Discover and read the best of Twitter Threads about #DiuresisJedi
Most recents (8)
Don't miss our monthly educational review #EHJACVC @ESC_Journals!
This month by the great @ArgaizR: fluids in #AKI
Co-starring: @ThinkingCC @khaycock2
Extremely proud that our journal offers a platform to 3 great clinicians & Twitter educators. I always learn from them...
This month by the great @ArgaizR: fluids in #AKI
Co-starring: @ThinkingCC @khaycock2
Extremely proud that our journal offers a platform to 3 great clinicians & Twitter educators. I always learn from them...
A strong argument is made to switch mainstream thinking in #AKI away from the fallacious concept of fluid responsiveness in all to a primary assessment of fluid tolerance.
Probably the most important thing I have learned on Twitter: #VExUS
Probably the most important thing I have learned on Twitter: #VExUS
Why do I like #VExUS so much? Because it really changed my everyday practice... Portal vein became part of my standard #echocardiography assessment.
And that's what we want to achieve with this review, offer something directly applicable at your bedside!
And that's what we want to achieve with this review, offer something directly applicable at your bedside!
Weekly QIPS Pearl! Today we’re myth-busting the idea that yOu cAn oNLy sAfELy diUrEsE 1-2 L/day! How to safely accomplish a balanced diuresis. #QIPSPearls
Huge shoutout, credit, and thank you to @msiuba @PulmCrit and the #DiuresisJedi crew for the various sources and information that led to this post - it has genuinely changed my practice regarding diuretic approach, and hopefully this helps disseminate that information further!
Obligatory tie-ins
Why are thiazides effective in augmenting natriuresis when added to loops?
We all know that exposure to loops➡️increase in NCC channels in the distal tubule
BUT there's more
Did you know that there's a mechanism for thiazide sensitive NaCl reabsorption in the collecting duct?
We all know that exposure to loops➡️increase in NCC channels in the distal tubule
BUT there's more
Did you know that there's a mechanism for thiazide sensitive NaCl reabsorption in the collecting duct?
Electroneutral NaCl absorption can also occur in the collecting duct through the parallel action of pendrin and NDCBE (Na-dependent Cl/HCO3 exchanger) which is upregulated by Ang II and mineralocorticoids (when Ang II present)
2 cycles of pendrin = 2HCO3- to the lumen for 2Cl-. 1 Cl- is recycled to NDCBE resulting in net reabsorption of 1 NaCl and 2 HCO3- (Cl- through CLCK2 and Na and HCO3- through AE4 in the basolateral membrane)
The whole mechanism appears to be thiazide sensitive
The whole mechanism appears to be thiazide sensitive
Fluid overload is bad news for patients:
1. Causes AKI
2. Prevents organ and patient recovery
3. Increases mortality
Ill share some of the data masterfully presented by @criticalbeansmd today at #KidneyWk starting with the take home points, in case this is the only tweet you see
1. Causes AKI
2. Prevents organ and patient recovery
3. Increases mortality
Ill share some of the data masterfully presented by @criticalbeansmd today at #KidneyWk starting with the take home points, in case this is the only tweet you see
Fluid Overload is very common, is all over the place and it has several definitios.
Patients accumulate weight at least for the first 7 days if the ICU doesn’t have some sort of FLUID STEWARDSHIP program in place. Remember fluids are drugs #KidneyWk.
Patients accumulate weight at least for the first 7 days if the ICU doesn’t have some sort of FLUID STEWARDSHIP program in place. Remember fluids are drugs #KidneyWk.
There is no single situation in which Fluid overload is beneficial for patients. On the contrary. It is bad in every situation, doesnt matter how we slice or present the data. Liberal fluid strategies are always worse #KidneyWk
🚨 Multi-part case #Tweetorial
24y man no PMH. 3-4 days myalgias, freq diarrhea. 2L saline given on med floor -> hypox/tachypnea. COVID pend.
A 👍
B RR30-34, SpO2 92% 5L NC
❤️ MAP 90, HR 110s ->150s over 12 hrs
D Avpu
E Anxious
L CRP 58 (ULN 0.9), Cr 1.4 (no baseline), Lact 4.8
24y man no PMH. 3-4 days myalgias, freq diarrhea. 2L saline given on med floor -> hypox/tachypnea. COVID pend.
A 👍
B RR30-34, SpO2 92% 5L NC
❤️ MAP 90, HR 110s ->150s over 12 hrs
D Avpu
E Anxious
L CRP 58 (ULN 0.9), Cr 1.4 (no baseline), Lact 4.8
WOB is moderately elevated.
What diagnostic manuever do you think is most important at this point?
What diagnostic manuever do you think is most important at this point?
Unlike most MC questions, you also get to choose a therapeutic maneuver while dx is happening. What's your first choice?
More case details to follow tomorrow!
More case details to follow tomorrow!
Dr. Gattinoni or: How I Learned to Stop Worrying about P-SILI and Love Furosemide
WEIRD THREAD 🧵 About the blood-gas barrier and #COVID19 (1/9)
WEIRD THREAD 🧵 About the blood-gas barrier and #COVID19 (1/9)
Clinical Case: A 4 year old Thoroughbred Horse with a history of recurrent racing-associated epistaxis comes to your office complaining of decreased track performance. He wants to know if there is anyway to prevent this from happening (2/9)
What treatment would you recommend? (3/9)
Question to all #VExUS experts: "Do you ever diurese VExUS 0 ?" Thread below.
I admit not being a #VExUS user, but learned much from your tweets and have been practicing many #DiuresisJedi concepts.
@ArgaizR @msiuba @ThinkingCC @NephroP @load_dependent @khaycock2 @Thind888
I admit not being a #VExUS user, but learned much from your tweets and have been practicing many #DiuresisJedi concepts.
@ArgaizR @msiuba @ThinkingCC @NephroP @load_dependent @khaycock2 @Thind888
Ever since I read this great paper, tend to consider volume status and cardiac filling pressures as 2 separate and equally important concepts that both deserve optimisation in #ICU and #HeartFailure.
Basically, V-p correlation is all over the place! (1/6)
journal.chestnet.org/article/S0012-…
Basically, V-p correlation is all over the place! (1/6)
journal.chestnet.org/article/S0012-…
What I learned from you all is that #VExUS & especially portal vein flow is a great tool to assess the impact of ⬆️(right-sided) pressure on organ function. This gives you more confidence to diurese patients, even when hypotensive or still hemodynamic unstable. (2/6)
submassive PE due to liver mass leading to IVC obstruction with visible ivc clot! improved with lysis #StoweEM20 by @ThinkingCC
portal vein gas on ultrasound is more sensitive for badness (vs AXR or CT) but doesnt necessarily indicate a catastrophe! no longer “the undertakers sign” #StoweEM20 by @ThinkingCC
