I was invited back to The Curbsiders for a discussion about hypernatremia. I had a great time and through the magic of Hannah Abram’s production and Matt Watto’s edits it turned out pretty good. I listened Toit and I didn’t come up with any major gaffs. Take a listen. What do you think? As usual all comments should come through Twitter.
Lecture on hyperosmolar hypotonic hyponatremia
This is a formal lecture on the Tweetorial I posted about a patient with beer drinkers potomania but presented with increased serum osmolality due to ethanol intoxication.
Keynote • PowerPoint • PDF
Note: The presentations are designed to be displayed in KeyNote, the powerpoint version may be weird, especially the animations, and some of the icons maybe jaggy.
Following the lecture Scott and I recorded an episode of the EMCrit podcast, episode number 242! Scott Weingart is a medical education revolutionary. If you are interested in learning about him check out this episode of Explore the Space.
Hyperkalemia with The Curbsiders
I had the honor of being invited back to the Curbsiders to discuss hyperkalemia. I am not all the way through the episode yet, but so far I have not heard any embarrassing mistakes. But I’ll be sure to post any retractions and corrections here when I come across one.
ASN Kidney Week Podcast
During Kidney Week, the ASN sets up a daily podcast. This year, for the first time I was invited to participate on day three. I think it turned out pretty good. Give it a listen.
Davita Podcast
Back in August, I went to Denver to spend a couple of days with the social media and communications teams at Davita. Davita headquarters is really cool. I loved getting a chance to peak behind the curtain into the inner workings of a professional communication team. I loved hearing the war stories of how they reacted and responded to the John Oliver dialysis piece. My overall impression was one of a well run and professional organization staffed by talented people. Dialysis mortality in the US has fallen 25% over the last 16 years. This didn’t happen by accident.
One of the highlights of going to Denver was recording a podcast with Dr. Provenzano (@DrBobPro). Robert Provenzano is one of my oldest mentors. I first met him as a first year fellow at the NKF Spring Clinical Meeting in Chicago. A year later he hired me to work for St Clair Nephrology, the practice where I am now a partner. He has been a constant advisor and advocate. It was a pleasure to chat social media with him.
This podcast just launched on iTunes last week. I think it turned out pretty good. Take a listen.
Annals of Internal Medicine Podcast
One of the best medical bloggers is Robert Centor. He has been blogging since the flood (Don’t believe me? Here is his first blog post from May 19th, 2002) and beyond longevity he has been able to develop an enthusiastic engaged audience. He is both prolific and brilliant. I have had a few interactions with him virtually. And we are RunKeeper friends so I keep an eye on his fitness. (He repeatedly trounces me in workouts-per-month).
Dr. Centor introduced me to The Curbsiders. When I saw that he was a guest on The Curbsiders, it was an instant badge of approval and I started listening. He also is, famously, the Chair of Medicine at Kashlak Memorial Hospital.
Last year he heard my diuretics discussion on The Curbsiders and invited me to participate in a podcast for the American College of Physicians. I said yes and then didn’t hear from him for almost year. Then he resurfaced and we recorded the podcast. Then another 6 months went by. I had forgotten about the thing and then last week the podcast dropped.
I think it turned out good (except for me saying medullary collecting duct when I meant cortical collecting duct. How embarrassing.)
The Annals On Call catalog of podcasts looks amazing. It is apparent that the slow pace I experienced was due to Dr. Centor building a deep catalog for his first season. Impressive work, but not unexpected from the guy who has been furiously blogging for 16 years.
Curbsiders #104: Renal Tubular Acidosis
This is the back half of my Acid-Base talk, a detailed dive into non-anion gap metabolic acidosis with an examination of renal tubular acidosis. This one turned out pretty good.
Here is a link to the Curbsiders page for this episode.
This is the sequel to #88 Acid base, boy bands, and grandfather clocks with Joel Topf MD
Before that I did episode #67 and #69 on chronic kidney disease
Before that was #48 Hyponatremia Deconstructed
And I started my Curbsiders career with #31 Diuretics, leg cramps and resistant hypertension.
So non-anion gap metabolic acidosis is my fifth or sixth appearance on the Curbsiders. Thanks guys.
Curbsiders Podcast on rapid interpretation of ABGs
I did another podcast with the Curbsiders. This one was on basic acid-base interpretation. It went pretty well. Great editing.
Two more NephTalk Podcasts
I was given the opportunity to work with Satellite Healthcare on their NephTalk podcast and hosted three episodes. The first one, on infection in dialysis units, was posted via RSS and picked up by iTunes. But the next two episodes I hosted were not posted to the RSS feed and so won’t show up in your podcast player of choice (by which I mean Overcast).
So you you’ll have to listen to them like your grand father did, as he walked to school bare foot, through the snow, uphill, both ways, via a web player. Sorry.
NephTalk: A new nephrology podcast by Satellite Health
Satellite Healthcare is a non-for-profit dialysis company. They partnered with NephJC to do Bloggger’s Night the last three years and sponsor the NephJC Kidneys. This year they launched a Podcast, NephTalk. I was lucky to get invited to help out. I have hosted one, an interview with Sumi Sun about preventing blood stream infections. Here is her abstract from Kidney Week:
Background: CVCs are associated with catheter-related bloodstream infection (BSI) resulting in increased morbidity and mortality. Following our report of significantly reduced infection when 320 μg/mL gentamicin in 4% citrate is used as the CVC locking solution (Moran AJKD 2012), this has remained the standard of care in patients dialyzing with a CVC, unless physician order requested otherwise. The infection rates were monitored through an internal QC program developed for National Healthcare Safety Network (NHSN) reporting.
Methods: This study evaluated NHSN data with self-reported infection rates from January 2014 to December 2016 in a non-profit dialysis provider with a total of 57 free-standing dialysis facilities serving more than 5000 HD patients. BSI was reported according to NHSN criteria. Data were audited through comparison to an internal infection control report and discrepancies reconciled prior to final NHSN submission. Blood cultures were mandated before any antibiotic administration for suspected BSI, and 85% or more are sent to one internal lab (Ascend).
Results: The rate of catheter-related bloodstream infection over the three years was 1.00 episodes/100 patient months, 54% lower than the national average of 2.16 for CVC-related BSI (2014 NHSN BSI Pooled Mean Rate/100 patient-months). Monthly BSI rates showed minor fluctuations, however none exceeded the national average in any given month.
Conclusion: Gentamicin 320 μg/mL in 4% sodium citrate as a routine catheter lock demonstrated sustained low CVC-related BSI rates in HD patients, with approximately half the infection rate compared with the national average. Gentamicin-citrate lock should be considered the standard of care in patients with CVC access.