A question that junior doctors ask themselves every day: in this septic patient with hypotension, how much fluid should I give, and how much would be too much? #fluidchallenges @acutemedicine @acutemedicine The first question is always what the physiological impact of the low blood pressure is. Ultimately it is a bunch of numbers; some people with advanced heart failure have an SBP of 80 on a good day and they tolerate that remarkably well.

Fellows of the @RCPLondon are sometimes invited to serve on appointment advisory committees (AAC) for consultants. This is a pleasure and an honour, and one often comes away learning about how other hospitals handle common problems in acute care. Not infrequently I am contacted to assist AACs somewhere in the area. These are posts for @acutemedicine consultants.

Of the most recent panels I have agreed to assist, the majority was cancelled due to a lack of applicants. This is quite unsettling.

The drug #dexamethasone is a steroid. Now the word "steroid" evokes all manner of reactions, but in essence medics use "steroids" mainly in exchange for a specific subgroup of the huge class of hormones and their analogues, namely the #glucocorticoid group. All steroid hormones are produced in the body from cholesterol (don't worry statin users, there's plenty for everyone). They are converted by enzymes in various organs to specific hormones that are released and controlled by all manner of systems. (O)estrogen, progesterone...

Last talk: Dr Tahseen Chowdhury @NHSBartsHealth about new diabetes therapies. #AGMConfUK Diabetes worldwide 400 million and rising. Linear increase in the UK. 1:4 hospital inpatients have diabetes. Main problem is the numerous forms of end-organ diabetes damage. Independently associated with some cancer. #AGMConfUK