Today I gave the first lecture of the ’08-’09 Academic Year. This was morning report for internal medicine. I did a lecture on IVF, diuretics, total body water and dysnatremia. It was a good lecture but Powerpoint only. I am about half-way done with the killer handout I am working on and am disapointed that I didn’t finish it. Hopefully will have it done for the next lecture in two weeks.
Getting ready for a Fluids and Electrolytes lecture
Only a nephrologist ever capitalizes Fluids and Electrolytes.
I am so excites. I get to give the first lecture on July 1. I love the nervous energy that comes with fresh second years and new interns still getting used to the length of their newly lengthened coats.
I am working over my standard F&E Emergencies. I am putting together a new handout designed to be kept in the pocket. While working on the talk I re-found this classic review of diuretic therapy by Craig Brater. Dr. Brater was elevated to Dean of Indiana University Medical School right before I got married at the end of my residency. We had our rehearsal dinner at this Columbia Club on the Circle. I bumped into Dr. Brater right before dinner and congratulated him on becoming the dean.
Teaching on Two Ell: Calcium metabolism
Our second year resident set the bar high by doing a great overview of calcium metabolism. Here is his handout. All it was missing was some evidence based data.
Teaching on Two Ell: Home blood pressure monitoring
This noon comference was not done by me but by Dr. Steigewalt. The whole team was there.
Dr. Steigerwalt provided some great handouts:
- Call to Action on Use of Reimbursement for Home Blood Pressure Monitoring from Hypertension
- The editorial from the recent HYVET trial.
- She used the American Heart Slide Set
Dysnatremia handout
One of my (soon to be former) fellows wanted a copy of this work-sheet handout on electrolyte free water clearance.
Teaching on Two Ell: Acute Renal Failure and GFR
Yesterday we discussed the problem with the curvilinear relationship between gfr and creatinine and how the MDRD equation dispenses with this problem. Today we will go over a handout introducing GFR, MDRD and how to manage them, including referral to a nephrologist.
Additionally I want to do my canned acute renal failure lecture. This lecture has been made obsolete by the recent ATN data and data from Vanderbilt so it will need to be revised.
Teaching on 2 Ell, the second week
On Monday one of our interns gave a lecture on the range of renal pathology possible found with lupus nephritis.
This was a follow up on her lecture on the renal manifestations of lupus nephritis by WHO criteria. After her lecture we went down to bowels of the hospital to look at the kidney biopsy we had done on Friday on one of our patients with lupus.
On Thursday we began interpretation of Acid-Base disorders.
Also on Thursday I lectured the house staff on Nephrogenic Fibrosing Dermopathy, Acute Phosphate Nephropathy and Contrast Nephropathy. Renal adventures in imaging.
On Friday the 13th we completed Acid-Base disorders. As part of acid-base we talked about the anion gap. This article in CJASN on the anion gap was wonderful.
Rhabdomyolysis
Just got my second rhabdomyolysis patient in the last 2 months. Both had anuric acute renal failure and both had CPKs over 100,000.
In fellowship, the dogma was that sodium bicarbonate was ineffective and could do harm. The reasoning was that alkalinizing urine made calcium-phosphate less soluble, increasing the likelihood of calcification in the tubule extending the renal damage.
Recently, I found a paper from the Journal of Trauma 2004 by Brown and Rhee (Alternative) which showed compelling trends for improved outcomes with mannitol and bicarbonate. What was so impressive to me was that as the disease got more severe (higher CPK) the experimental group appeared to do relatively better. The authors were prevented from reaching a significant p value primarily by having too few patients with severe rhabdo.
I will use the handout from a prior morning report on the subject for the teaching session on Monday.
Two Ell
This month I’m attending on the renal ward at Saint John Hospital and Medical Center. I have a huge team: one fellow, one second year resident, three interns (2 categorical and one ER resident) and two medical students. I have been having a blast teaching them.
I am going to track all of the teaching I do this month here.
So far this is the formal (as opposed to bedside) teaching we have done:
Monday June 2: Introduction to Two-Ell
Tuesday June 3: Nephrotic Syndrome
Wednesday June 4: Dialysis basics and Anti-hypertensive agents saves lives
Thursday June 5: Renal Adventures in Imaging (the nephrologic implications of Gadolinium and NFD, phosphate nephropathy as a complication of colonoscopy prep, and contrast nephropathy)
More to come.
