A young patient who was engaging in heavy weightlifting presented to the ED with proximal muscle weakness. The night before he had one hour of acute onset bilateral leg and hip flexor cramps with stiffness and “hardened” muscles…
Yet another manuscript evaluating fluids for IV replacement was published in JAMA this week underscoring the importance and controversial nature of the topic. A large meta-analysis involving 10,868 patients from 38 trials showed that hydroxyethyl starch (HES) was…
Fluid therapy is essential in ICUs and not surprisingly there is still much controversy about which fluid to use, how much and when. Nephrologists often roll their eyes at other subspecialty’s preferences, e.g. surgeon’s preferences for Ringers, citing…
At some point during evolution humans lost the enzyme uricase and during the long and tedious process of getting to the modern age and this was initially a good thing. Uric acid accumulation as a result of uricase…
Can you have an acidosis with normal serum bicarbonate? Of course you can, it’s just incomplete. Incomplete distal renal tubular acidosis (idRTA) that is. RTA was first described in 1935, confirmed as a renal tubular disorder in 1946,…
Recently, we were asked to see a patient on the consult service with a rising creatinine, a BUN of close to 200 and decreased urine output. The patient was a diabetic who had an STEMI several months previously…
