💡 Acute liver failure (ALF) pearls 💡

1) Bilirubin 🧍 is neither specific nor sensible for ALF since it lags in contrast to PT/INR. ⏱️

2) Transaminases over 15-20x upper normal limit should raise suspicion about:
👉🏻 acetaminophen 💊
👉🏻 virus (HAV/HBV) 🦠
👉🏻 ischemia 🩸 3) Ischemia (aka shock liver ❤️‍🔥) is the most common cause of acute liver injury (ALI) among critical ill patients in ICU. 🥵
👉🏻 Right Heart failure ❤️‍🩹

🎬

🧵... This is my third and final thread about sodium bicarbonate in critical care 🧂

☝🏻If you missed the first and second part about 8.4% and 1.3% bicarb, I strongly recommend you to read them before moving on 🏃🏻.

x.com/jackdeliuc/sta…

x.com/jackdeliuc/sta…
🧐 I will summarize the indications for bicarb administration in critically ill patients🤒, according to the current levels of evidence.

Here is the legend:
🟢 good recommendation
🟠 grey zone (weak evidence)
🔴 eminence-based evidence (aka probably worthless)

🎬 2nd chapter

...🧵This a thread about 1.3% sodium bicarbonate🧂 (aka isotonic bicarb drip) in critical care.

☝🏻 If you missed the first part about 8.4% bicarb, I would strongly recommend you to read it before moving on 🏃🏻.

https://x.com/jackdeliuc/status/1888671550238273944?t=8fGOu6r5Hh5Rhz6E9oNcZg&s=08

Some math 🧑🏻‍🏫:

📝 1.3% = 13 g/L = 150 meq/L sodium and 150 meq/L bicarbonates

📝 1.3% = 0.150 meq/ml = 300 mOsm/L (isotonic solution roughly equivalent to 0.9% NaCl ☝🏻)

🧑🏻‍🔬 1.3% bicarb drip is crafted as shown in the pic.

...🧵This is a thread about 8.4% sodium bicarbonate (aka bicarb amp) in critical care.

This the first part in a series of three about sodium bicarbonate 🧂in critical care:
🧐I will get in deep to complexities, benefits, risks and clinical implications of this (overused) drug. Necessary premise: this is a complex, huge and tricky topic, so forgive me if I missed some key points. I did my best in digging deep into my FOAMed references and literature. I hope you enjoy the discussion and share your opinions as well.

👉🏻 This a thread about Hypocalcemia in critical care.

🧐 Why hypocalcemia is important in critical care and when do we need to take care of it? Let's start with two 🔑 points:

👉🏻ionized calcium from blood gas is what only matters (not the serum total calcium, or even the calculated one).

👉🏻mild and harmless hypocalcemia is extremely common in critical ill pts: replacing calcium routinely as a reflex is just pointless.

13y male. Headache, severe cyanosis. SpO2 ~80% (pulse oximetry). No response to 100% FiO2. Normal Lung/Heart US.
Here the arterial blood gas. Here the BGA: PO2 > 100mmHg, normal SaO2.
Severely abnormal MetHb was detected (> 40%).

Parenchymal changes caused by liver hemodynamic alterations (pseudotumor).

Small areas of liver tissue are known to be supplied by a "third inflow" venous system separate from the usual dual blood supply of the portal vein and hepatic artery. This is a normal variant and it is composed of aberrant veins or parts of normal veins that directly enter the liver independently of the portal venous system; such veins communicate with intrahepatic portal branches to various degrees.

Point-of-Care Ultrasound Applications in the Outpatient Clinic: A rapid diagnosis of Congestive hepatopathy in an ederly man, applying VExUS at the bedside.
His medical history was remarkable for (referred) Afib.
@NephroP @ButterflyNetInc @hepocus @HunPocus @Pocus101 @pocusmeded 1) IVC is clearly dilated with absence of inspiratory collapse.

A case of EBV Acute Hepatitis in adulthood.

There are no significant changes in liver echo-texture in acute viral hepatitis.
However, enlarged perihepatic lymph nodes are a fairly constant feature.

@hepocus @Pocus101 @pocusmeded @thepocusatlas @NephroP @drmarcogarrone Doppler techniques can be used to
reveal an unspecific hyperdynamic state in hepatic vessels with a higher diastolic arterial
blood flow when compared with healthy individuals.