Yup, and yet CKD is a major risk factor for AKI!
True, improving pre-renal can also be clinically hard to tell apart from recovering ATN depending on when they present.
This encapsulates my feelings on FeNa reasonably well. It still has some good use-cases, but we need to stop using it indiscriminately for every AKI!
(Ref below, VA markup/emphasis mine)
pmc.ncbi.nlm.nih.gov/articles/PMC...
Ha, I did think of that and downgraded my language to "most" :)
In a lot of ways medicine is like troubleshooting a computer, but not all the parts are replaceable and in most cases "have you tried turning it off and back on again?" isn't useful advice.
I wonder if this will result in any changes?
US House Panel Launches Antitrust Probe of Medical Residency System: www.doximity.com/newsfeed/17e...: www.doximity.com/newsfeed/17e...
Hang on let me write this down:
"prescribe more ACEi, fewer snakebites." OK, got it!
With the PTH not super elevated I imagine there's less risk for adynamic bone dz with a bisphosphonate. Although, I'm unsure of the target iPTH when using it for 1°HPT. Looks like I'm d/t do some reading. :)
Either way would be risk/benefit discussion with the patient about the unclear risk and benefit and make the decision together.
My $0.02: your patient doesn't fit neatly into any trials. Benefit unclear but maybe a 24h uCa & see if the hypercalciuria is resolved?
Figure if high bonr turnover...Ca has to go somewhere, right?
If PTH still overly active I'd favour cinacalcet but PO bisphos probably reasonable (& titratable)?
What's the weather like up there?
Standard metformin practice is:
GFR 45+. No changes
GfR 30-45. Decrease dose
(but don’t initiate new therapy)
GFR <30. Discontinue
But maybe some low risk patients with CKD IV are losing a benefit by discontinuing their metformin?
I'm curious if the CKD4 patients had a higher eGFR Cr-Cys C? Would be nice to see new safety data with updated assessment methods!
Egophony is just sound. I wonder if there's a Doppler equivalent on POCUS?
Dad jokes are pretty benign.
I swear the word "spellcheck" was in there somewhere
What I can't seem to do is my posts prior to posting them...
Getting caught up on my HoP episodes!
On the subjevt of poisonings: I wanted to share this diagram to estimate the best method to use to enhance elimination from the body.
I also can't overstate how helpful poison control is in these situations. Make sure to call them!!
It's been a long time comung, but at our lab we just implemented a cystatin C panel. It adds a Cr automatically and outputs a calculated eGFR Cr-Cys C automatically!
Since the Cr is the cheaper test it makes sense to add it on in most cases.
When I was younger I just to have cool dreams. Now my dreams are "we need to treat this RPGN patient but no one can find the biopsy results."
Done. Let me know your thoughts.
(6) The authors proposed comparing ABG/BMP might help diagnose equipment errors.
My conclusion: both methods have potential pitfalls For bizarre results, checking against the *other* method might help confirm that it's real (both directions!).
Oh and definitely check an ABG in a lipidemic pt :)
(4, cont'd) the agreement between chem panels and ABGs seems to vary by device and lab methods used, but in the quoted study they agreed in ~95% & ~99% for ±2 & ±3 mmol/L (respectively).
(5) Common pre-prep errors were trialed and it didn't seem to effect the results by much.
(6) →
(3) This covers the case where there are ↑triglycerides, but doesn't really say which is more accurate in general.
*** many pubmed searches later ***
I came across this article (see excerpt):
academic.oup.com/clinchem/art...
(4) After getting access to the article (finally), I learned this →
@raghumnephdoc.bsky.social please forgive my delayed response. You sent a great article, so I wanted to scrutinize it properly! Here's what I learned:
(1) ↑↑triglycerides interfere w/any indirect ISE measured HCO₃⁻ (same as in pseudo-↓Na!)
(2) Most automated chem panels use indirect ISE
(3) →
Fair, but I'd argue extremes of pH, pCO2 are inherently bizarre situations themselves.
Things like negative anion gaps and broken delta-delta estimations are more common in these scenarios.
The main point I'm trying to make is not to trust equations over a clinical assessment in a vacuum, haha.
Discrepancies are unfortunately inevitable with any equation. Estimation from 2 measured values (pH, pCO₂) generally under less controlled conditions than the chemistry lab may cause variation from a more directly measured HCO₃⁻. Equations are great, but we have to remember their limitations!
Given the pCO2 and pH I expect there to be a pretty bad metabolic acidosis.
But remember: for ABGs generally the HCO3- is calculated from the other two numbers. Sometimes there are discrepancies between the calculated and measured values.
The latter is more accurate.
What was the bicarbonate on the BMP?
On the bright side I think I just became 10 years younger!
