Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
When would you consider using hypertonic saline for patients with refractory acute decompensated heart failure and diuretic resistance?
In patients with acute decompensated heart failure (ADHF) and diuretic resistance, hypertonic saline combined with furosemide has shown potential in improving clinical outcomes. This combination can decrease mortality, reduce hospital stay and readmission rates, and enhance diuretic effectiveness by...
Is there benefit to performing CVVH instead of intermittent hemodialysis for a patient with AKI secondary to rhabdomyolysis who requires renal replacement therapy?
My CRRT threshold is low, but a patient with AKI and rhabdo will have continuous K and Phos release from dead cells so I prefer a continuous therapy. This depends on the degree of rhabdo and the degree of AKI, but would lean towards CRRT for a moderate to bad rhabdo, same for TLS and same with acute...
Do you intensify the dialysis prescription for patients with end stage kidney disease who develop uremic pericarditis despite regular dialysis sessions?
This was what we did 30 years ago, it did not work. I remember as a fellow there were two explanations for pericarditis in a renal patient, uremic pericarditis if they had not started RRT and something else ("viral etc) if they were on RRT. This was based on the assumption that RRT was good enough t...