renal
Education
Hypochloremic (“Contraction”) Alkalosis
Metabolic alkalosis is a derangement characterized by increased plasma bicarbonate (HCO3-), resulting in a pH > ~7.45. This can be a product of hydrogen ion (H+) loss (e.g., vomiting or renal losses), intracellular shifting...
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Education
Desmopressin (DDAVP) Clamp
Patients with severe hyponatremia ( < 120 mEq/L) can present with altered mentation, seizures, lethargy, and even coma. After identifying the likely cause(s), treatment is centered around a combination of sodium replacement (usually with...
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Pharmacology
Chlorothiazide
Chlorothiazide (Diuril) is a thiazide diuretic that inhibits the sodium-chloride cotransporter in the nephron's distal convoluted. As such, it increases the excretion of water, sodium, and chloride; however, not to the degree of loop...
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Education
Hyponatremia Correction For Hyperglycemia
Sodium is the primary cation (positive-charged ion) in the extracellular space. Therefore, dilutional hyponatremia can occur if free water is added to the extracellular space from fluid shifts and infusions.
Let's look at this basic...
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Education
Hypernatremia And Free Water Deficit
Sodium (Na) fluctuations portend increased in-hospital death for ICU patients, and when working them up, it's essential to determine if these disorders are acute or chronic (> 48 hours or unknown duration). For hypernatremia...
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Education
Lactated Ringers And Normosol In Hyperkalemia
As an intensivist and anesthesiologist, I spend considerable time pondering the physiology and evidence for practices and questioning dogma rampant in the ICU/OR settings. I've heard one recurrent theme: the fear of using Lactated...
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Education
Green Urine Discoloration
Urine color is often under-appreciated in working up a patient's clinical status (especially in the ICU and OR). "Highlighter" yellow urine is often seen in patients on B vitamin complexes (it’s a water-soluble vitamin,...
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