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#GI #GIbleed #urea

Elevated BUN: creatinine ratio favors UPPER over lower GI bleed.

Why?

1) Hb in stomach --> amino acids (aa).
2) aa absorbed by small intestine.
3) aa transported and taken up by liver.
4) In the liver, aa undergo deamination, leading to release of NH3. Image
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5) NH3 (aka ammonia) is converted to urea by the urea cycle, leading to elevated blood urea levels.
6) Meantime, creatinine is not influenced by the protein/aa bolus.
7) Thus, BUN/creatinine ratio is increased.
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So why does blood cause this bump in urea and increase in BUN/creatinine ratio, whereas a steak dinner does not?

Because blood has poor BIOLOGICAL VALIUE (the protein is poorly utilized by the body).

The LOWER the biological value of a protein, the HIGHER the urea.
Read 4 tweets
1) Welcome to an #accredited #tweetorial on a unique emerging (in Ph3 now) option for specifically reversing the #antiplatelet effects of #ticagrelor: it's #bentracimab. Expert faculty is antithrombotic agent reversal guru @md_pollack of @UMMCnews, working to create #AHealthierMS
2) This program is intended for #healthcare professionals and is supported by an educational grant from PhaseBio Pharmaceuticals. Faculty disclosures are listed at cardiometabolic-ce.com/disclosures/, and prior programs are available for 🆓CE/#CME credit at cardiometabolic-ce.com.
3) It is an unfortunate fact of life that one cannot prescribe #anticoagulant or #antiplatelet (together, #antithrombotic) therapy without increasing a patient's #bleedingrisk. That is why it should be an individualized risk:benefit decision, ideally . . .
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