CORE IM

What are the challenges of recommending bisphosphonates to patients who have normal bone density? Dr. Ann Garment discusses this in the latest episode of Beyond Journal Club, a collaboration between @coreimpodcast.bsky.social and NEJM Group. Full episode: nej.md/4q7hOK3 

#MedSky

6/ Thanks to all for this great learning!

By: @shreyatrivedimd.bsky.social Dr. Alice Kennedy Dr. Ross Prager
Graphic: Dr. Alice Kennedy
Audio: Xi Park

5/ When is Doppler most useful clinically?

💧 Differentiating AKI
💧 Guiding decongestion
💧 Phenotyping septic shock
- Ex: more fluids vs. vasopressors
💧 Investigating delirium

4/ VExUS score combines assessment of:

💧 IVC
- Short axis
💧 Doppler of hepatic vein
- Look for retrograde flow
💧 Doppler of portal vein
- Measure pulsatility
💧 Doppler of intrarenal veins
- Look for discontinuation flow

**validated in post cardiac surgery patients

3/ High risk for congestion injuries:

💧 Sepsis
💧 Heart Failure
💧 AKI
💧 Post cardiac surgery

2/ Volume overload 🚫🟰 venous congestion

💧 Volume overload: evidence of excess extracellular volume
💧 Venous congestion: high back pressure leading to reversal of blood flor from RA into end organs, which can cause injury

1/ 🚨 NEW episode on venous congestion & the VExUS score 💧

Venous congestion is a century-old concept, but modern tools now allow clinicians to detect, quantify, and monitor it ‼️

🖥️: www.coreimpodcast.com/2025/11/19/v...

Check out thr second part of a @coreimpodcast.bsky.social podcast episode on HRS www.coreimpodcast.com/2025/10/22/h...

5/ Thanks to all for diving into this debate on diabetes drugs!

Authors: @shreyatrivedimd.bsky.social, Dr. Tracy Rabin, Dr. Kenneth Fifer and Dr. Cary Blum

Graphic: Amy Mu

Audio: Kathreene Gala

4/ SGLTis are best for:

🍬 Patients with HFrEF/HFpEF or CKD
🍬 ASCVD or high CV risk
🍬 Patients prioritizing oral route
🍬 Patients w/ “a little bit of everything”
🍬 A1C lowering is not priority

3/ GLP1RAs are best for:

🍬 Patients with obesity
🍬 Established ASCVD
🍬 Needing dual benefit: glucose + weight control
🍬 Proteinuric diabetic kidney disease already on ACE/ARB & SGLT2i

2/ Metformin is best for:

🍬 Overweight patients with no ASCVD or HF
🍬 Budget-conscious patients
🍬 Initial therapy in most patients

1/ 🚨 NEW episode on first line meds for Type 2 DM ‼️

Let’s dive in and discuss whether tried and true metformin vs. newer options, like SGLT2i or GLP1RA, are better for YOUR patient 🌊

🖥️: www.coreimpodcast.com/2025/11/05/d...

2/ Thanks, Dr. Stephen Cooper!

1/ 🚨 NEW video on Lp(a) ‼️

Let’s review what it is, who should be screened, and what we can do about it if it’s elevated

🎥: www.youtube.com/watch?v=lKkf...
Behind the scenes: www.youtube.com/watch?v=Xh9L...
🖥️: www.coreimpodcast.com/2025/04/02/l...

TRUE ‼️

Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids!

www.coreimpodcast.com/2023/06/28/s...

#TriviaTuesday

True or false: 1mg dexamethasone is approximately equal to 20mg hydrocortisone

Do the benefits of bisphosphonates outweigh the risk of side effects? Dr. Ole-Petter R. Hamnvik explains. Learn more about bisphosphonates and fracture prevention in the latest episode of Beyond Journal Club, a podcast from @coreimpodcast.bsky.social and NEJM Group: nej.md/4q7hOK3 

#MedSky

Had so much to say about HRS we had to split it into two episodes!
Check out part 2 on HRS treatment, Transplant, and a topic near and dear to my heart, palliative care.

7/ Thanks to all!

Authors: @shreyatrivedimd.bsky.social @noahmarkewitz11.bsky.social Dr. Yaling Tang

Experts: Dr. Juan Carlos Q. Velez, Dr. Nikhilesh Mazumder, Dr. Marina Serper

Graphic: Dr. Dexter Nwachukwu

Peer Reviewers: Dr. Justin Belcher and @ebtapper.bsky.social

Audio: Kathreene Gala

6/ Palliative care?

🫘 The❓is whether to do chronic dialysis knowing it won’t ⬇️ the liver disease
🫘 W/ dialysis: expected lifespan is a few months
🫘 W/out dialysis: expected lifespan is days-weeks
🫘 BP may too ⬇️ for dialysis

💡 Early palliative care involvement is best

5/ Transplant?

🫘 Dialysis can act as a bridge to transplant 
🫘 Liver transplant is based off MELD 3.0
🫘 To be considered for simultaneous Liver Kidney transplant must be on dialysis for 6+ weeks, or have a GFR < 60 for at least 90 days prior to dialysis start

4/ Diuretics:

💡 “No BP no PP”

🫘 Before managing volume, first raise the MAP ‼️
🫘 Diuretics may raise Cr mildly, but acceptable if patient is improving clinically

3/ Albumin:

🫘 Only given to bring patients to euvolemia

💡 A main side effect of CONFIRM was respiratory compromise by giving repeated doses of albumin

2/ Vasoconstrictors:

1️⃣ Terlipressin
- CONFIRM trial
- Contraindications: Cr > 5, MELD > 35, ACLF grade 3, volume overload, or active ischemia
2️⃣ Norepinephrine
3️⃣ Midodrine, octreotide
- Usually only given if contraindications to terlipressin

1/ 🚨 NEW #5Pearls: Hepatorenal Syndrome Part ✌️

Let’s dive into treatment 🌊!
1️⃣ Vasoconstrictors
2️⃣ Albumin
3️⃣ Diuretics

Goal: raise MAP by 10-15 ‼️

🖥️: www.coreimpodcast.com/2025/10/22/h...

Amazing episode, thanks @juancarlosqvelez.bsky.social @coreimpodcast.bsky.social and crew!

Something I've always struggled with below. Appreciate any insights!

Check out the new episode of the @coreimpodcast.bsky.social podcast about hepatorenal syndrome (HRS) #HRS #Nephrology

5 pearls is such a great series because even when it’s covering a topic I think I know well, there’s always something important I learn — many such moments in this excellent episode.

Yeeeees can’t wait to listen