Joscha von Rappard

I guess you are being sarcastic….Unfortunately it’s not a question of routine vaccination but a question of leading people away from false propaganda….i have absolutely no idea how we could achieve that.

You are right. I understand you now.

I would say it makes a big difference. If your buffer capacity is spend you are turning instantly from being not good but alive into being dead…..

You haven’t calculated in the produced methane gas in your bowels 😉

„Rule out“ is seldom true in medicine but in my experience a high urine creatinine/high osmolarity and a urine sodium <20 seldom comes with a severe ATN.

The next thing will be GLP-1 users are more likely to win the lottery…

And if you measure bicarb and ends up with a discrepancy…you still don’t know which value you should trust more. So in general I do trust the calculation and wouldn’t make a big fuzz about that the value is „just calculated“

It’s probably more an academically question and I don’t want to be too nerdy, but…the calculated bicarb is not en estimation it is a calculation based on the physiological principles of our acid base handling….maybe @kidneyboy.bsky.social can wade in to give us steering…

Wow, never thought about that. Thanks a lot!

I can look it up if you want, but I think it was a young patient with a diabetic keto acidosis and obviously well functioning lungs…

Interesting, so what was your theory why his values were so deranged? It’s hard to imagine a patient with values like this after a normal dialysis session.

Beware of the units…I live in a kPa region….pCO2 of 1 is not that seldom either.

This patient must have a recirculation value from hell in his dialysis access. Fistula or catheter?

If you believe in Henderson Hasselbalch…I can’t think of a Szenario where the values can have a discrepancy. Please explain!

I can trump that…not that seldom I am afraid.

Right you are. Let’s call it Vitamin D‘ont

Vancomycin PK project: Nuts & Bolts guide Emerging evidence shows the benefits of using pharmacokinetics to adjust vancomycin dosing.  What follows is a guide about how to do it.  I will keep this up-to-date, so please let me know if you find...

discussion of it and an online calculator:

emcrit.org/squirt/vanco/

the clearance of vanc is proportional to the GFR as discussed here:

pmc.ncbi.nlm.nih.gov/articles/PMC...

I'll build a formula embed to calculate GFR from two vanc levels into the IBCC when I get a chance

we should do this more

🙏👏

📌

You are right. It’s not that everyone is throwing jokes around. If you work several years with the same group of people you get a sense who might be humorwise on the same page and who is not (not judging). So at my shop it’s more a group of friends making fun of each other.

I think you are right, there is certainly a substantial toxicity potential. Partly because I was always privileged (or lacking the sensors to feel humiliated) or because I was surrounded by real good people, I never experienced the dark side of the institutionalised hospital banter.

I think that’s true statement and I probably or certainly underestimate the privilege being born with my skin colour. To my defence I might add that it is very easy to forget because diversity in skin colour is nearly non-existent in my part of the world….

The way my colleagues and me are making fun of each other has nothing to do with insulting, because there is no intention to harm the other person. But I understand you. It is always difficult when the “ toxicity” depends on the people involved.

I think you’re right, actually. My thinking about privilege was coined in a way that I always felt privileged to be in that profession, to get the exceptional training I got and I felt privileged to be in a position where I am able to care for patients and being involved in medical education.

Interesting, I didn’t read it like that. I had the impression he/she wanted to stress the fact that doctors are a privileged group of people and therefore supposed to feel more gratitude towards the education being offered.

That was supposed to be a joke….of course i don’t consider any specialty (or human being) as inferior. I put it deliberately there as a joke.
The whole point of banter is that every joke is wrapped in mutual respect.

You might be right. There is a gray area between toxic work culture at one side and a hypersensitive non functional system on the other side. I am trying to stay in the middle lane.

🤣

No, he is joking. Normal banter between colleagues

Well, that’s part of the fun. No? Everybody is making fun of everyone. Our haematologist is making constantly fun about me and I can’t walk pass a cardiologist without a joke about their inferior profession. It’s a big (and maybe) silly hospital-game since the beginning of time.