Clinical articles

Spontaneous bleeding

June 7, 2009

  Lisa Sanders hits another home run – Losing Consciousness. Those who enjoy hearing about rare syndromes will enjoy this one – I sure did.

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Tolvaptan finally available

May 30, 2009

  Tolvaptan is an ADH antagonist.  We will have few indications, but in the rare true SIADH patient, this drug will have some value.  I do not know the cost. I see many hyponatremia patients, and few of them have persistent SIADH.  I am glad to have this option for those rare patients.  The NEJM [...]

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Acid base answer

May 28, 2009

  Making rounds yesterday in the ICU, we found this electrolyte panel Electrolyte panel Na  138 Cl  109 BUN  58 K 4.2 HCO3  17 creat  1.8 Blood Sugar  206 Clinical context – 50 year old woman with known cirrhosis and gram negative sepsis.  Her creatinine and BUN are improving with volume expansion.  I asked readers [...]

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Another acid base problem

May 27, 2009

  Making rounds today in the ICU, we found this electrolyte panel Electrolyte panel Na  138 Cl  109 BUN  58 K 4.2 HCO3  17 creat  1.8 Blood Sugar  206 Clinical context – 50 year old woman with known cirrhosis and gram negative sepsis.  Her creatinine and BUN are improving with volume expansion.  Explain her decreased [...]

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Wherefore statins?

February 5, 2009

  Most readers know that I run morning report 2-3 times each week (at 3 different hospitals.)  We frequently discuss the rationale for statin therapy.  Many students and residents focus on LDL and LDL goals, yet recent data suggest that statins really work in at least 2 ways.  Clearly, statins do lower LDL, and thus probably [...]

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Thinking about sore throats

January 9, 2009

  Earlier this week I received an email asking my opinion of an ER sore throat policy.  The question focused on acute rheumatic disease prevention, and ask my opinion on testing and treatment.  Here is my short answer: This is a classic question.  I will provide a fairly long answer. I know of 5 reasons [...]

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What would you do? Part 2

December 26, 2008

  The primary care physician drew blood cultures and started moxifloxacin.  Two days later the blood cultures come back growing gram negative rods in the anaerobic bottles.  He is called back to the ER.  On exam he has a fever of 103, markedly swollen right tonsil with exudates, mild swelling of right neck, but no [...]

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What would you do?

December 24, 2008

  A 30-year-old man comes to your office for 2 days of progressive pharyngitis.  He is unable to eat but is drinking well.  He has a temp of 103 and endorses a drenching night sweat.  He has a swollen right tonsil with marked exudates.  His right neck is slightly swollen.  You cannot feel anterior or [...]

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Treating hyponatremic encephalopathy

May 17, 2008

  I am current at the ACP annual meeting, and this morning heard a brilliant grand rounds on hyponatremia – given by Juan Carlos Ayus.  I have found an excellent article in the Southern Medical Journal that he co-authored on treatment of dysnatremias and also provide this Medscape link – Hospital-Acquired Hyponatremia — Why Are [...]

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Treating stage III and stage IV CKD with calcitriol

May 9, 2008

  Activated Vitamin D Associated with Mortality Drop in Chronic Kidney Disease For patients with moderate-to-severe chronic kidney disease and hyperparathyroidism, activated vitamin D appears to lower the risk of death over two years, an observational study found. The 429 patients with stage 3 or 4 disease who took oral calcitriol had a 26% reduced [...]

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