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.

Was reanimation unsuccesful?

Poll & 🧵: First, let's go #BackToBasics w/ lactate:

💉 2 enantiomers: L & D

💉 Formed from pyruvate by LDH (usual ratio 10:1)

💉 PKa 3.8 (lactate predominant over lactic acid)

💉 Can be used for ATP formation or gluconeogenesis (lac➡️pyruvate➡️A-CoA or lac➡️pyruvate➡️oxaloacetate)

🚨 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

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 Offending meds were withdrawn, IVC was seen at 0.9 cm and albumin infusion was started.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:

🥚 67 kDa protein

🥚 Accounts for 75% of plasmatic oncotic pressure

🥚 Exclusively produced in the liver

🥚 Pleiotropic effects: 🚫 inflammatory, 🚫 oxidative & immunonodulatory