Adrenal suppression: An under-recognized complication of a common therapy
Bibliographic record
Abstract
A five-year-old girl presented to the emergency department with a seizure. A bedside glucose measurement confirmed that she had hypoglycemia (blood glucose level of 1.6 mmol/L). A venous blood glucose measurement confirmed the bedside result. The seizure resolved with the administration of intravenous dextrose and phenobarbitol. She had a three-year history of asthma for which she had been prescribed a fluticasone inhaler and instructed to take two puffs, morning and night (500 μg/day). During asthma exacerbations, her parents were administering extra doses. She had not received any oral glucocorticoids (GCs). In the months preceding presentation, she had been mildly fatigued but otherwise well. There was no identified precipitating event (eg, fever or acute illness); there were no missed doses of fluticasone. On physical examination, the girl appeared small but well. Her weight and height had fallen from the 25th percentile to the 10th percentile over the course of one year. She was not cushingoid and her skin was not hyperpigmented. The examination was otherwise unremarkable. Following resolution of the seizure, venous blood gas and serum electrolytes were normal; however, a urine test was positive for ketones.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".