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Buku Renal is part of the free Buku Medicine app on Android and iOS, answering the commonest clinical nephrology qs. Follow for tweetorials and renal education
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Oct 27, 2021
3 min read
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?
Feb 21, 2021
3 min read
✳️ 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)
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)
Jan 2, 2021
6 min read
“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 👇
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)