Tag: Podcast

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An introduction to sodium and water

A number of years ago, I was invited to write a chapter introducing sodium and water for a new medical text book under the Scientific American brand. I remember being disappointed that I didn’t get hypo- or hypernatremia and being stymied for awhile before I figured out how I wanted to the topic. Ultimately, I had a great time writing the chapter and, at least at the time. I was quite proud of the work. The textbook was somehow abandoned somewhere between inviting the chapter authors and publication. The publisher pivoted to some online component that was supposed to rise out of the ashes of the text book and they asked me to do additional work. I never did that work and they never asked a second time, so I don’t know if that ever came to fruition.

Anyways, this chapter has been sitting in the bowels of my Google Drive for years.

I hadn’t thought about this until recording chapter seven of Channel Your Enthusiasm podcast where we are reading through Burton Rose’s classic Clinical Physiology of Acid Base and Electrolyte Disorders. In Chapter 7, Rose discussed using simple math to predict the changes in intracellular and extracellular fluid volume following various fluid and solute challenges. This is exactly what I did in my Scientific American chapter. I found the exercise to be a profound moment of understanding.

Here is a link to the Google Doc:

Google Doc

And a PDF of the same:

PDF

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Newest project: Channel Your Enthusiasm

One of my favorite podcasts was Joane Robinsons and David Chen’s Game of Thrones recap podcast, A Cast of Kings. As I listened to it I wondered if the same idea could be used for medical textbook. To have people read the book together and have a monthly podcast that summarized and commented on each chapter.

So we put together Channel your Enthusiasm, the Bud Rose Book Club and Cocktail Hour, a Renal Physiology Podcast.

Here is the team

The website for the podcast is RoseBook.Club.

You can subscribe to the podcast on your choice of services:

The URL for Channel Your Enthusiasm is: http://www.rosebook.club/episodes/?format=rss and you should be able to use that to subscribe to the podcast using any podcast player. I use Overcast. Alternatively you can find it on Apple Podcasts and Spotify.

You can also listen to us on Apple PodCasts
And Spotify Podcasts

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Links to useful podcasts for residents and students rotating on nephrology

Michael Eastman sent me this list of podcasts. He send out an e-mail to residents at the beginning of a nephrology rotation so that residents and students can use their windshield time to brush up their nephrology skills.


Hi all:

I wanted to pass along a compilation of nephrology-related podcasts that I’ve been sharing with the residents.  I find them quite entertaining (and educational!).  Feel free to listen or share with the residents as well, since I usually don’t come on service until halfway through their rotation.  All are quite good.  My favorites are the ones on hyperkalemia and hyponatremia.  The ones on dialysis and transplant are also very good.  Finally, check out all 3 of the links at the bottom from the EMCrit website.

#2: Are You Treating Hypertension Adequately? Discussing the Implications of SPRINT.  

#20: Hypertensive urgency and severe hypertension  

#31: Diuretics, leg cramps, and resistant hypertension with The Salt Whisperer  

or:  Diuretics, leg cramps, and resistant hypertension (Reboot)

#39: Secondary hypertension, hyperaldosteronism, Cushing’s, and pheochromocytoma 

#48: Hyponatremia Deconstructed

Or: REBOOT #48 Hyponatremia Deconstructed

#61: Vasculitis and Giant-Cell Arteritis: ‘Rheum’ for improvement 

#65: Scott Weingart of EMCrit on Emergency versus Internal Medicine: The Devil of the Gaps

#67: Chronic Kidney Disease Pearls with @kidney_boy, Joel Topf

#69: CKD Prescribing Do’s and Don’ts with @kidney_boy, Joel Topf

#77: Hypertension Guidelines Showdown

#87: Toxicology 101: Talking Tox with The Dantastic Mr. Tox & Howard

#88: Acid base, boy bands, and grandfather clocks with Joel Topf MD

#104: Renal tubular acidosis with Kidney Boy, Joel Topf MD

#108: Point-of-care Ultrasound for the Internist

or:  Reboot #108 POCUS: Point-of-care Ultrasound for the Internist

#137 Hyperkalemia Master Class with Joel Topf MD

or:  REBOOT: Hyperkalemia Master Class with Joel Topf MD – #137

#143 NephMadness: Fluid Wars

#144 NephMadness: Inpatient Hypertension

#145 NephMadness: Hepatorenal Syndrome vs AKI 

#146 NephMadness: Pain Meds in Chronic Kidney Disease 

#150 HFpEF Update with Dr Clyde Yancy MD

 #170 Hypernatremia is Easy with Joel Topf MD

#192 Dialysis for the Internist with Joel Topf MD 

#199 NephMadness: Hyperkalemia, Diet, K+ Binders, Exercise

#204 NephMadness 2020: SGLT2 Inhibitors

#210 Kidney Transplant for the Internist

#226 Kidney Boy on Acute Kidney Injury: Myths & Musings

#230 Kittleson Rules Acute Heart Failure

#250 Nephritic/Nephrotic

Other podcast episodes which you may enjoy while on your nephrology rotation:

Hyponatremia w/ Kidney Boy:   https://emcrit.org/emcrit/ed-nephrology/

Right heart failure w/ Sara Crager:  https://emcrit.org/emcrit/right-heart-sara-crager/

Central Line pro tips:  https://www.youtube.com/watch?v=XUjncj6ybak

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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.

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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.

From USRDS 2017 Atlas

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.

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Some addenda to my Curbsiders podcast on NAGMA

In my discussion on The Curbsiders I talked about the urine anion gap as a way to estimate urine ammonium. Here are the figures I would have shown for the urine anion gap, if the Curbsiders was a television show rather than a podcast:

The urine anion gap is wildly inaccurate at estimating urine ammonium. In this study of 1,044 people with chronic kidney disease, the urine anion gap was 42, while the urine ammonium was only 21:

Would you trust a technique to measure serum sodium if it was twice the actual serum sodium?

There is a second way to estimate the urine ammonium, the urine osmolar gap. The urine osmolar gap was devised to escape a different weakness in the urine anion gap, the problem with large amounts of urine anions, like ketones or hippurate.

The osmolar gap assumes that the difference between the measured and calculated osmolality will largely be made up by ammonium salts.

Here is a tweetorial about this, if that is your thing:

Part One: Don’t trust equations:

Part Two: But you need to understand the equations so you can use them properly, the urine anion and osmolar gap:

The other mistake I made was an over simplification on how NH4+ is made. I said NH3 was made in the proximal tubule but it is more complicated than that. A lot more complicated. From David Goldfarb:

The proximal tubule makes 2 molecules of NH4+ via Glutaminase which also produces a  1 alpha-ketaglutamate (AKG). The AKG generates 2 molecules of HCO3 which is added to the blood. The NH4 gets tossed into the tubular fluid. So for every NH4+ created in the proximal tubule, one bicarb gets added to the blood.