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.

If Tony breu is here we are in the right place

Portal hypertension and the development of varices If only there was a way to block the alpha and beta adrenergic pathways to offset these changes IF ONLY!!!! #medsky #liversky

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.

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?

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...

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. 🙂

This is fascinating. When can we expect to see this in print?

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.

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!

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.

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

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...

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.

one cause of hypernatremia in ICU = recovery from AKI! [1] urea *accumulates* while kidney is failing… [2] kidney recovers➡️ clearance of accumulated urea obligates the excretion of H2O (similar to using oral urea to tx hypoNa) so hypernatremia can be a sign of renal recovery 🤯 #EMIMCC #nephsky

Thank you Paul!

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.

#GIM #starterpack who should be added? #GIMproud #IMproud go.bsky.app/MiCFMex @elasticdo.bsky.social @indupartha.bsky.social @rbganatra.bsky.social @dhpomerantz.bsky.social @gimapreceptor.bsky.social @colleenchristmas.bsky.social @drmommy.bsky.social @paulnwilliams.bsky.social

Check out the 100th episode of The Curious Clinicians!

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

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

1/2 In today's Morning Report, I learned that DRESS is associated with the reactivation of herpesviruses, particularly HHV-6. Whether this or other herpesviruses are part of the pathogenesis of DRESS or a consequence of DRESS remains...

1/2 In today's Morning Report, I learned that DRESS is associated with the reactivation of herpesviruses, particularly HHV-6. Whether this or other herpesviruses are part of the pathogenesis of DRESS or a consequence of DRESS remains unsettled. https://buff.ly/3URyPK8

3. Is going on now- led by David Griffiths in Edinburgh for post-ICU patients The rest of them- damn right. Would be easy to make many of them pragmatic nudge-based trials.

2. I usually cite this study below, telmisartan vs rest in an ED setting. Park SK, et al. J Hypertens. 2017 Jul;35(7):1474-1480.

1. In my country, we tend not to give K, if normal values (not talking about polyuric states, ketoacidosis etc) 2. In nephrology hypertensive urgency tends to be a real one... but if asymptomatic pts, no changes on EKG, etc... tend to just observe Related discussion www.nephjc.com/news/inpatie...

Here are 10 randomized trials I'd love to see (share links if they've been done!): 1. Potassium repletion to >4.0 vs 3.5 or 3.0 in hospitalized medical patients 2. Treatment vs observation for hypertensive urgency 3. Iron supplementation (likely IV) vs placebo for anemia of…

Here are 10 randomized trials I'd love to see (share links if they've been done!): 1. Potassium repletion to >4.0 vs 3.5 or 3.0 in hospitalized medical patients 2. Treatment vs observation for hypertensive urgency 3. Iron supplementation (likely IV) vs placebo for anemia of chronic inflammation

Recently, I came across a meta-analysis of corticosteroids in acute MI. Most studies are from the 70s and 80s, predating current therapies. That said, the authors reported: ☞ Decreased mortality: OR 0.74, 95% CI 0.59-0.94 ☞ RCTs alone: OR 0.95, 95% CI 0.72-1.26…

Recently, I came across a meta-analysis of corticosteroids in acute MI. Most studies are from the 70s and 80s, predating current therapies. That said, the authors reported: ☞ Decreased mortality: OR 0.74, 95% CI 0.59-0.94 ☞ RCTs alone: OR 0.95, 95% CI 0.72-1.26 https://buff.ly/40P2RBV

Thanks to everyone who replied. Let me summarize what others have added: 💡Renal ultrasound to assess kidney size/echogenicity better differentiates AKI from CKD 💡Although PTH can increase in AKI, the magnitude of rise is greater in CKD 💡Prior labs and response to treatment are probably best!

lemme guess before watching? Gabapentin -> vasodilatation induced pedal edema -> loop diuretic classic prescribing cascade (as seen with amlodipine) eg agsjournals.onlinelibrary.wiley.com/doi/10.1111/... #MedSky

Like everything it is a piece of useful information But not sensitive or specific enough on its own!

PTH can certainly increase in AKI, however the magnitude of increase in PTH can be different in AKI vs CKD. Size of the kidneys may be helpful if the kidneys are small (although they are not always small in CKD) but kidney echogenicity can be abnormal on both AKI and CKD so it is not a good marker

Yup! Unreliable to use PTH as a differentiator because of peripheral PTH resistance and change in set point. Normalization can also lag behind a few days after AKI recovery in some cases. IMO kidney US is still the best way, ie small and/or echogenic kidneys

QUESTION 🤔How quickly does PTH increase in acute kidney injury (AKI)? I learned (and have taught) that PTH can be used to suggest chronic kidney disease. At today's Clinical Reasoning Conference, our discussion (Jeff Williams) cautioned me not to just come to this conclusion.

Algorithm for sky high liver enzymes 🏆think ischemia, even if BP normal 🏆stones! 🏆Tylenol, NAC 🙏history over blood tests

Why are patients on gabapentin more likely to be prescribed a loop diuretic? We answer this question on a recent episode of The Curious Clinicians. Have a look! www.youtube.com/watch?v=mD7c...

1/THREAD In 2009, an enormous 20 pound lobster was caught off the coast of Newfoundland. His captors named him George, and he was estimated to have been ~140 years old. Read on to find out how in the world a lobster could live to such an old age. #MedSky

Learning how to create a starter pack for Hospital Medicine & HM adjacent folks. Please LMK who to add #HMSky go.bsky.app/T4mMCNx

1/11 🤔Why does chronic hepatitis C infection "require" the intermediary of cirrhosis in order to cause hepatocellular carcinoma (HCC)? Chronic hepatitis B can "skip" this step, going directly from chronic infection to HCC. Why the difference?