🧵Let's talk hypernatremia

So often we discuss the correction rate of hyponatremia, but what about hypernatremia? #medtwitter #nephtwitter #meded

🧐What is your correction rate for chronic hypernatremia? Older guidelines recommend a correction of no more than 8-10 mEq/dL in 24 hours borrowed from pediatric literature

“Fast” correction is generally considered to be more than 12 mEq/dL per day

pubmed.ncbi.nlm.nih.gov/20412412/

⁉️What is the difference between mineral and organic acidosis?
⁉️Why does one cause more hyperkalemia than the other?

Join me on this 🐇🕳️rabbit hole #tweetorial on metabolic acidosis and it's effect on potassium.

📊To start, which type of acidosis causes more hyperkalemia? Metabolic acidosis is defined as a ⬇️low pH due to a ⬇️decrease in bicarbonate extracellularly

💎Mineral acids (aka inorganic acids) are “synthesized from earth minerals.”

🥬Organic acids are metabolized by the cell and occur naturally.

The 🎩baron of kidney stone prevention has been citrate supplementation.

📖Let’s quickly review hypocitraturia and its relationship to stones.

Where is most of your citrate reabsorbed? Which condition is ❌NOT associated with hypocitraturia?

🤔🔬Why are kidney stones so interesting?
Because the 🔑tubules > glomeruli

Disagree if you like, but it’s true.

A short thread on some mechanisms associated with calcium stones...

#nephtwitter #FOAMed #MedEd #uronephrology #kidneystone #nephrolith Which is a risk factor for calcium oxalate stones?

Which is your favorite hypertension syndrome #eponym? So a short #VisualMnemonic quiz thread on some of the #HTNsyndromes I can never remember🤔 (list is not all inclusive)

Some are better than others.🤷‍♀️If nothing else, hope it's fun.🎉
#timetostudy #boardprep

Is being pregnant magical🌟?
I’m not so sure, but let’s give OB a Nephrology twist. 🍼🐣

#nephtwitter #obtwitter #endotwitter #reallythekidneysarethecoolest #medtwitter #tweetorial

Why do you gain weight when you are pregnant? The average woman ⬆️gains a plasma volume of 1250 mL (an increase of 45-55%).

Significant lab values changes include
- Plasma Na ⬇️reduced by ~ 5 mmol/L
- Plasma osmolality ⬇️reduces by ~10 mOsm/kg
- Cr ⬇️decreases by 0.3 mg/dL due to increased GFR among other changes

The Tale of the Low Chloride

Once there was 34 year old man who used marijuana and was 🤮nauseous, vomitting, and confused. The resident 📞calls and says, "All the electrolytes are abnormal!! Can you help?"

renalfellow.org/2019/12/16/ske…

@TheSkeletonKG #FOAMED #medtwitter #tweetorial You say of course and see the patient. 🥼🩺His BP was 131/87 mmHg with a HR of 142 bpm. He was fatigued, but AOx3. Moist mucous membranes, normal skin turgor, and no LE edema.

💉Labs are shown and reveal a serum osmolality of 263 with ALL normal labs 3 months prior.

HIV. Sickle cell pain crisis. Metabolic acidosis and hypokalemia. 🥼⚕️Just another night on call. Let's break it down in the inaugural #tweetorial by the #FOAMED #medtwitter @TheSkeletonKG

Full post here! @RenalFellowNtwk renalfellow.org/2019/10/03/the… 30 yo woman with sickle cell anemia and HIV on lamivudine, tenofovir, alafenamide, and efavirenz presents with a pain crisis. 💉💉Labs are shown.