & Reilly, B. (1994). Monitoring heparin therapy. Annals of internal medicine, 120(2), 169-70.
• Khanna, S. K., Agnone, F. A., Leibowitz, A. I., Raschke, R. A., & Trehan, M. (1993). Nonfamilial diffuse palmoplantar keratoderma associated with bronchial carcinoma. Journal of the American Academy of Dermatology, 28(2 Pt 2), 295-7.
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  A 61-year-old black woman had epidermoid carcinoma of the lung and the recent onset of diffuse hyperkeratosis of the palms and soles. These findings suggested an association between internal malignancy and palmoplantar hyperkeratosis. This report discusses the palmoplantar keratodermas, including those associated with malignancy.
• Raschke, R. A., Reilly, B. M., Guidry, J. R., Fontana, J. R., & Srinivas, S. (1993). The weight-based heparin dosing nomogram compared with a "standard care" nomogram. A randomized controlled trial. Annals of internal medicine, 119(9), 874-81.
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  To determine whether an intravenous heparin dosing nomogram based on body weight achieves therapeutic anticoagulation more rapidly than a "standard care" nomogram.
• Reilly, B. M., Raschke, R., Srinivas, S., & Nieman, T. (1993). Intravenous heparin dosing: patterns and variations in internists' practices. Journal of general internal medicine, 8(10), 536-42.
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  To characterize internists' dosing practices when administering and adjusting intravenous heparin regimens.
• Guidry, J. R., Raschke, R. A., & Morkunas, A. R. (1991). Toxic effects of drugs used in the ICU. Anticoagulants and thrombolytics. Risks and benefits. Critical care clinics, 7(3), 533-54.
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  Anticoagulation is being used increasingly in the critical care areas. Thrombolytic therapy is now commonly used in emergency departments and coronary care units for treatment of AMI. Heparin therapy for unstable angina and for a 48 to 72 hour period following thrombolytic therapy for AMI is becoming commonplace. Beginning warfarin therapy concomitantly with heparin to decrease the total duration of heparin and the duration of hospital stay for DVT therapy is encouraged. The use of low-dose warfarin to prevent DVT in hip surgery, improve catheter patency, and prevent catheter-related subclavian thrombosis is increasing. Along with the increased use of anticoagulation must come a greater appreciation of the complications associated with the agents used, and of how to prevent or treat the hemorrhagic or thrombotic morbidity that may arise. Acute hemorrhage with thrombolytic agents must be recognized and the immediate implementation of conservative and aggressive measures begun. Heparin-induced thrombocytopenia with thrombosis is an often-unrecognized problem that may occur in 1% to 2% of heparin recipients and result in limb amputations. A delayed onset (6-10 days) requires frequent platelet counts for early diagnosis and treatment. The resurgence of warfarin use for prevention of cardiovascular and cerebrovascular disorders demands observation for skin necrosis from protein C and S inhibition. Early recognition of symptoms and syndromes associated with organ system hemorrhage in patients receiving chronic anticoagulation is imperative. The use of antagonists, such as protamine sulfate for heparin, vitamin K1 for warfarin, and antifibrinolytic drugs for thrombolytic agents, may be necessary in treating hemorrhagic events. However, their use may worsen the thromboembolic event initially treated.
• Raschke, R., & Hertel, G. (1991). Clinical use of the heparin nomogram. Archives of internal medicine, 151(11), 2318, 2321.
• Raschke, R., Arnold-Capell, P. A., Richeson, R., & Curry, S. C. (1991). Refractory hypoglycemia secondary to topical salicylate intoxication. Archives of internal medicine, 151(3), 591-3.
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  We describe a case of severe refractory hypoglycemia secondary to topical salicylate intoxication. A 72-year-old man with psoriasis and end-stage renal disease was treated with a topical cream containing 10% salicylic acid. The patient presented with encephalopathy and subsequently developed hypoglycemia refractory to infusions of large amounts of glucose. A serum salicylate concentration was elevated at 3.2 mmol/L. Emergent hemodialysis was accompanied by rapid lowering of serum salicylate concentration and resolution of refractory hypoglycemia. Salicylate is well absorbed across normal and diseased skin. Salicylate markedly impairs gluconeogenesis and increases glucose utilization, resulting in hypoglycemia. To our knowledge, this is the first article on hypoglycemia due to the application of topical salicylate.
• Raschke, R., Scholl, W., Klemm, S., & Husfeldt, K. J. (1991). [Spontaneous rupture of the arteria hepatica propria]. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen, 62(7), 566-8.

Presentations

• Gallo, T., Raschke, R. A., & Curry, S. (2019, May). Heparin-induced thrombocytopenia computerized risk score in laboratory-tested patients. ABRC Research Conference. Phoenix, AZ.