Discover and read the best of Twitter Threads about #endotwitter

Most recents (6)

Hi #medtwitter! We’re halfway through 2020(‼️), New month = new case with @TheSkeletonKG. A little rusty in the clinic, ready for a consult? 🤓 Join us as we figure out this patient’s #hypercalcemia. Let’s break it down with a #tweetorial. #NephTwitter

👉🏼renalfellow.org/2020/07/20/ske…
1/ 55 y/o F with no known comorbidities comes in for 3 months of on-and-off left flank pain and a recently treated UTI. Her labs:
2/ Because Nephrology is cool, you are excited to investigate 🕵🏻‍♀️🕵🏾‍♂️🕵️ her hypercalcemia. What's the next thing you order?
Read 20 tweets
Is being pregnant magical🌟?
I’m not so sure, but let’s give OB a Nephrology twist. 🍼🐣

#nephtwitter #obtwitter #endotwitter #reallythekidneysarethecoolest #medtwitter #tweetorial

Why do you gain weight when you are pregnant?
The average woman ⬆️gains a plasma volume of 1250 mL (an increase of 45-55%).

Significant lab values changes include
- Plasma Na ⬇️reduced by ~ 5 mmol/L
- Plasma osmolality ⬇️reduces by ~10 mOsm/kg
- Cr ⬇️decreases by 0.3 mg/dL due to increased GFR among other changes ImageImage
There is an entire milieu of hormone changes during pregnancy🤰. Some are natriuretic and some are anti-natriuretic.

Sources: Comprehensive Clinical Nephrology Chapter 42, pubmed.ncbi.nlm.nih.gov/22879432 ImageImage
Read 18 tweets
1/
#medtwitter is fairly comfortable managing “normal” DKA right? But how about in the anuric dialysis patient? The cookbook protocol can be deadly.

Read this #tweetorial to learn about how their DKA pathophysiology is fascinatingly different.

#meded #nephpearls #endotwitter
2/
Quick recap of normal DKA pathophysiology;

🔑 insulin requirement > insulin supply

✅ “stress hormones” rise
✅ blood glucose rises & because glucose is an osmotic diuretic, there is a huge, inappropriate urine output
✅ body makes ketones as alternative fuel, so pH falls
3/
Recap of normal DKA;

✅ patient symptomatic,extracellularly dry, 6 litres down & counting
✅ whole body K low due to osmotic diuresis, but often ⬆️K at first due to hypertonicity/ low insulin/ acidosis
- serum K then rapidly falls as INsulin drives K & glucose INtracellularly
Read 18 tweets
History of Diabetes. A thread.

1550 B.C: “Too Great Emptying Of The Urine”

First ever recorded mention of diabetes in Ebers Papyrus, written around 1550 BC, excavated in 1862 AD from an ancient grave in Egypt.

#EndoTwitter #Diabetes #MemoryLane
@JoyYWu @StanfordMed @MedscapeEndo @TheEndoSociety @Endocrine_News Around the same time, Indian physicians seemed to stumble upon a mysterious illness with "Honey Urine" which attracted ants and flies. They started to use the ants to diagnose the illness.

#EndoTwitter #Diabetes #MemoryLane
@JoyYWu @StanfordMed @MedscapeEndo @TheEndoSociety @Endocrine_News 230 B.C

Egyptian healer/historian, writer of 'On the Names of the Parts of the Human Body', Apollonius of Memphis, names the illness "Diabetes" (dia – through, betes – to go].

#EndoTwitter #Diabetes #MemoryLane #MedTwitter
Read 13 tweets
💥Current American Diabetes Association guidelines recommend Metformin as the 1st line therapy for all T2DM patients👇🏽
⚡️But should Metformin be the 1st line therapy in T2DM patients with cardiovascular disease?
1/
#Metformin
#endotwitter
#cardiotwitter
💥Let’s review the following about
Metformin:

⚡️Mechanism of action
⚡️Safety profile
⚡️Cardiovascular benefits
2/
💥How does Metformin work?

⚡️It inhibits gluconeogenesis in the liver by mitochondrial inhibition & by ⬆️ activation of AMP-kinase👇🏽
⚡️It ⬆️ insulin sensitivity
⚡️It may have additional pleiotropic
effects👇🏽
3/
Read 12 tweets
1/15

For my first #Tweetorial, I will start with a question:

Which of the following medications from the SGLT2 inhibitor class have been shown to decrease cardiovascular morbidity and mortality?

#Diabetes #EndoTwitter #MedEd #MedTwitter #DM2 #T2D #CardioTwitter
2/15

Sodium glucose transporters (SGLT) in proximal tubules mediate glucose reabsorption.

How?
Na/K ATPase moves Na out & K into the cell ➡️gradient for Na to flow intracellular

SGLT uses this potential to move glucose against its gradient from the tubular fluid into the cell.
3/15

SGLT2 inhibitors block glucose reabsorption
➡️renal glucose excretion
➡️glucose levels⬇️

Because this has nothing to do with insulin, they usually don’t cause hypoglycemia or weight gain.

Actually, because of the osmotic diuresis, they decrease blood pressure & weight.
Read 15 tweets

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