Internist & intensivist made @incmnszmx | Interested in critical care, hemodynamics, MV and #POCUS. Also fan of literature, music, films and life curiosities 🔍
Feb 5, 2021 • 21 tweets • 15 min read
ED 3 AM: 🚨 ambulance rushes in, pt in his 40's unconscious, BP 50/20, HR 140. Reanimation is started and arterial gases are ordered: lactate 10! Two hours later, pt conscious, MAP >65, HR 100, new arterial gases are ordered: lactate 9.
💉 Can be used for ATP formation or gluconeogenesis (lac➡️pyruvate➡️A-CoA or lac➡️pyruvate➡️oxaloacetate)
Feb 4, 2021 • 20 tweets • 10 min read
🚨 Interesting non Covid case yesterday! 🤓
25 YO male, pauci-immune GN previously treated w/ ciclosporine + ⬆️ dose steroids. Arrives @ triage w/ SOB, fever, AKI KDIGO 2 & this CT scan:
dDx was DAH vs acute pulmonary edema (❤️renal syndrome type 1 vs 3). NIV was started w/ excellent response, FiO2 ⬇️ from 100% to 40%. Met the pt yesterday, already on abs & diuretics, but still ⬇️ UO. Neph wanted to star RRT. Pt had Gallavardin phenomenon on 🩺 + 🥶. #POCUSFirst
Jan 28, 2021 • 14 tweets • 9 min read
Some days ago i had a pt with cirrhosis Child Pugh C admitted for AKI during my shift. Offending meds were withdrawn, IVC was seen at 0.9 cm and albumin infusion was started.
This common situation got my mind started: why is 🥚 so good for cirrhotic pts kidneys?
A brief 🧵:
👇🏽
First, let's start by mentioning some of albumin's main properties:
