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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
Oct 27, 2021 11 tweets 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 6 tweets 3 min read
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)
Jan 2, 2021 19 tweets 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 👇

#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)