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

Note the different between HCO3 and tCO2 should be closer than 19 and 9. #NKFClinicals

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Joel M. Topf, MD FACP

@kidney_boy

Apr 14

@rajmehrotra1122

At the #NKFClinicals to see @rajmehrotra1122 win the Michael Lazarus distinguished scholar award.

His lecture begins, “Consider the patients’ lived experience” #NKFClinicals

Dr: “Labs look good”
Patient: “but doctor why do I feel like crap”

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

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Joel M. Topf, MD FACP

@kidney_boy

Apr 13

I presented a poster at #NKFClinicals. This came from working with ViforCSL on the KALM-1 and KALM-2 meta-analysis of the pivotal trials of difelikefalin for CKD associated pruritus (CKDaP). About a year ago we brainstomed what other lessons could we could pull from the data.

A question we had was how quickly do people respond to the drug, or put more practically, if you start a patient on difelikefalin and a month later they are still having intense itch, how likely will it be that they still could respond?

Look at the only figure on the poster and focus on the bars, this gives the fraction of people who will ultimately respond to difelikefalin who have responded at 4 weeeks, 8 weeks and 12 weeks.

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Joel M. Topf, MD FACP

@kidney_boy

Mar 29

Never in the history of medicine has so much been done, by so many, so incompetently, with so little consequence as in the treatment of severe hyponatremia. #Tweetorial 1/10

You shouldn't correct hyponatremia too fast. The speed limit is 8 mmol/L per day. We are terrible at it. In George et al, 41% of 1,490 pts were corrected faster than 8 mEq/L. Look at the poor slobs at the left of the nomogram whose Na actually went down 🤪 2/10

Thankfully this incompetence is rarely punished. Of the 611 (41% of 1490) patients who over-corrected in the George trial, only 7 developed osmotic demyelination syndrome (ODS). Screw the sodium correction and you can get away with it 99% of the time. 3/10

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Joel M. Topf, MD FACP

@kidney_boy

Mar 9

https://twitter.com/dwaldenwrites/status/1633538542084186133

The begining of my medical career was dominated by HIV

Start med school in 91. Magic Johnson announces he is HIV+
MS3 med students do blood draws on HIV+ patients (phlebotomy refuses)
MS4 lost my first patient, advanced dementia HIV
Graduated in '95, peak HIV, 50k US deaths

https://twitter.com/dwaldenwrites/status/1633538542084186133

The whole clincal world was HIV, but you would go to the textbooks and they would still be calling HIV HLTV3. It was bonkers. It was in this envirnoment that UpToDate crushed Harrisons.

Then during residency HAART emerges and the whole thing melts away in a matter of years. All that knowledge about opportunistic infections becomes less a critical part of IM and selective ID knowledge.

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