Here are some of my favorite hyperkalemia pearls that will help take your understanding of the disease process to the "201" level!

And, yes, this ominous banana is meant to be an abstract visualization of the serious consequences of hyperkalemia.

Read on!

- Thread -

1/18 Only 2% of total body K is extracellular.

In HyperK, the resting membrane potential becomes LESS negative, leading to downstream effects on electrical conductivity.

Chronic changes in extracellular K lead to compensatory mechanisms to reduce this excitability.

2/18

https://twitter.com/433928803/status/1743256123019526364

Picking up hyperkalemia on an EKG can be lifesaving.

We all know about "peaked T-waves," but the underlying pathophysiological basis for the various EKG changes is confusing and unintuitive.

A thread on EKG findings in hyperkalemia!

- Thead -

1/15 Disclaimers

Though these are the "classic" EKG changes, patients do not necessarily progress in this order.

EKGs do not always correlate with the actual K level - it depends on the chronicity of the elevation.

Lastly, EKG changes are NOT sensitive for hyperkalemia.

2/15

Hyperkalemia gets so much attention because it's a common, complex emergency with potentially life-threatening cardiac implications.

Here's my approach to working up and managing HyperK in the hospital, along with some key pathophys everyone should know!

- Thread -

1/17 Check out these @pointofcaremed digital resources on hyperkalemia for use at the point of care!

Online Template


Podcast


YouTube


2/17 pointofcaremedicine.com/inpatient/hype…
podcasters.spotify.com/pod/show/point…

The medical education community on X is unparalleled.

Here are some of my favorite posts and threads related to #meded from 2023!

Each and every one of these exceptional educators deserves a follow!

What posts/threads would you add?

1/27 Learning from such amazing clinicians inspired me to begin posting my own threads this year and to create @pointofcaremed.

If you haven't yet, please check out the website and podcast and let me know what you think!

Here's a thread I'm proud of!



2/27

https://twitter.com/ROKeefeMD/status/1673300116801998849

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

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

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

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

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

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

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

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

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:

Admission Template and Dotphrases:


Podcast:


YouTube:


2/20pointofcaremedicine.com/cardiology/adhf
spotifyanchor-web.app.link/e/kOn46nKbSAb

ADHF with overload is the most common cause of admission in the United States.

Confident diuresis is a skill set all IM interns must master.

Follow these tips to take your inpatient diuresis to the next level!

~ Diuretics 201: A Thread ~

#tipsfornewdocs #MedEd

1/18 Check out the @pointofcaremed podcast episode on this topic.

spotifyanchor-web.app.link/e/hJ1tDQYEDzb

Here's a TL;DR for the episode

2/18

Talking about hyponatremia is so stereotypically internal medicine and is, quite frankly, something I used to loathe.

Here's a simplified approach to hyponatremia in the inpatient setting, along with some key clinical pearls.

- Thread -

#MedEd #MedTwitter #FOAMed #POCM

1/25 Use this @pointofcaremed template to help you master the topic!

pointofcaremedicine.com/nephrology/hyp…

And check out the podcast and YouTube video to go with it!

anchor.fm/pointofcarepod…



2/25

As an intern, one of the highest-yield schemas I learned was for persistent fevers despite treatment with abx.

I use it all the time as a resident, especially when working with cancer patients.

Let's go through it!

- Thread -

#MedTwitter #MedEd #FOAMed #tipsfornewdocs

1/24 The general ddx for persistent fevers in the hospital, despite abx:

1. Wrong bug
2. Wrong drug
3. Wrong process
4. No source control
5. Not enough time

Let's take them one at a time.

2/24

Some of the most challenging cases on the leukemia service were patients who seemed totally stable but wouldn't stop fevering!

#OncID is one of my favorite parts of cancer care.

Let's talk inpatient neutropenic fever!

- Thread -

#MedTwitter #MedED #FOAMed #OncTwitter

1/23 Check out the neutropenic fever inpatient template @pointofcaremed

pointofcaremedicine.com/hematology-and…

Also, check out the podcast and a video with accompanying slides on our new YouTube channel!

spotifyanchor-web.app.link/e/lGRz5aFLNwb



2/23

The difference between corrected calcium and ionized calcium has always confused me.

Understanding where calcium is in our body, the units we use to measure each, and how they interact really helps me keep it straight.

- A Thread -

#MedEd #MedTwitter #FOAMed

1/11 Only 1% of total body calcium is outside your bones and teeth.

Of the ~0.1% (~350mg) that circulates in plasma:

- 40% is bound to protein (albumin)
- 10% complexed with anions
- 50% is "free" ionized calcium (iCal)

Only iCal is physiologically active.

2/11