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Robert Centor
@medrants
, 3 tweets, 2 min read Read on Twitter
1/
 #5goodminutes with #KashlakChief
Great case conference, your job = diff dx Questions encouraged.
@thecurbsiders @CPSolvers
2/
 60+ woman w/ worsening forearm pain. Fell 1 month ago - forearms developed open sores. Debridement worsened the sores X 2. Antibiotics did not help. Now transferred to your hospital quite sick needing BP support.
3/
 Both forearms have large necrotic lesions. She has a new lesion on her abdomen. PMH - ESRD, DM2, CAD, Increased BP - on appropriate meds.
Will answer questions as best I can. Answer with brief tweetorial tomorrow
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#5goodminutes #KashlakChief

More from @medrants see all

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Robert Centor
@medrants
1/ How to decipher today's abnormal FBP:

82 yo woman admitted 4 GI bleed (esophageal ulcer) Transfused & volume repleted.
4 days later BMP 142/3.4/112/17/5/0.8
Admission
142/4.2/101/25/45/1.3
#KashlakChief asks
Why is the bicarb 17?
@CPSolvers & @thecurbsiders
2/
She has a bicarbonate of 17 with an anion gap of 13. Her albumin was normal.

Initial assumption - normal gap metabolic acidosis.

Two possibilities - losing base or inability to buffer daily acid
3/
Losing base occurs when we have GI losses. The patient had no diarrhea, no previous Gi surgery, thus this seemed extremely unlikely. Patients with normal renal function need liters of diarrhea to develop this much lowering of their bicarbonate.
Read 11 tweets
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Robert Centor
@medrants
1/
 Hypokalemic quadriparesis (or severe hypokalemia)
39 yo Egyptian admitted with quadriparesis &K = 1.3
Spend #5goodminutes reading how #KashlakChief conceptualizes &teaches this electrolyte disorder. hope @thecurbsiders and @CPSolvers enjoy & @kidney_boy appropriately critiques
2/
 Step 1 determine the acid-base status. Patients can get severe hypokalemia and have normal gap acidosis, normal acid-base or metabolic alkalosis. I am not certain about increased anion gap acidosis, but suspect that some DKA patients have severe hypokalemia.
3/
 Let's first understand the normal gap acidosis hypokalemia. There are two major possibilities - distal RTA (Type 1) or diarrhea. We diagnose distal RTA when we have a normal gap acidosis and an elevated urine pH.
Read 16 tweets
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Robert Centor
@medrants
1/
 Pathergy - several colleagues mentioned this key concept. Search for a precise definition, we use the term to group skin lesions that worsen w/debridement or even just minor trauma.
#KashlakChief presents #5goodminutes & @thecurbsiders & @CPSolvers @uabimres
2/
 As the presentation unfolded on Wednesday, the first big clue was that the lesions occurred after seemingly minor scrapes, and then worsened with debridement. The cause of the skin lesions became more complex after we learned that the patient had ESRD on dialysis.
3/
 The lesions actually looked similar to calciphylaxis. Two findings (prior to biopsy) made that diagnosis less likely. Her Ca 7.5 (alb 2.2) and Phos 4.5 did not give that high a calcium-phosphate product. Then her CT of the lesions did not show calcium.
Read 7 tweets

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Joe M
@StormIsUponUs
For 2 long years, Trump has been under the microscope, every inch of his life scrutinized and vetted, while the nation hung in the balance wondering if he was really a crook, or if we've all been unwilling victims in the largest consolidated public scam in history. Now we see. 🇺🇸
We sat through the whole charade while the full weight of our legal and law-enforcement apparatus went to work searching for crimes of the now totally exonerated DJT - all so the public would have no choice but to accept the same rigor being turned back around on [THEM]! #PAIN
So don't ever let anyone tell you Trump was merely 'selected' for this role in #TheStorm. He lifted his skirt for the entire nation at great personal and financial expense, and deserves a whole new medal that hasn't already been tarnished by the monsters who once ruled the earth.
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Joe M
@StormIsUponUs
Extraction, sale and use of human byproducts is fundamentally unAmerican. It leaves us vulnerable to exploitation by organized criminals and today we see the result in the industrialized harvesting of babies, melanin from Haitians, adrenachrome from kids and Lord knows what else.
It eventually grew to beat oil, guns, sex trafficking and opioids as [their] leading source of revenue. The Clinton Foundation would act as global operations HQ, with [PP] a core node in the supply chain. The world is being run by a whole new level of sick organized criminals.
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West Wing Reports
@WestWingReport
All Americans should be pleased that the job market continues to grow:
Last 24 months of Obama: +5,132,000 (Feb. 2015 to Jan. 2017)
First 24 months of Trump: +4,801,000 (Feb. 2017 to Jan. 2019)
data.bls.gov/timeseries/CES… …
#Job growth since 2008 (millions)
2008: -3.56
2009: -5.06
2010: +1.06
2011: +2.09
2012: +2.14
2013: +2.30
2014: +2.99
2015: +2.71
2016: +2.24
2017: +2.06
2018: +2.56
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Why did the unemployment rate go up - after 304K jobs were added to the economy? Of course you're dying to know this, and that's where WWR's Paul Brandus comes in. The simple answer: the two data points - jobs created and the unemployment rate - come from two separate surveys /1
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Nithyananda on Wealth
@eN_wealth
#Pain is a #blessing in disguise!

Just look back at your life. When you were happy about something, did you ever wonder about the meaning of life? Did you look inwards to see who you are, what life is all about? Did you feel the need to deeply know about the ultimate Truth? No!
When things go smoothly you just blindly follow the same routine with barely any awareness or consciousness. There is nothing to jolt you into awareness from your routine so you continue without any awareness. But when #pain happens, it makes you look at life objectively.
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🔮
@magicshopjk
☆ ⁎ ˚ midnight, lose my mind ⁎ ˚ ☆

「 jikook au 」

jimin and jungkook meet at a party when jungkook tries to save jimin from unwanted attention.. by pretending to be his boyfriend.
→ 1
instagram
jimin is a dance major and a great student.
jungkook is a photography major, new student at their uni, transferred to SNU about a month ago.
→ 2
twitter profiles for good measure
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mycatholicwife
@mycatholicwife
A Thread for Men: When your #woman is #emotional, #crying or #stressed out, do not hold it against her. One of the lies of #feminism is that men and women are the same, including that we should process #emotions the same way. Reject the lie. Listen and learn in the posts below.
#Women have much greater #hormonal fluctuations each month than #men do. Simply put, a woman's thought life and #emotions are more prone to high highs, and low lows. This isn't a "design flaw" but rather how #God made a #woman to be in touch with the needs of small #children.
Nothing is more short-sighted as a #man than viewing a #woman as an "overly emotional" or "flawed" version of a man's thought process or #emotions. A woman that does not let her emotions out will become very #passiveaggressive, #depressed or #angry. Your job is to be an #outlet.
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