Vomiting or nasogastric tube (NG) decompression can lead to metabolic alkalosis, often associated with hypokalemia. When asked what the source of the K loss is, most people assume it is lost in the gastric fluid. However, gastric fluid…
This is the story of a 64 year old male mason with past medical history notable for hypertension and hyperlipidemia who was referred to me for evaluation of proteinuria. The patient noted onset of lower extremity edema nine…
Magnesium (Mg++) is a predominantly intracellular divalent cation which is critical for many metabolic processes and participates in >300 enzymatic reactions. It is essential for many critical transporters including the Sodium/Potassium ATPase cotransporter. Mg++ also has a critical…
Patients over 65 tend not to choose peritoneal dialysis for a host of reasons, not the least of which is PD is underutilized in the US in general. However, a recent study suggests that PD may be preferable…
A colleague of mine at another academic institution recently informed me about a patient that had been admitted to the ICU with organophosphate poisoning. In spite of aggressive treatment, the patient remained critically ill with multiorgan dysfunction and…
I recently saw a patient in clinic who had sustained a head injury and developed hyponatremia that persisted after discharge. In his chart was a great deal of debate over the cause of his hyponatremia: SIADH or cerebral…
Almost every transplant clinic I have, one of my patients will ask about reducing his or her immunosuppression. This happened again this week. Needless to say that this is one of the most frustrating area in transplantation where…
Historically – before CHOIR and CREATE – Goals for anemia management were Hb level of 11-13 g/dl Iron saturation > 20% Ferritin >200. CREATE changed the tide which was followed by CHOIR. CREATE (Epo-β) had intent to treat…
Nephrologists for many years have been able to accurately measure kidney function, a measure termed the glomerular filtration rate or GFR. To this end we have been the envy of many other specialties. However the GFR can be…
I recently saw a patient in my outpatient clinic who was referred for management of chronic kidney disease presumed to be caused by chronic lithium-induced nephrotoxicity. The patient presented with a serum creatinine ranging from 1.4-1.5 mg/dL over…
