Lithium is indispensable as an effective treatment for bipolar affective disorder. However, it has a narrow therapeutic index with desired therapeutic levels between 0.6 and 1.2 mEq/L. Lithium is handled by the kidney (responsible for almost all its…
In the poisons and toxins bracket I learnt some interesting facts. The Dietary Supplement Health and Education Act of 1994 (DSHEA 94) is an example of the power of big business in Washington. Subsequent to acts such as…
A patient who had been working in a recycling company that handled thermometers presented with fever, dry cough, fatigue and rash. Based on imaging (CXR showed massive radio-opaque material in the lungs, right atrium and right ventricle; skeletal…
We were recently consulted on a patient with a history of repeated admissions with pneumonia who had developed AKI following treatment with Tobramycin. It got me thinking about the mechanisms of aminoglycoside toxicity. The traditional teaching is that…
As a new renal fellow I’ve felt fairly comfortable with the list of NSAID associated renal conditions. But after taking care of a patient this past month with fulminant hepatic failure due to a Tylenol overdose it’s been…
The first order of business for today’s Renal Fellow Network is to welcome another regular contributor to the mix: nephrology fellow Albert Lam, of Brigham & Women’s Hospital. Fresh off the Nephrology boards, Albert will be periodically posting…
A very interesting article in this month’s JASN by Herlitz et al describes a cohort of 10 bodybuilders with chronic kidney disease, making a compelling case that anabolic steroid use is an underrecognized cause of secondary FSGS. The…
Bizarre case of hypernatremia: a suicide attempt by a 73 year-old Japanese man in which the individual drank massive amounts of soy sauce. According to this 2006 Neurology paper by Machino et al, the patient presented with vomiting,…
Okay, you’re probably not going to see this in your lifetime, but imagine how cool you’ll seem when you whip out “matchstick ingestion” as part of the differential diagnosis for hyperkalemia and AKI. Matchstick heads are comprised of…
One of the more common (and potentially successful) suicide attempts is to drink a bunch of antifreeze, which contains ethylene glycol. As we all know, this is typically diagnosed by characteristic lab abnormalities: patients present initially with an…
