db's Medical Rants

I have written before about my concerns over a HgbA1c goal of 7.0. Others have questioned this goal even more strenuously then me. This study may lead to a new evaluation of this ill-conceived performance indicator.Diabetes Study Partially Halted After Deaths
For decades, researchers believed that if people with diabetes lowered their blood [...]

This article caught my eye as an interesting fact to remember (internists like to collect facts which they may need one day). Then I noticed that the first author was a friend with whom I have previously written an article!
Wernicke encephalopathy is a serious disorder caused by thiamine (vitamin B-1) deficiency. Dr Carl [...]

Our classical method for identifying CKD uses serum creatinine. As serum creatinine increases, GFR decreases. We now have formalas to estimate GFR from serum creatinine, age, race and sex (eGFR). However, while eGFR works well for populations, it has great variation for individuals. A growing body of data supports cystatin C [...]

Earlier this week, I rounded on a patient who had just had a myocardial infarction. He is 48 years old, and has an increased waist circumference. His cardiologist noted an elevated blood glucose (around 170) and asked us to care for his diabetes.
He has a normal HgbA1c, but we clearly believe that he [...]

Risk of Steroid-Induced Osteoporosis Often Ignored
I picked this article from the title alone. This problem occurs frequently in the COPD patients who I see at the VA hospital. On reading the article, I was delighted to see that the first author is a colleague at my institution.
Despite international guidelines, the prescribing of anti-osteoporotic [...]

The data continue to accumulate that Cystatin C identifies CKD earlier (and perhaps more accurately) than serum creatinine – Cystatin C May Identify “Pre-CKD” in Elderly With Normal eGFR
A new report shows that cystatin C, a still-novel marker of kidney function, identifies increased risk for death and cardiovascular (CV) and chronic kidney disease (CKD) in [...]

Physicians May Miss Signs of Chronic Kidney Disease
A lot of primary care physicians need to bone up on the signs of chronic kidney disease, according to investigators here.
When randomly selected family practitioners and internists, were asked which diagnostic tests they would order for a hypothetical patient with symptoms and lab values consistent with chronic kidney [...]

Thromboembolic disease represents a major dilemma for clinicians. We know how to treat the patient acutely, but we never really know how long to continue anticoagulation.
This is an important question, because the treatment is not benign. A recent article suggests a way to distinguish those who will not have recurrent thromboembolism. Test [...]

Can That Strange Rash Really Be Scarlet Fever?
As my wife and I left a movie theater one night, my cellphone rang. Our baby sitter was calling to inform us about a strange, rough rash racing across the chest of our 5-year-old daughter, Bess. This succinct announcement set my mind running.
Whenever doctors hear of an interesting [...]

I have a saying that I use when teaching about heart failure: “The goal of diuretic therapy in heart failure is to keep the patient not wet, it is not to make the patient dry.” The concept that I try to bring forward is that we need diuretic therapy to reduce symptoms, but [...]

Today I have a puzzle from a recent admission to my VA service. The patient is a 60 year old man with stable cirrhosis (presumed secondary to alcohol), chronic pancreatitis, hypertension, hepatitis C, and chronic kidney disease (creatinine 1.5). He currently takes bicitra, B12, hydralazine, hctz, Insulin, lactulose, lisinopril, magnesium, and pancreatic enzymes.
At [...]