1/ My patient has tachycardia, fevers and lactic acidosis. Does he/she have sepsis? Heffner et. al found that, up to 18% of patients with SIRS, initially diagnosed as sepsis, had a non-septic SIRS also known as "sepsis mimicker". #Tweetorial 2/ A 30-ish y.o. patient with history of type 1 diabetes mellitus, essential hypertension & asthma presented to the ED with a 2-day history of dry cough. No dyspnea, chest pain, documented fevers, sweats, rhinorrhea or sore throat. Mentions 30-lb wt loss + fatigue last 6 months.

1/ Hey #MedTwitter learners!
What is your first reflex when you are faced with sinus tachycardia?
Give fluids, make sure patient is not in overt shock. Most likely.
But what if your sinus tachycardia persists and the exact cause remains elusive? #thread 2/ It is normal to give a fluid bolus when you have sinus tachycardia in the hospital. Sinus tachycardia is commonly a sign of intra-vascular depletion with baro-receptor stimulation and sympathetic nervous system activation.

1/ Diabetes mellitus is one of the most active areas of drug development. Fascinating advances have occurred in the past decade, leading to easier-to-administer medications and reductions in cardiovascular mortality. 2/ I saw a young patient with T2DM & obesity (BMI 62 kg/m2). She was being treated with high-dose insulin glargine at night, lispro sliding scale & metformin. Her morning BS were ~140 and her pre-meal levels ~150 mg/dL. Despite these numbers, her A1c was 8.6%. Next step?

1/ There is more to serum protein electrophoresis (SPEP) than meets the eye. A SPEP is a rich exam, with a wealth of information, that has been relegated to the land of malignant hematology with advances in lab testing. Let's rediscover its richness through a few clinical cases. 2/ This is what a normal SPEP pattern looks like. Albumin (60%) - globulins (40%). Normal A:G ratio 1.5-2.5.
Globulins comprise alpha 1, alpha 2, beta 1, beta 2 and gamma globulin portions.

1/ #Lymphopenia has recently been under the spotlight with the ongoing COVID-19 pandemic.

This is a quick #Tweetorial attempting to decypher the mechanisms behind lymphopenia, its causes and potential consequences.

What is the most common cause of transient lymphopenia? 2/ Lymphocytes are predominantly T cells (~70%, CD4/8), followed by B cells (~10-20%) and NK cells (~10%).

Normal ALC (absolute lymphocyte count) ranges between 4000 and 10000 cells/microL.

Lymphopenia (or lymphocytopenia) is defined by an ALC of <1000 cells/microL for adults.

1/ What trace element deficiency can cause a syndrome similar to vitamin B12 deficiency? #BroadenYourDifferentials #MedTwitter 2/ It is indeed Copper deficiency! A.k.a. hypocupremia.

1/ Can hemolytic anemia exist with no reticulocytosis?

Incoming #MedTwitter #Tweetorial #HemOnc #heme #hematology 2/ We've all been taught that hemolysis and hemorrhage are accompanied by a compensatory marrow response which leads to reticulocytosis and a slight increase in MCV (reticulocytes are larger than your average RBC).
But what if hemolysis co-existed with reticulocytopenia?