Lecture Schedule
March 21 Providence MS3: Acid-Base
February 28 Providence MS3: Sodium
January 24 Providence MS3: Body Water
January 3 St John Hospital Residency: Potassium
2014
December 12 St John Nephrology Fellowship: ASN Kidney Week: reviewed.
December 11 Mclaren Macomb: potassium and alkalosis
December 6 St John Hospital Residency: AKI
December 5 St John Nephrology Fellowship: NephSAP
November 26 Providence Hospital Internal Medicine: Potassium
November 22 Providence MS3: Acid-Base
November 13 Mclaren Macomb: Potassium
November 8 ASN Kidney Week, NephMadness
November 7 ASN Kidney Week, Introduce KDIGO Mobile App
October 24th St. John Hospital MS3: Acute renal failure
October 22nd: Providence Hospital Internal Medicine residency: Acute Kidney Injury
October 17th St John Nephrology Fellowship: Fellow level hyponatremia part 2
October 10th St John Nephrology Fellowship: Fellow level hyponatremia part 1
October 9th Mclaren Macomb: Acute Kidney Injury
October 3 St John Nephrology Fellowship: NephSAP Fluids and Electrolytes
September 27 ACP of Michigan: Uric Acic, Hypertension and Gout
September 17 Beaumont Hospital and Medical Center: Acid Base
September 11 Mclaren Macomb: Fluids and Electrolytes
September 12 Providence Hospital MS3: Acid-Base
September 6 St John Hospital Residency: Sodium
August 29 St John Nephrology Fellowship: Anemia
August 27 Oakland University Beaumont School of Medicine 2nd years: Potassium, alkalosis and secondary hypertension
August 27 Providence Hospital Internal Medicine residency: Acid-Base
August 19: Oakland University Beaumont School of Medicine 2nd years. Acid Base
August 15 Oakland University Beaumont School of Medicine 2nd years. Na and water TBL
August 3 Providence Hospital MS3: Sodium
August 2 St John Hospital Residency Acid Base
July St John Hospital Residency
July Providence Hospital
June 14 Providence Hospital MS3: Potassium
June 11 St. John Hospital MS3: Acid-Base
May 16 St. John Hospital MS3: Fluids and Electrolytes
May 13 William M. Davidson Medical Education Week: NephMadness recap
May 10 Providence Hospital MS3: IVF and sodium
May 8 Mclaren Macomb: NAGMA
May 3 St John Hospital internal medicine residents: Board review
May 2 Providence Hospital Grand Rounds: Social Media in Health Care
April 23 St John Hospital ID Fellowship: HIV and the Kidney
April 12 Providence Hospital MS3: Acid-Base
April 10 Mclaren Macomb: Acid-Base part 2
April 9 St John Hospital MS3: Acute Renal Failure
April 5 St John Hospital internal medicine residents: Metabolic alkalosis
March 22 Gift of Life Minority Organ and Tissue Transplant Education Program: Social Media in Transplant
March 15 Providence Hospital MS3: Potassium
March 14 St John Hospital internal medicine residents: How to give a Lecture Lecture
March 21 St. John Hospital MS3: Acid-Base
March 13 Mclaren Macomb: Acid-Base
March 1 St John Hospital internal medicine residents
February 15 18 Providence Hospital MS3: Fluids and Electrolytes
February 14 St. John Hospital MS3: Fluids and Electrolytes
February 13 Mclaren Macomb: Hyponatremia
January 18 Providence Hospital MS3: Acid-Base
January 17 St John Hospital MS3: Acute Renal Failure
January 9 Mclaren Macomb: IV Fluids
January 3 St John Hospital Nephrology Fellowship: NephSAP divalent ions part 2
2013
December 13 St John Hospital Nephrology Fellowship: NephSAP divalent ions part 1
December 11 St. John Hospital MS3: Acid-Base
December 7 Providence Hospital MS3: Sodium and Water
December 6 St John Hospital Nephrology Fellowship: Renal Week Recap
November 27 St John Hospital and Medical Center Grand Rounds: Medicine and Social Media
November 13 St. John Hospital MS3: Fluids and Electrolytes
November 9 Providence Hospital MS3: Potassium
November 9 St John Hospital internal medicine residents: Diabetic Nephropathy, A New Hope
