🧵 CHRONIC DIARRHOEA: The Complete Clinical Breakdown
If you master this, chronic loose stools will never confuse you again 👇
#MedTwitter #FOAMed #InternalMedicine #Gastroenterology 1️⃣ What is Diarrhoea? Let’s begin at the roots 💧
Diarrhoea means passing loose or watery stools more than usual.
Objectively
● Stool weight more than 200 g in a day
● Or three or more loose stools per day
Chronic diarrhoea = more than 4 weeks
Remember: patients judge diarrhoea by consistency, not weight or frequency.

🧵 HYPOXEMIA: The ICU Masterclass

1️⃣ Start with the foundation
Hypoxemia = low PaO2 in arterial blood (mmHg).
Hypoxia = low oxygen at tissues.

A patient can have SpO2 99, Hb 5 and lactate 7. This is hypoxia despite normal saturation.

❓ SpO2 98 but lactate rising. What failed?
A Oxygenation
B Oxygen delivery

#MedTwitter #FOAMed #ICU #CriticalCare #InternalMedicine 2️⃣ DO2 is the real determinant of survival
DO2 = Cardiac Output × CaO2
CaO2 = 1.34 × Hb × SaO2 + 0.003 × PaO2

Most oxygen is carried on hemoglobin.
Cardiac output determines delivery speed.
SpO2 alone cannot tell you if tissues are suffocating.

🍺 ALCOHOL : The Most Socially Accepted Toxin

We celebrate with it, mourn with it, and cope with it.
Yet alcohol quietly kills nearly 3 million people every year, ranking among the top ten causes of preventable death worldwide.

Let us understand the full story from casual use to full blown dependence.
#MedTwitter #PublicHealth 🧵 🔹 1. The Language Has Changed

Stop saying “alcohol abuse” or “ETOH abuse”.
These are outdated and stigmatizing.

🩺 Use
• Unhealthy Alcohol Use : the broad term for all harmful drinking
• Risky Use : any amount that increases health or social risks
• Alcohol Use Disorder (AUD) : clinically significant impairment as defined by DSM 5

Language matters. We treat disease, not morality.
#AddictionMedicine

🧵 “ALL PEP at ONE PLACE” — The Ultimate Thread for Clinicians & Students

What to do after exposure to 👇
☣️ HIV
🦠 Hepatitis B
🧪 Hepatitis C
🐕 Rabies
🔩 Tetanus

#MedTwitter #USMLE #NEETPG #InfectiousDiseases

@DrAkhilX @prarit_v @doctors_squad @drkeithsiau @DoctorLFC ⚕️ HIV PEP (Post-Exposure Prophylaxis)

Every second counts! Start within 2 hours, never beyond 72 h.

Step 1: Wash wound with soap + water. No spirit, betadine, or bleach.
Step 2: Evaluate exposure (needle-stick, mucosal, skin contact).
Step 3: Baseline tests → HIV, HBsAg, HCV.
Step 4: Start PEP immediately (don’t wait for reports).

Preferred 4-week Regimen:
💊 TDF + 3TC + DTG (1 OD)

Counsel about adherence + safe sex until final test (3 months negative = clear).
#HIV #PEP #MedEd

@DrAkhilX @prarit_v

🧠 Orthostatic Hypotension (OH): The Forgotten Cause of Falls, Fatigue & “Coat Hanger Pain”

A complete clinical breakdown every resident should know 🩺
#MedTwitter #USMLE #neetpg 1️⃣ Case Starter
72-year-old man with diabetes & hypertension admitted for syncope.
BP normal lying down, but every time he stands, he feels dizzy.
Diagnosis: Orthostatic Hypotension (OH)

Let’s unpack this 👇

🧵 1️⃣ Inpatient Hyperglycemia

25% of hospitalized patients have diabetes.
But even non-diabetics with hyperglycemia face worse outcomes — higher infection rates, longer stays, more readmissions, and higher mortality.

Hyperglycemia isn’t just a number. It’s a prognostic marker and a modifiable target.

