Attending Rounds

An acid-base question

February 9, 2012

35-year-old man admitted for worsening ascites. We know the patient because he had just left AMA 3 days before.  He had HIV with a low CD4 and did not take any anti-retrovirals.  He also had hep C cirrhosis with encephalopathy and worsening ascites.  He did take spironolactone and lactulose and the lactulose was causing diarrhea. [...]

Read the full article →

VA Dec 2011 – day #5 – on call

December 20, 2011

Yesterday our team took call.  I saw patients both in the morning and the afternoon.  As I type this, I only know that we will have between 8 and 10 patients to see.  Yesterday I saw 3. One raised some interesting questions.  This was the second patient I have seen in the past month with [...]

Read the full article →

VA Dec 2011 – day #4 – the increasing creatinine

December 19, 2011

A patient gets admitted for a COPD exacerbation.  The patient has right sided heart failure symptoms, so we continue the diuretic therapy. The initial creatinine is 1.0, but the next day it goes to 1.3.  We blame the increase on over aggressive diuresis, and give some modest replacement.  The physical exam fits our hypothesis. The [...]

Read the full article →

VA Dec 2011 – day #2 – an acid-base problem

December 17, 2011

50 something patient with combination of restrictive and obstructive disease.  This electrolyte panel caught everyone's attention. 139 91 25   3.0 42 1.2   ABG pH 7.45 pCO2 59 pO2 59 Bicarb 41 What likely happened to this patient?  What do you want to do now?

Read the full article →

VA Dec 2011 – day #1 – cellulitis and tinea pedis

December 16, 2011

Yesterday I started back on VA wards.  As I have done occasionally in the past, I will share some thoughts each day from my VA ward experience. The patient of the day is one who has had repeated episodes of left leg cellulitis.  The patient has had osteomyelitis documented one time (3rd metatarsal).   On [...]

Read the full article →

On starting a new internal medicine residency

December 7, 2011

We have exciting news.  We are accepting applications for a new internal medicine residency.  We need 8 interns and 8 second year residents for July 2012.  UAB – Huntsville Regional Medical Campus Internal Medicine Residency – a brand new residency created in cooperation with Huntsville Hospital. For many years I have written on this blog [...]

Read the full article →

Metabolic disarray – understanding and treating the hyponatremia

September 3, 2011

Now obviously this is my opinion, and other may differ. We have an alcohol abusing woman who presented with a Na of 110 mEq/L and depressed mental status.  She awoke as saline increased her sodium quickly to 120 mEq/L.  This occurred because her urine osms of 150. This patient admitted to a beer diet.  Her [...]

Read the full article →

Metabolic disarray – more information

September 1, 2011

To recap:   47-year-old woman found stuporous and hypotensive.  She has known alcohol abuse and decreased LVEF around 30%.   Her labs come back, and you should provide plausible reconstructions of these results. Fluid Balance Panel  110 59 38 73 3.2 30 2.2 8.0 Arterial Blood Gas on 2L nasal oxygen pH 7.57 pCO2 31 [...]

Read the full article →

Metabolic disarray

August 30, 2011

47-year-old woman found stuporous and hypotensive.  She has known alcohol abuse and decreased LVEF around 30%.   Her labs come back, and you should provide plausible reconstructions of these results.   Fluid Balance Panel  110 59 38 73 3.2 30 2.2 8.0   Arterial Blood Gas on 2L nasal oxygen   pH 7.57 pCO2 31 [...]

Read the full article →

Quick acid-base answer

August 17, 2011

Kudos to torontointernist.  The Canadian understood the big clues.  Here we have a patient with a normal gap metabolic acidosis plus a proximal tubule leak – 2+ urine glucose with a normal serum glucose.  This suggests strongly Fanconi's syndrome.  I mentioned a chronic disease and a medication.  Several medications can cause Fanconi's, but the most [...]

Read the full article →

← Previous Entries