Clinical articles

Hypokalemia and chewing tobacco

November 17, 2006

My search for a reference on this phenomenon found this great story – A Medical Mystery, and How Physicians Solved It The patient was a woman in her 80′s who complained of weakness and muscle spasms in her back. She appeared healthy and ate properly, but she had high blood pressure and, most strikingly, a [...]

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Treating hyponatremia

November 15, 2006

My students and residents know that I love acid-base and electrolyte problems. Since hyponatremia is the most common electrolyte abnormality in the hospital, I often discuss it on rounds and in morning report. Most hyponatremia is transient, and easily treated. However, sometimes we have a patient with chronic hyponatremia. Three major situations cause most of [...]

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Screening for progressive CKD

September 14, 2006

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 as a better screening [...]

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Preventing diabetes

September 8, 2006

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 has [...]

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Think osteoporosis with chronic steroid use

August 17, 2006

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 [...]

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More data on Cystatin C

August 17, 2006

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) [...]

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CKD – the knowledge deficit

August 1, 2006

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 [...]

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Who will have a recurrent DVT?

July 30, 2006

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 to assess [...]

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Streptococcal infections, often routine, but still can cause fear

July 25, 2006

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 [...]

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The danger of excess loop diuretics

July 20, 2006

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 that overdiuresis [...]

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