Month: July 2012

ZDogg does it again! The man is unstoppable!

I get nervous when I need to dialyze someone who is severely hyponatremic. Dialysis has the power to change the sodium concentration very fast. Patients with chronic, compensated hyponatremia need their sodium corrected slowly. Experts recommend increasing the sodium by less than 12 mEq/L/day and to actually undertarget only 6 mEq/L/day to give you some margin for error.

Over the week-end we were consulted on a patient with a sodium of 106 and acute renal failure. By the time we were forced to dialyze the patient the sodium was up to 112. To do this safely we selected CVVHD and then diluted our dialysate down to 120 mEq/L.

Here is a Keynote (100 mb), PDF (155 kb) and a narrated version of that presentation (118 mb) where I walk through the algebra on how to mix a dialysate of any final sodium concentration.

The movie available for download is very high quality. Below is a YouTube conversion of that video to save you the 118 mb download.

This is some serious Sodium Jujitsu and I awarded my team the first Nephrology Merit Badge: Sodium Ninja (pages | pdf). Designed for Avery 5163 2×4 labels.

Nephrology Merit Badge, updated for the 21st century as a sticker for your iPad

The first time PBFluids was referenced in the medical literature was in Matt Sparks’ article on nephrology internet resources.

Extremely high levels of serum creatinine have been reported in the literature.³ The highest level of serum creatinine reported was 37 mg/dL.³

So what is the highest previous creatinine reported in the literature? Well according to the author, Said Abuhasna, it’s 37 from this post at PBFluids. Nice to see blogs being included in the canon of medical literature. Though it would be even nicer if they spelled my name right.

One of the best stories about Steve Jobs was his tirade is response to the MobileMe disaster.

He gathered the MobileMe team together and asked,

“Can anyone tell me what MobileMe is supposed to do?”
Having received a satisfactory answer, he continues,
“So why the f*** doesn’t it do that?”

He then picked another executive to run the project on-the-spot. Ultimately, this resulted in the service being shuttered and replaced with iCloud.

I never had any problems with MobileMe; it always worked fine for me. However, I foolishly relied on it to host files for PBFluids. This includes all of the presentations and handouts that are the highest trafficked pages of the site. Well, MobileMe stopped accepting new subscriptions a year ago and as of June 30th the hosted files are no longer accessible. I have downloaded all of the material and will start re-uploading the files to DropBox.  The problem is rewiring all of the past links to the new file locations. This will take some time.

As I looked through the collection of files that used to be hosted at MobileMe I found a lot of journal articles and other copyrighted works. I have no idea how popular these links were but I remember when I uploaded them, PBFluids was a lonely backwater, where I was the sole source of traffic. I put the files the files online for my own use in teaching and on rounds. I don’t plan on replacing these files.