I am a second year nephrology fellow. I always find acid base and electrolytes interesting but have always looked for a good book which would help me get a better perspective on this topic. Are there any books that you would recommend.MD
First we had the highest creatinine followed by the lowest creatinine.
Update: some commenters asked about the BUN: 6 mg/dL. FYI today the Cr is down to 0.28 and the BUN fell to 3!
The patient has SIADH and low creatinines are a usual finding. She also has a crazy low uric acid of 1.4. Not quite Uricase low but getting close. Her admission sodium was 108, her urine sodium today was a whopping 156 with a urine potassium of 34. So if you calculate her electrolyte free water clearance (the amount of her urine which is electrolyte free water):
Mr. S., a 38 y.o. African American male, came to the hospital with nausea, vomiting and fatigue. Initial creatinine was 36.2 mg/dl. After hydration overnight it came back at 38 mg/dl.
Update: one of the comments asked about the patients body habitus, rhabdo and BUN.
- Mr S. is muscular but no body builder
- He was not in rhabdo. I would not include an elevated creatinine due to muscle breakdown under the crazy numbers tag as it essentially represents a lab error, in that the creatinine is no longer a measure of severity of the renal failure or the chronicity but rather a measure of the aggregate muscle damage.
- His BUN was 139 mg/dL
This patient had a remote diagnosis of hypertension but had been out of any medications for months. The computer showed a 2 year old creatinine of 2 but the patient denied any memory of being told he had CKD.
Yesterday I started on the consult service mid-month. We are experimenting with having the atendings rotate from the dialysis floor to the consult service every two weeks. I am skeptical because of the lack of continuity but in the spirit of 80-hour weeks we are trying it out.
Yesterday I lectured on electrolyte free water clearance and tea and toast syndrome.
Here is the lecture on Electrolyte free water:
The online version doesn’t look great. Download the file and then try it.
The lecture on tea and toast syndrome is below:
Lecture on IV Fluids and sodium
I had eight 3rd year medical students. I did a quick pole and 6 of the 8 had or were planning on getting an iPhone/iPod touch. One student had an Android G1. No Blackberries, no Windows Mobile.
Is it too early to declare a winner in the medical smart phone arena?
Though weight-loss books will doubtless always be more popular, what might be called weight-gain books, which attempt to account for our corpulence, are an expanding genre.
On July first I gave a lecture on IV fluids, total body water and hyponatremia. This handout is similar to the lecture I give to the medical students titled sodium and water. It adds a half baked section on potassium but this handout really needs to have th sodium section tightened up and shortened, the potassium section finished and short sections on the treatment of phos, magnesium and calcium disorders.
- Here is the PDF
- Here is the native Pages documentin case you use Pages and are interested in finishing this work in progress.