Everyone knows when it comes to hypertension, NSAIDs are bad but paracetamol is fine, right?

But is it? How much sodium 🧂 is in 4 grams of soluble paracetamol tablets?

A #medtwitter tweetorial thread!

✳️ Why do we sometimes recommend oral sodium bicarbonate in CKD?

When GFR declines then sulphates, phosphates & small organic anions build up.

💥This causes a metabolic acidosis in CKD - the ‘R’ in GOLDMARK (see photo)

#MedEd #nephtwitter The acidaemia in CKD (may) cause:
➡️ Bone demineralisation
➡️ Faster CKD progression
➡️ Protein & muscle catabolism
➡️ Hyperkalaemic tendency

These flow diagrams always make cause & effect appear certain - in reality there is a fair bit more uncertainty (from Dobre 2020 NDT)

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)