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Joel M. Topf, MD FACP Profile picture
@kidney_boy
Apr 14, 2023 • 8 tweets • 4 min read • Read on X
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Pseudohyperkalemia
Serum potassium is higher than plasma potassium. #NKFClinicals ImageImage
Sometimes Fist clenching
Sometimes Tourniquet
in the NEJM 1990 Image
Seasonal temp effects on potassium #NKFClinicals Image
Potassium’s of 6 due to genetic abnormalities in the RBC releasing K after blood draw. #NKFClinicals ImageImage
in the first, the blood clotting releases K, in the other heparin causes the high K in the plasma #NKFClinicals ImageImage
Pseudohyperkalemia Image
Pseudohypokalemia cell uptake of K ImageImage
Conclusion Image

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More from @kidney_boy

Joel M. Topf, MD FACP Profile picture
Apr 13
When we published our study <> of ODS and hyponatremia we were pummeled for including people at low risk of ODS because we included Na levels between 120 and 130. They said it is well known "that ODS is incredibly rare/non-existent at those levels." 1/4evidence.nejm.org/doi/10.1056/EV…
Of course one of the reasons it was thought to be incredibly rare was that no one looked for CPM in patients with Na from 120-130. We found a fair number (≤5 of 12). 2/4 Image
Our findings are replicated in a study from Australia. The authors took a different approach to investigating ODS. Instead of starting w/ hyponatremia and working forward to ODS, they started with a dx of ODS and worked backwards
3/4ncbi.nlm.nih.gov/pubmed/35717664
Read 4 tweets
Joel M. Topf, MD FACP Profile picture
Sep 17, 2023
Gadolinium in dialysis patients.
What's up with that?
#Tweetorial
1/11
Nephrogenic systemic fibrosis (NSF) is an iatrogenic disease that presents with hardening of the skin and other organs. It is often lethal. I treated 5 people with this condition (including one with AKI). Terrible.
2/11 Image
The etiology of NSF was unknown and there were many theories. In 2006, Thomas Grobner published a small case series showing 5 patients developing NSF within weeks of receiving gadolinium contrast for MRI.
3/11pubmed.ncbi.nlm.nih.gov/16431890/
Read 12 tweets
Joel M. Topf, MD FACP Profile picture
Aug 12, 2023
I just recently recommended the Renal Physiology book by Bruce Koeppen and Bruce Stanton. I thought it was a good medical student level text book: pbfluids.com/2023/08/ouwb-s…
But I came across this question in Chapter 8 Regulation of Acid Base. It is a straight forward question asking the learner to interpret simple acid-base cases. Image
But the question falls apart when you look at the answer... Image
Read 7 tweets
Joel M. Topf, MD FACP Profile picture
Apr 14, 2023
Lab guy from Yale up next Joe El Khoury He is on YouTube. Episode 1 was on pseudohyponatemia
209 subscribers. Clinical Chemistry with Joe El-Khoury Image
Here is the YouTube channel: youtube.com/@ClinChemJoe

https://t.co/LWupt0HWN1 #NKFClinicals
Despite calling it “laboratory error”, a lot of the problem happens long before the sample gets to the lab. #NKFClinicals Image
Read 9 tweets
Joel M. Topf, MD FACP Profile picture
Apr 14, 2023
Michael Emmett on electrolyte artifacts
Pre-analytical and analytical #NKFClinicals Image
Starting with pseudohyponatremia
These are real cases
The osmolality was 294, so there is a huge gap. 44ish
Implies Artifactual decrease in sodium
Her triglycerides were >6000 #NKFClinicals Image
Note the different between HCO3 and tCO2 should be closer than 19 and 9. #NKFClinicals Image
Read 12 tweets
Joel M. Topf, MD FACP Profile picture
Apr 14, 2023
At the #NKFClinicals to see @rajmehrotra1122 win the Michael Lazarus distinguished scholar award. Image
His lecture begins, “Consider the patients’ lived experience” #NKFClinicals

Dr: “Labs look good”
Patient: “but doctor why do I feel like crap” ImageImage
Dialysis is a 4-6 hour time commitment. There is no other chronic condition that takes a greater commitment by patients.

One way to help patients is give them a choice of modality.

#NKFClinicals
Read 14 tweets

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