Starting allopurinol can be a turning point in managing gout, but it's not without its challenges.
Understanding the nuances of initiating treatment can prevent complications and pave the way for long-term relief.
- Thread -
1/10
Allopurinol inhibits xanthine oxidase, preventing the formation of uric acid.
This will lead to lower uric acid levels in the blood.
2/10
Nov 7, 2023 • 13 tweets • 3 min read
The pathophysiology of an acute gout flare is much more interesting than "uric acid crystals deposit into the synovium."
Here are some of the most fascinating aspects that will help you better understand the workup and management of gout flares!
- Thread -
1/12
Gout is characterized by the chronic deposition of monosodium urate crystals into the synovium.
The "solubility threshold" for monosidum urate is ~6.8 mg/dL, above which circulating uric acid can turn into crystals.
This can constantly happen without causing a flare!
2/12
Nov 6, 2023 • 31 tweets • 9 min read
In acute gout flares, there's more than meets the eye!
A deep dive reveals a fascinating story of unusual pathophysiology and a number of unintuitive clinical pearls!
Read on for some surprising truths and practical tips for management!
- Gout 201, A Thread -
1/25
Check out these @pointofcaremed digital resources on Gout Flare for use at the point of care!
They include admission checklists, HPI intakes, differentials, sample dotphrases, and key clinical pearls, along with a podcast and YouTube video with accompanying slides.
2/25
Oct 26, 2023 • 13 tweets • 3 min read
Here are some of the highest-yield pearls related to the clinical presentation and diagnosis of community-acquired pneumonia (CAP)!
Let me know what your favorite pearls are, and if you'd add anything!
- Thread -
1/12
You can still have a viral infection AND a bacterial pneumonia; having a positive RVP does not mean you should withhold antibiotics in the right clinical scenario!
2/12
Oct 23, 2023 • 29 tweets • 8 min read
Pneumonia is the leading cause of infectious death in the US and one of the most common reasons for inpatient admission.
In IM, you'll see it over and over and over.
Here's my approach to the workup and management of inpatient CAP, along with some key pearls.
- Thread -
1/24
Check out these @pointofcaremed digital resources on CAP for use at the point of care!
They include admission checklists, HPI intakes, differentials, sample dotphrases for the EHR, and key clinical pearls, along with a podcast and YouTube video with accompanying slides.
2/24
Sep 10, 2023 • 7 tweets • 2 min read
Here's a @pointofcaremed table with some high-yield information about the commonly used vasopressors in sepsis.
While we're at it, here's a brief thread on some key clinical pearls when it comes to selecting and titrating pressors.
- Thread -
1/6
When it comes to pressors, many are taught:
norepi --> vasopressin --> epi
This often works well, however keep the following pearls in mind.
First, norepi can lead to tachyarrhythmias and doesn't make sense in AFib with RVR if you're giving beta-blockers like metop
2/6
Sep 8, 2023 • 8 tweets • 2 min read
In sepsis, lactate is bad and needs to be corrected immediately via aggressive fluid resuscitation, right?
Well, maybe. But it's complicated.
A brief thread on lactate in sepsis!
1/7
Elevated lactate is most commonly attributed to hypoperfusion 2/2 hypotension and we usually give fluid in response.
However, it can also be thought of as a reflection of endogenous epinephrine production, which stimulates aerobic glycolysis via beta-2 adrenergic receptors.
2/7
Sep 5, 2023 • 29 tweets • 9 min read
As a senior resident, I thought I had a pretty strong understanding of sepsis and septic shock.
But after doing a deep dive, I realized there's so much nuance.
Here's my approach to workup and management, along with some key pearls and lessons.
- Thread -
1/26
Check out the @pointofcaremed digital resources on sepsis and septic shock for use at the point of care!
They include templates with admission checklists, sample dotphrases for the EHR, and key clinical pearls, along with a podcast and YouTube video with slides.
2/26
Jun 26, 2023 • 20 tweets • 8 min read
Each year, Acute Decompensated Heart Failure (ADHF) leads to over 1,000,000 hospitalizations in the U.S.
Here's my approach to admitting a patient with ADHF, along with some key clinical pearls.
IM Interns - bookmark this!
#MedEd #MedTwitter #tipsfornewdocs
1/20
Check out these @pointofcaremed digital resources for ADHF: