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Josh King Profile picture
Josh King
@nephrotox
Nephrology & Med Tox at @UMMC. Medical Director @MDPoisonCtr. Program Director @UMMCKidney. BOD @acmtmedtox. MAB @NKFMDDE. Tweets not med advice.
Feb 17, 2023 • 10 tweets • 2 min read
This is the big one!!
Ethylene glycol poisoning RRT recommendations.
Tremendous job by main authors on this one.
Come on, you were already looking for compelling afternoon reading - here you go! TL;DR:
If you use fomepizole (many countries) and the patient doesn't have substantial acidosis, EXTRIP suggests HD at [EG] > 310 mg/dL (AKA 50 mOsm/kg)
Major difference from prior recs.
For ethanol use: > 310 recommended, 124-310 mg/dL (20-50 mOsm/kg) suggested.
Feb 17, 2023 • 4 tweets • 2 min read
Update. Thanks to the awesome, aggressive HD (achieved BFR 500 DFR 800!) by @MoHanouneh + team, this patient's labs improved rapidly (lab #2 on right = 2.5h into HD) and hemodynamics are much improved (1/3) They were put on CRRT overnight to augment the HD effect. Note the improvement with CRRT is rather unimpressive compared to that with HD. Aggressive HD remains the best way to improve odds for a good outcome in MALA. (2/3)
Feb 16, 2023 • 5 tweets • 3 min read
This is the highest anion gap I've ever seen (57!) in a patient with metformin-associated lactic acidosis from this afternoon.
@NephRodby - if you're looking at record #s, here's one to share Really scary labs notable f... Here's a small bit about metformin. It's kinda sorta a decoupler (personally I'd go with more glycerophosphate dehydrogenase inhibitor).
Sep 26, 2021 • 6 tweets • 2 min read
A few choice Phillipus Aureolus Theophrastus Bombastus Von Hohenheim (#Paracelsus) quotes:
“Every little hair on my neck knows more than you and all your scribes”
“My shoe buckles are more learned than Galen and Avicenna”
“My beard has more experience than your high colleges” Also, in addition to physick, he dabbled in alchemy and astronomy. E.g., concepts like bufonis arcanum – the secret of the toad (he believed that they could be used to treat plague). He wrote entire books on alchemy (albeit some posthumous ones were probably written by others).
May 29, 2020 • 16 tweets • 5 min read
Although propofol can also turn urine green, we gave this patient methylene blue for vasoplegia / refractory shock. Read on for some CCB poisoning discussion. 1/ Severe calcium channel blocker poisoning is a difficult clinical challenge. These patients are profoundly hypotensive and generally receive the kitchen sink re: therapies. @toxiferoustales breaks down the mechanism:
emcrit.org/toxhound/sneak…
2/
Apr 1, 2020 • 5 tweets • 6 min read
@J_Corky @MNpoisoncenter @Eastmanov1 @jonbcole2 Perfect timing to ask. See below: our PC was called with this case at the same time I was on renal service and our fellow was asked to see them. 50-odd yo woman presents with fatigue and these labs. @J_Corky @MNpoisoncenter @Eastmanov1 @jonbcole2 This is all uremia here (Ketones neg, sal neg)
I have personally not found a reference which correlates anion gap to degree of uremia - probably because degree of uremia is:
2/
Mar 3, 2020 • 20 tweets • 10 min read
Thanks #medtwitter #meded #nephpearls for answering this question! As suggested by the wisdom of the crowd, the correct answer is cyanide poisoning due to "vitamin B17." (Shout-out to @J_Corky who guessed early on). See tweetorial for discussion! @J_Corky Wait, they didn't cover that in training? Vitamin B17 is not a vitamin - it's marketed as one, though, and used as alternative therapy for cancer and "general health." Some alternative rx is innocuous - vitamin B17 is not.