Let’s break it down 👇
#MedTwitter #Endocrinology

@DrAkhilX @prarit_v @Doctors__squad @DoctorLFC @drkeithsiau 2️⃣ Pathophysiology & Clinical Impact

🏥 Why hospital hyperglycemia is dangerous:
•Impairs neutrophil and T-cell function
•Increases cytokine release and oxidative stress
•Impairs wound healing
•Promotes thrombosis and endothelial dysfunction

📊 Outcomes:
•↑ Mortality in sepsis, MI, stroke
•↑ Post-op infections & AKI
•↑ ICU admissions & readmissions

Even stress hyperglycemia (no prior diabetes) predicts poor prognosis.

1️⃣
🔴 Vitamin B12 Deficiency — The Great Pretender

It can present as anemia, neuropathy, depression, or even dementia.
A simple, treatable cause behind complex presentations.

Let’s decode B12 deficiency completely from molecule to management 🧵

#MedTwitter #FOAMed #InternalMedicine

@DrAkhilX @prarit_v 2️⃣
💊 What is Vitamin B12 (Cobalamin)?

A water-soluble vitamin containing cobalt at its core.
It exists in two active forms
• Methylcobalamin (cytosol)
• Adenosylcobalamin (mitochondria)

These are required for essential cellular reactions that sustain DNA synthesis and myelin formation.

🧵 GUILLAIN–BARRÉ SYNDROME (GBS): The immune storm that paralyzes

A 28-year-old walks in saying, “Doctor, my legs feel rubbery.”
3 days later, he can’t stand.
By day 7, he’s on a ventilator.

That’s GBS — a medical emergency that turns your immune system against your own nerves.

Let’s decode it fully 👇

#MedTwitter #NeuroTwitter

@DrAkhilX @prarit_v 1️⃣ Definition & Core Idea

GBS is an acute autoimmune polyradiculoneuropathy causing rapidly progressive, symmetrical, areflexic paralysis.

🌀 Monophasic course:
•Progresses to peak (nadir) in ≤4 weeks
•Plateau for 2–4 weeks
•Then slow recovery

Most common cause of acute flaccid paralysis worldwide (after polio).
Incidence: ~1.8 per 100,000/year.
M:F = 1.5:1

🧵1. FIBROMYALGIA: The Pain You Can’t See 💭

“Doctor, I feel pain everywhere. But my tests are normal.”

That’s the daily story of a Fibromyalgia patient — where the pain is real, but invisible to scans.
Let’s understand this misunderstood condition in depth 👇

#MedTwitter #Fibromyalgia #Rheumatology

@DrAkhilX @prarit_v 2. What exactly is Fibromyalgia?

Fibromyalgia (FM) is a chronic, widespread pain syndrome caused by central sensitization — a malfunction of the brain’s pain processing system.

It’s not an autoimmune, inflammatory, or muscular disease.
It’s a pain perception disorder — the brain’s “volume knob” for pain is turned up too high 🔊.

🧵 NAUSEA & VOMITING — The Complete Clinical Guide 🤢🤮

Every doctor sees it.
Every patient fears it.
But few understand how complex it really is.

Here’s a master thread covering everything from mechanism to management — simplified, evidence-based, and high yield.
#MedTwitter #FOAMed #Medicine

@DrAkhilX @prarit_v 1️⃣ Let’s start with basics 🩺

Not every “vomit” is the same:

🤢 Nausea — uneasy feeling of needing to vomit
😬 Retching — dry heaving, contractions but nothing out
🤮 Vomiting — forceful expulsion of gastric contents
😑 Regurgitation — effortless return of food, no nausea
😋 Rumination — re-chewing of food, behavioral

Knowing which one you’re seeing is the first diagnostic step.

1️⃣
🚺 Why do some women develop coarse facial or chest hair like men?
It’s not just “extra hair” — it’s a clinical sign that hormones are talking.

Let’s decode HIRSUTISM — causes, evaluation & treatment 👩‍⚕️
A detailed, evidence-based thread 🧵👇
#PCOS #Endocrinology #Dermatology

@DrAkhilX @prarit_v 2️⃣
🔹 Hirsutism = excessive terminal (coarse, pigmented) hair growth in male-pattern areas in women — face, chest, abdomen, back.

⚠️ Differentiate from hypertrichosis → generalized fine hair (vellus), not androgen-driven, often drug-induced (phenytoin, minoxidil, cyclosporine).
#MedicalEducation #WomenHealth