October 24-28 Michigan State Medical Society: Diabetic Nephropathy, A New Hope
October 24 Providence Hospital MS3: Acid-Base
October 26 Providence Hospital MS3: Sodium and Water
October 9 St John Hospital MS3: Acute Renal Failure
September 11 St. John Hospital third year medical Students: Fluids and Electrolytes
September 7 St John Hospital internal medicine residents: Non-Anion Gap Metabolic Acidosis
August 31 Oakland University Beaumont School of Medicine 2nd years. PBL: Glomerular Disease
August 24 Oakland University Beaumont School of Medicine 2nd years. PBL: Acute and Chronic Kidney Disease
August 21 Oakland University Beaumont School of Medicine 2nd years, Acid-Base
August 20 Oakland University Beaumont School of Medicine 2nd years, Potassium Balance Disorders
August 17 Oakland University Beaumont School of Medicine 2nd years. PBL: Sodium and water
August 16 Providence Hospital 3rd year medical students: Potassium
August 3 St John Hospital internal medicine residents: Acute Kidney Injury
August 2 St John Hospital Nephrology Fellowship: Anemia and lack of placebo controlled trials
August 1 Providence Hospital internal medicine residents: Acute Kidney Injury
August 2 St John Hospital Nephrology Fellowship: Anemia and lack of placebo controlled trials
August 1 Providence Hospital internal medicine residents: Acute Kidney Injury
July 25 St Mary Hospital Grand Rounds: Acute Renal Failure, an update
July 24 St John Hospital internal medicine residents: Acid-Base
July 19 Providence Hospital 3rd year medical students: Sodium
July 17 Providence Hospital internal medicine residents: Water, IV Fluids, Sodium, Diuretics
July 13 Providence Hospital 3rd year medical students: Acid-Base
July 10 St John Hospital third year medical Students: Acute Renal Failure
July 3 St John Hospital internal medicine residents: Water, IV Fluids, Sodium, Diuretics
June 12 St John Hospital third year medical Students: Acute Renal Failure
June 8 Providence Hospital 3rd year medical students: Potassium
May 24 Providence Hospital 3rd year medical students: Sodium
May 15 St. John Hospital third year medical Students: Fluids and Electrolytes
May 4 St John Hospital internal medicine residents: Renal Anemia
April 19 Providence Hospital 3rd year medical students: Acid-Base
April 18 Providence Hospital Resident Reasearch Day: Judge
April 10 St John Hospital third year medical Students: Acute Renal Failure
April 6 St John Hospital internal medicine residents: HIV associated nephropathy
March 20 St. John Hospital third year medical Students: Fluids and Electrolytes
March 13 St. John Hospital third year medical Students: Acid-Base
March 2 St John Hospital internal medicine residents: board review
February 24 UIC/Advocate Christ Medical Center Residents: Non-Anion Gap Metabolic Acidosis
February 10 Providence Hospital 3rd year medical students: Potassium
February 9 Providence Hospital 3rd year medical students: Sodium and Water
February 3 St John Hospital internal medicine residents: Tolvaptan is effective in which patient and metabolic alkalosis
February 2 St John Hospital Nephrology Fellowship: Board Review NephSAP CKD and Progression part 2
January 19 St John Hospital Nephrology Fellowship Initiation of Dialysis
January 17 St John Hospital third year medical Students: Acute Renal Failure
January 12 Providence Hospital 3rd year medical students: Acid-Base
January 5 St John Hospital Nephrology Fellowship: Board Review NephSAP CKD and Progression part 1
2012
December 13 St. John Hospital third year medical Students: Acid-Base
December 8 St. Mary’s Hospital in Saginaw: Fructose, CKD and Hypertension
December 2 St John Hospital internal medicine residents: Severe lactic acidosis and electrolyte disorders of the drunk.
