Share this page!

Enter URL or ID to Unroll

You can paste full URL like: https://x.com/threadreaderapp/status/1644127596119195649
or just the ID like: 1644127596119195649

How to get URL link on X (Twitter) App

  1. On the Twitter thread, click on or icon on the bottom
  2. Click again on or Share Via icon
  3. Click on Copy Link to Tweet
  4. Paste it above and click "Unroll Thread"!
  5. More info at Twitter Help
Elliot Tapper Profile picture
@ebtapper
Jul 29, 2019 • 3 tweets • 3 min read • Read on X
Pitfalls in the diagnosis & management of Wilson Disease

In this month's @Clin_Chem_AACC features:
- False + ceruloplasmin(⬆️triglycerides)
- False + hepatic copper(?lab error)
- Patient harm (neuropathy, pancytopenia) due 2 copper deficiency on hi dose zinc
#meded #pathtweet ImageImageImage
Case report: clinchem.aaccjnls.org/content/65/8/9…
Commentary by Twomey highlighting role of IT and QA from clinical pathology: clinchem.aaccjnls.org/content/65/8/9…
Commentary by me on the importance of patient-centered testing: clinchem.aaccjnls.org/content/65/8/9…
Patients will tell us their diagnosis - if we are listening

Tests can be helpful but also misleading. This story is a cautionary tale.

Thinking about a zinc tweetorial. In the meantime, here's a link to ceruloplasmin #tweetorial

• • •

Missing some Tweet in this thread? You can try to force a refresh
　

Keep Current with Elliot Tapper

Elliot Tapper Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @ebtapper

Elliot Tapper Profile picture
Jun 9, 2023
WHAT is the deal with Milk Thistle?
WHY is it used to treat liver disease?
HOW does it work?
DOES it work?
ARE you ready for a #tweetorial?
🧵
#medtwitter #livertwitter Image
Milk Thistle, a history:
1⃣Use to treat snake bites (Dioscorides)
2⃣To carry off bile (Pliny the Elder)
3⃣Great for liver disease (1500's: Otto Brunfels)
4⃣In 19th Century 🇺🇸, the 'Eclectics' popularized herbology, especially milk thistle, for the liver ImageImageImageImage
Fast forward to today:
1⃣Herbal supplements are a multibillion dollarindustry
2⃣A quarter of the population takes an herbal supplement
3⃣~5% of the US population is using Milk Thistle, including 12% of people with liver disease

What do they get out of it? ImageImage
Read 12 tweets
Elliot Tapper Profile picture
Jun 4, 2023
I once did a cost effectiveness analysis comparing shotgun vs deliberate testing for elevated ALT

pubmed.ncbi.nlm.nih.gov/27717864/ @JHepatology

We found that broad testing didn’t add much costs but increased false positives, especially when pretest probability of NAFLD was high
Then, In this RCT, John Dillon comparing usual care to broad evaluation of elevated liver enzymes, the cost per incremental diagnosis was 284💷 but was def cost-effective

pubmed.ncbi.nlm.nih.gov/31226388/
I don’t know of many examples of RCTs that confirm or support cost-effectiveness analyses so

A) cool!
B) understanding the differences in the results hinges on the assumptions in the model and the design of the RCT
Read 4 tweets
Elliot Tapper Profile picture
Jun 4, 2023
How to read a cost-effectiveness paper

This is a powerful method. But poorly understood, often maligned. My goal is to improve critical appraisal and help good analyses get the appreciation they deserve

🧵#MedTwitter CEA: cost-effectiveness analysis
A decision must be made!

All CEA begins with a clinical decision where we are uncertain about the best path forward. Nevertheless, when we face patients we must do something, even if that something is nothing. CEA brings our dilemma to life. Helping us quantify trade offs
Usually we compare a fair description of usual care to an alternative - make sure you agree the choice is fair, realistic, and represents an actual clinical dilemma
Read 20 tweets
Elliot Tapper Profile picture
Jun 2, 2023
An older man comes to the ED with abrupt onset nausea, & diarrhea

He is joined by her daughter whom he is visiting from abroad

Testing is below
The diagnosis is unclear
Until his daughter got just as sick too
🧵
#livertwitter #liverstory #MedTwitter Image
ALT >1000 has a narrow differential diagnosis



There's lots of tests you can order.
But most diagnoses are made in the H+P

Like this one

In fact, in this case, my attending said the diagnosis was obvious from the beginning

Just not to me
When I meet someone with ALT>1000, I think:

1⃣Ischemic hepatitis. Right 🫀failure? 🫀-genic shock? Cool legs?
2⃣Biliary 🪨. Pain? imaging!
3⃣Drug induced liver injury. Tylenol? Run every med through livertox.gov
4⃣Viral hep. Hep A/B/C

But these weren’t the answers
Read 16 tweets
Elliot Tapper Profile picture
Feb 6, 2023
The correct answer is variceal bleeding

First, the lactate is up. Take this patient seriously
Second, the obvious clues are lower hemoglobin, platelet consumption.
Third, the ammonia is crazy high. This seals the deal for variceal bleeding.

Why is that?

next slide please
Ammonia is a biomarker of badness

1. Liver dysfunction
2. Portosystemic shunting
3. Dehydration, renal injury (🫘eliminates nh3)
4. Sarcopenia (💪eliminates nh3)
5. Malnutrition

6. And upper GI bleeding
Where is all that ammonia coming from?

The answer is hemoglobin and albumin are isoleucine-poor. This means that when our blood enters the gut, it is not a nutritious source of protein. It gets broken down for waste. That waste, my friends, is ammonia
Read 9 tweets
Elliot Tapper Profile picture
Oct 12, 2022
5 steps toward a killer talk
🧵
1️⃣practice by recording yourself on the memo app. Listen next day while walking. Refine. Repeat.
2️⃣stay on time, preferably under. If 10 min slot, 9. If 15, 12. If 30, 25.
Read 6 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

Send Email!

:(