1/9 🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving. And yet, it isn't. Let's examine why.
Tony Breu
@tonybreu.bsky.social
Hospitalist, VA Boston Healthcare System. Co-host, Curious Clinicians Podcast
Glucose IS an effective osmole in the absence of insulin or insulin resistance. So hyperglycemia does lead to polydipsia (and polyuria due to osmotic diuresis)
1/ Does the tryptophan in turkey really cause a food coma? I've heard this repeatedly, while also being told that it is a myth. Let's have a look at the physiology of a Thanksgiving meal...
1/9 🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving. And yet, it isn't. Let's examine why.
Sigh. Only about half of veterans with cirrhosis hospitalized with SBP received guideline-directed IV albumin: journals.lww.com/ajg/abstract... Rates increased from 2008 to 2022, but disparities persistent: black patients were less likely to get albumin than white patients. Lots of work to do.
Albumin for Spontaneous Bacterial Peritonitis: Care... : Official journal of the American College of Gastroenterology | ACG
ated trends and patient, practice-, and facility-level factors associated with use among patients with cirrhosis hospitalized for SBP confirmed with ascitic fluid criteria. Results: Among 3,871 Vet...
journals.lww.com
I'm in favor of still calling them #tweetorials as well. It feels delightfully anachronistic and points to the roots/history on the other platform. #MedSky, who is with me?
Tony Breu@tonybreu.bsky.social · 2y agoI agree, Liz. I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread). Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
Honey, stop what you're doing, new hyponatremia research just dropped! What's it say? It looks like slow correction is associated with worse outcomes, like death and length of stay! Was it just a small study? No, it was a meta-analysis of almost 12,000 patients! jamanetwork.com/journals/jam...
Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia
This systematic review and meta-analysis evaluates the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.
jamanetwork.com
1/4 What is the mechanism of pruritus/itching in Hodgkin Lymphoma (HL)? For today's Morning Report, Chief Resident Carter Baughman shared a case of HL that presented with months of pruritus. I was surprised to learn that up to 30% of patients with HL present with this symptom. t.ly/RU2Qj
I did not realize we are 60% oxygen by weight until today Makes sense though. Neat. 🙂
Tony Breu@tonybreu.bsky.social · 2y ago2/ To begin, it's essential to understand which elements make up the human body. Amazingly, just six compose >98% of your weight: ➤Oxygen: 61% (varies based on water composition) ➤Carbon: 23% ➤Hydrogen 10% ➤Nitrogen: 2.6% ➤Calcium: 1.0% ➤Phosphorus: 0.6% https://buff.ly/3YU4dIY
This is fascinating. When can we expect to see this in print?
Elliot Tapper@ebtapper.bsky.social · 2y agoThis study by challenges dogma @anandvkulkarni.bsky.social gave a tapering dose of prednisone for alcohol hepatitis instead of 40mg for 28 days And it paid off with fewer infections @tonybreu.bsky.social
This study by challenges dogma @anandvkulkarni.bsky.social gave a tapering dose of prednisone for alcohol hepatitis instead of 40mg for 28 days And it paid off with fewer infections @tonybreu.bsky.social
I used @en.blueark.app to transfer tweetorials previously posted on Twitter here to @bsky.app. Very fair price and quick process. If you do the same, note my previous comments, particularly regarding links and search.
Tony Breu@tonybreu.bsky.social · 2y agoA few observations on BlueSky, after a week of use: ☞REPOSTS v LIKES: I don't see what others like, so reposts seem more powerful ☞LINKS: These consume the number of characters in the link, not a set amount (like Twitter) ☞SEARCH: I'm underwhelmed. It doesn't consistently result posts I know exist
Ok, #SciSky… what are we calling a thread that explains a research paper? (What used to be a tweetorial.) Skysplainer? Blutorial?? Let’s see ‘em!
Agreed. This is smart. Musk abandoned twitter. We love Twitter. Let's reclaim the name!
Tony Breu@tonybreu.bsky.social · 2y agoI agree, Liz. I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread). Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
I agree, Liz. I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread). Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
Liz Wayne@lizwaynephd.bsky.social · 2y agoWhy not still call it a tweetorial? That other platform is “X” We don’t have to give up tweeting because Elon and Jack did.
A few observations on BlueSky, after a week of use: ☞REPOSTS v LIKES: I don't see what others like, so reposts seem more powerful ☞LINKS: These consume the number of characters in the link, not a set amount (like Twitter) ☞SEARCH: I'm underwhelmed. It doesn't consistently result posts I know exist
There you go - it’s live! www.nejm.org/doi/full/10.... From #AHA24
Colchicine in Acute Myocardial Infarction | NEJM
Inflammation is associated with adverse cardiovascular events. Data from recent trials suggest that colchicine reduces the risk of cardiovascular events. In this multicenter trial with a 2-by-2 fac...
nejm.org
I am at the beginning of my AI journey of discovery, you know the place where you are still dumbfounded by what the machine can do. In this case it developed a pretty compelling electrolyte curriculum for nephrology fellows 😳 pbfluids.com/2024/11/ai-c...
AI Curriculum
I am still in the “amazed by what AI can do” stage Here is me prompt i am teaching a class on electrolyte abnormalities for nephrologists. What would be good tricky things to teach I th…
pbfluids.com
This radiologist applauds this thread. Btw, you can also go the other way, I’ve used air (careful where you put it!) and CO2 as “inverse” contrast in people allergic to Iodine contrast.
Now I feel like Bluesky has made it. I missed these. I use your tweetorial of why PWIDs develop R-sided endocarditis without *apparent* valvular damage in class 👍
1/14 🤔 Why do we use iodine as an intravenous contrast agent? The answer requires a review of the composition of the human body and a brief tour of one of my favorites, the Periodic Table of Elements.
I'm expecting big things from @sophieclaudel.bsky.social now that I see she's here on @bsky.app. If you're interested in kidneys or just want to learn more about anything medicine related, give her a follow.
Check out the 100th episode of The Curious Clinicians!
What have we learned after 100 episodes?
How time flies! On June 3rd, 2020, when the world was still in lockdown, we released our very first episode on the pathophysiology of fingernail clubbing. Mo...
buff.ly
We've sold over 2k copies of @critcaregame.bsky.social ! It's sooo much work to get them out, but we've finally boxed up a few hundred more. Order on our website and it should reach you (in the US) within a week or two. www.criticalcaregame.com
Critical Care: The Game
Critical Care: The Game is a hospital and medical themed co-operative strategy board game created by ICU doctors
criticalcaregame.com
There are some people where it makes sense But that doesn’t mean they need 28 days Or a specialty pharmacy for ‘olone Or a taper Or 40mg And so on