November 29 Providence Hospital 3rd year medical students: Potassium
November 17 Providence Hospital 3rd year medical students: Acid-Base
November 15 St John Hospital third year medical Students: Fluid and Electrolytes
November 15 St John Hospital and Medical Center Grand Rounds: Diabetic Nephropathy, an Update
November 11 U of C Alumni Reception. Marriott. 6:45pm
November 11 Blogger get together McGillins Olde Ale House. 8pm
November 11 AJKD Editorial Board Meeting Franklin 4 Room Marriott. 12:45-1:45
November 4 St John Hospital internal medicine residents: Non-anion gap
October 28 Providence Hospital 3rd year medical students: Sodium and Water
October 27 Providence Hospital Grand Rounds: Anemia and lack of placebo controlled trials
October 26 Michigan State Medical Society: Fructose, CKD and Hypertension
October 25 Providence Hospital Residency Program: What’s New in Potassium
October 22 Lupus Alliance of America: Panel discussion
October 20 Providence Hospital 3rd year medical students: Acid-Base
October 12 St. Mary Mercy Hospital: Fructose, CKD and Hypertension
October 11 St John Hospital third year medical Students: Acute Renal Failure
October 6 St John Hospital Nephrology Fellowship: Dialysis Kinetics
September 30 Providence Hospital 3rd year medical students: Acid-Base
September 22 St John Hospital Nephrology Fellowship: Physiology of Sodium and Water Handling
September 20 Royal Oak Beaumont Internal medicine residency: Acid-Base Disorders
September 13 St John Hospital third year medical Students: Acute Renal Failure
September 2 St John Hospital internal medicine residents: Potassium
August 30th Providence Hospital Residency Program: Potassium
August 26th Providence Hospital 3rd year medical students: Acid-Base
August 9th St John Hospital third year medical Students: Fluid and Electrolytes
August 5 St John Hospital internal medicine residents: Acid Base
July 26th St John Hospital third year medical Students: Acid-Base
July 22nd Providence Hospital 3rd year medical students: Fluids and Electrolytes
July 22nd St John Hospital internal medicine residents: Acute renal failure
July 21st Beaumont Family Practice Residency: Acute renal failure
July 21st St John Hospital Nephrology Fellowship: Anemia and lack of placebo controlled trials
July 19th Providence Hospital Residency Program: Body water, IV fluids and diuretics
July 1st St John Hospital internal medicine residents: Body water, IV fluids, diuretics and dysnatremia
June 14th St John Hospital third year medical Students: Acid-Base
June 9th: Abbott pharmaceuticals secondary Hyperparathyroidism: FGF-23
June 8th: St John Hospital and Medical Center: Update in CKD: Anemia
June 3rd: St John Hospital internal medicine residents: a case of Milk-Alkali syndrome and Fructose, Hypertension and Uric Acid
June 2nd: St John Hospital Nephrology Fellowship Program: NephSAP Fluids and Electrolytes
June 1st: Grand Rounds Beaumont Hospital: Fructose, Hypertension and Uric Acid
May 26th St John Hospital Nephrology Fellowship Program: Hyponatremia
May 17th St John Hospital third year medical Students: IVF and Hyponatremia
May 6th St John Hospital internal medicine residents: Nephrology board review
May 2nd: Michigan CRN meeting: Fructose, Hypertension and Uric Acid
April 29th: Providence Hospital third year medical students: Sodium in the morning, potassium at 11
April 20th: Providence Hospital third year medical students: Acid-Base
April 18th: St John Hospital cardiology fellows: Cardiorenal Syndrome
April 14th: Beaumont Gross Point family practice residents: IVF and Sodium Part 1
April 12th: St John Hospital third year medical Students: Acute Renal Failure
April 8th: St John Hospital internal medicine residents: How to give a lecture: Keynote Tutorial
March 29th: Providence Hospital internal medicine residents: hypernatremia and hypercalcemia
March 17th: St John Hospital third year medical Students: Acid-Base
March 4th: St John Hospital internal medicine residents: Cardiorenal Syndrome
Feburary 18th: Providence Hospital third year medical students: Potassium
Feburary 16th: Providence Hospital third year medical students: IVF and Na
Feburary 11th: Providence Hospital third year medical students: Acid Base
Feburary 8th: Providence Hospital internal medicine residents: Hyponatremia, hypokalemia
January 18th: St John Hospital Grand Rounds: Dialysis for the internist, an update
2011