Water deprived

Recently in the clinic we were asked to review a patient with suspected diabetes inspidus. She had been taking lithium for more than 20 years for bipolar disorder that was very well controlled. During a routine medical examination,…

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Lead Nephrotoxicity

I saw a patient in the clinic who was referred for evaluation by his PCP with CKD, a bland urine sediment and a history of hyperuricemia and gout. He had no history of diabetes or hypertension and had…

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A picture is worth…

Often on rounds with medical students or housestaff we will review why a serum creatinine of 0.8 mg/dl in a 40 year old athlete… may mean a much higher creatinine clearance than a creatinine of 0.8 mg/dl in…

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Femoral versus Jugular: part three

Previous posts have discussed various iterations of the cathedia study, a study comparing femoral and jugular placement of dialysis catheters in patients in the ICU. As mentioned before, the femoral route was not associated with a higher rate…

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In a Few Words

“A doctor, like a writer, must have a voice of his own, something that conveys the timbre, the rhythm, the diction, and the music of his humanity, that compensates us for all the speechless machines.” -Anatole BroyardIntoxicated by…

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Azathioprine in pregnancy

We recently discussed this issue in conference and I thought it might be worth sharing a few interesting points: Azathioprine is normally converted to the active metabolite 6-mercaptopurine. However, in pregnancy the placenta can metabolize azathioprine to thiouric…

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