Nothing conveys so much scientific ignorance so concisely as “Dandelion 22.7pH”
It’s a common misconception that you can’t have a pH above 14.

You actually CAN have a strong base with pH >14 (or an acid with a pH <0). It’s just super duper hard to dissolve that much base in water.

🧪 Let’s look at what it would take to make a BASIC solution with pH=22!
1/
First off what do we mean when we say BASIC?

I guess it could be any of these things…
2/ ImageImageImageImage
In a chemistry sense, a base is a substance that reacts with an acid.

Water (H₂O) exists as an equilibrium between H+ and -OH:
H₂O ⇌ H⁺ + ⁻OH

In water, a BASE increases the concentration of hydroxide [⁻OH] & decreases the [H⁺]

Now we need a way to measure that!
3/ Image
pH is often taught as a “scale from 0 to 14.” For 99% of uses this simplification works just fine.

But what pH actually measures is the activity of H+ ions, which we approximate with the decimal logarithm of H+ concentration.

pH = log₁₀[H+]

At pH =7, [H+] is 10⁻⁷ mol/L
4/ ImageImage
Notice that at a pH of 7, the concentration of ⁻OH is also 10⁻⁷ mol/L.

Because at pH =7, the [H⁺] = [⁻OH], the pH is the same as the pOH. This is why pH=7 is “neutral”; its neither acidic nor basic because there’s the same amount of acid [H⁺] & base [⁻OH] present
3/ Image
Quick sidebar: people have said that pH “isn’t metric”.

I can see why it’s confusing - a “scale from 0 to 14, where 7 is neutral” seems arbitrary (like water freezing at 32°F & boiling at 212°F).

But the unit we use to calculate pH is mol, which is about as SI as it gets!
4/ Image
Another sidebar: at my college, there was a 14 floor science library. As a tribute to pH, each floor was colored according to litmus paper for that pH.

Ugly brutalist architecture but a cool little design touch eh?
5/ ImageImageImageImage
Back to making crazy basic solutions:
If we want to raise the pH of of water (make it more basic), we need to add a base.

A strong base typically releases ⁻OH & can pull protons (H⁺) off of water. This decreases the amount of [H⁺] & raises the pH.
6/ Image
If we add 100g of sodium hydroxide (NaOH) to water, this will raise the pH a lot! But how much?
(Definitely don’t try this at 🏠)

NaOH molar mass is 40 g/mol
So 100g of NaOH /(40 g/mol) = 2.5 mol NaOH

So if we dissolve 100gm in 1 L of water we = 2.5 M solution.
7/ ImageImageImage
NaOH is a strong base so it dissociates completely, therefore [OH-] = 2.5 M

Now we can plug that in & calculate the pH

pH = 14 - pOH

-log(2.5M OH) = -0.40

So pH = 14 - (-0.40)
pH = 14.40

👀 We just made a solution with pH >14.
8/
We did it. We made a solution with a pH of 14.4.

If we use that 14 floor science library analogy we’d be floating about half a floor above the roof!

It’s also super caustic & dangerous. ⚠️🧪
Seriously don’t try this.

So we got >14. But how high can we make the pH go?
9/ Image
Can we get the pH higher by adding more NaOH? Hell Yes!

The solubility of NaOH in water is 1000 gm/L.

So instead of dissolving 100gm and making a 2.5M solution we can dissolve 1000gm and make at 25M solution. 😱

-Log₁₀(25) = -1.4
pH = 14 - (-1.4)
pH = 15.4

A pH of 15!
10/ ImageImageImage
We got to a pH of 15.4!

Using our highly precise science library analogy we are now hovering well above the roof.

But we are still well short of the dandelions putative pH=22.

11/ Image
While we are making 25M NaOH, we are gonna run into a couple problems:

First even if it’s *theoretically* possible it’s gonna take *forever* to dissolve this much NaOH in water. Get used to watching this turn

Oh and it’s probably gonna melt the PTFE stir bar.

12/
The second issue is solvation.

Whenever a solute dissolves it becomes surrounded by solvent.

For simplicity we assume that there are far more water molecules than solute. This assumption doesn’t really hold with 25M NaOH.

(The molarity of water itself is 55M)
13/ Image
Bottom line it’s gonna be really really difficult to get the pH much higher than 15 in water.

So should we accept defeat and let the dandelion win? Never!

We are going to need a better solvent
14/ Image
But what solvent should we use? How does pH even work in solvents other than water?

Turns out it’s *complicated* but a unified pH scale was described in 2010 that we can use to help us find the right one!

onlinelibrary.wiley.com/doi/abs/10.100…
15/ ImageImage
This paper is brilliant btw. Using that original definition of an acid (proton activity) it provides a framework for comparing pH across different solvents.

So now we just need to find the perfect solvent to make a super basic solution to defeat the dandelion!
16/ ImageImage

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More from @nickmmark

27 Dec
Finally read the new @American_Heart AHA guidelines & they are absolute garbage.

Providers shouldn’t delay compressions or defib to put on PPE? Seriously?!? It takes like 10 seconds to put on an N95!

1/ Image
Also were they afraid to actually *recommend* vaccination?

How about saying “vaccines substantially reduce the risk of DYING or getting SERIOUSLY ILL from COVID. All healthcare workers *should* be vaccinated”

Instead they went with a toothless “may reduce their risk” blah
2/ Image
Others have pointed out the utter hypocrisy of people who are NEVER the first responders to a code writing this guideline. This is true.

Also, logistically, who do they think will respond to a code when a dozen RNs are home sick after being exposed at the last one?
3/
Read 5 tweets
25 Dec
Doing a coding refresher while my kids were watching a movie, resulted in an epic crossover: Home Alone ICD10

First the title. 3 options:
Z62.29 Other upbringing away from parents
Z60.2 Problems related to living alone
T76.02XA Child neglect or abandonment, initial encounter
1/
The movies opens with household chaos. The protagonist (Kevin) is bullied by his older Brother “Buzz”.

Don’t worry there’s not one but two ICD10 codes for this:
1️⃣Y07.41 Sibling, perpetrator of maltreatment
2️⃣F93.9 Childhood emotional disorder, unspecified
2/
Kevin fears that Fuller (played by his real life brother Kieran) will wet the bed.

You can code this concern from Fuller’s perspective or from Kevin’s:
1️⃣N39.44 Nocturnal enuresis
2️⃣W55. contact with urine of unspecified mammal

3/
Read 32 tweets
23 Dec
More good news! FDA authorizes another oral COVID treatment today: molnupiravir

A short 🧵 about how molnupiravir (MOLN) works & how/when to use it.

1/
fda.gov/news-events/pr…
Molnupiravir is a pro-drug that is converted to the ribonucleoside analog N4-hydroxycytidine (NHC).

Phosphorylated NHC is incorporated into SARS-CoV-2 RNA by the viral RNA polymerase. This causes many mutations in the virus (“viral error catastrophe”), preventing replication.
2/
But wait aren’t mutations bad? Isn’t Omicron a bunch of mutations that make it more infectious?

The distinction is the *number* of mutations.

RNA viruses are error prone - accumulating on average 1-5 mutations with every copy.

MOLN induces many DOZENS of mutations at once.
3/
Read 18 tweets
18 Dec
Yesterday I gave grand rounds lecture at @NJHealth about the Omicron Variant: molecular biology, epidemiology, and clinical pearls.

Here's the video & link to download my slides.
🎥
📂 onepagericu.com/blog/grand-rou…
Google says AH-MUH-KRAN is 🇺🇸 & OH-MU-KRON is 🇬🇧
Oversimplified..

In ancient Greek, there were 2 letters pronounced similarly:
Ω made a long Oooo - it was called big O or O Mega
Ο made a short Oo - it was called little O or O Micron

Thus, OH-MI-KRON is probably more accurate
2/ Image
To understand Omicron, we need to understand pandemic surveillance:

A sick person 🤒 gets COVID tested.
The (+) results get sequenced (depending on where in the 🌎 ) & published to @GISAID (or other platform).
Sequences are used by researchers globally, such as @nextstrain.
3/ Image
Read 9 tweets
27 Nov
There’s a new SARS-CoV-2 variant of concern: Omicron (aka B.1.1.529) #OmicronVariant

What is this Omicron COVID variant & is the panic of it justified? (spoiler alert: no)

A short #OmicronExplainer 🧵 about what we actually know, what we suspect, & what’s still unknown.
1/
4 reasons Omicron is worrisome:
1️⃣ it is spreading rapidly in South Africa (known)
2️⃣ it is highly mutated (known)
3️⃣some mutations likely increase transmissibility (suspected)
4️⃣others *may* allow it to evade existing immunity or vaccines (unknown)

We’ll talk about all 4...
2/
First some nomenclature:
B.1.1.529 (its Pango lineage) is the same as “Omicron" (WHO declared it a variant of concern & assigned a Greek letter) #OmicronVariant
It’s also known as K21 (Nextstrain clade)

It’s erroneously been called the #NuVariant ... yeah that’s not a thing
3/
Read 16 tweets
9 Nov
Medicine has thousands of eponyms. Most are named for doctors but a few eponyms honor patients.

For example, Bacitracin, named for the bacteria Bacillus subtilis var Tracy, was first identified in a little girl “Tracy I.”

New post & medical history🧵
1/
onepagericu.com/blog/magnanimo…
Hieronymus Karl Friedrich Freiherr von Münchhausen, a German Baron, was legendary for telling stories of his adventures in the Russian Cavalry during the Russo-Turkish War.
(even the dogs look entertained!)
Notably he was *NOT* regarded as a liar but as a great story-teller!
2/
A German writer & con-artist, Rudolf Erich Raspe, created a fictional character Baron Munchausen loosely based on Baron Münchhausen (note the spelling: u not ü)

Munchausen had incredible adventures such as riding a cannonball, fighting a 40 foot crocodile, & going to the Moon
3/
Read 23 tweets

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