PulmCrit (EMCrit)

Since finishing my training, I’ve learned three new techniques for the management of hyponatremia:  the DDAVP clamp, use of hypertonic bicarbonate, and oral urea.  Meanwhile, I’ve removed the use of vaptans from my practice and grown more comfortable using 3% saline.  The confluence of these factors has transformed hyponatremia from something scary to something which […]

Using hypertonic saline to facilitate diuresis seems counterintuitive, paradoxical even.  Volume overloaded patients have excess sodium.   Why should we give them more?  Let’s start by trying to understand the underlying physiology. hypochloremia may cause renal sodium retention We generally don’t pay much attention to serum chloride levels.  Chloride is often viewed as a leftover, an […]

Hypokalemia is one of the most commonly encountered electrolyte abnormalities in critically ill patients, and perhaps the most commonly intervened upon abnormality.  Although this is mundane, it behooves us to understand it fully and treat it optimally.  Even minor nuances in treatment could potentially have significant impact, given how commonly hypokalemia is managed. The IBCC […]

The management of generalized convulsive status epilepticus remains in perpetual status controversius.  There is consensus that the front-line agent should be a benzodiazepine, but little agreement beyond that.  The much-awaited ESETT trial is a multi-center RCT comparing three anti-epileptic agents for ongoing status epilepticus (levetiracetam, fosphenytoin, and valproate).  This trial will be the highest-quality evidence […]

Brain death determination and support of a potential organ donor are core topics in critical care.  These topics aren’t particularly uplifting or glamorous, so they often are overlooked.  Consultants who don’t spend a lot amount of time in the ICU may be uncomfortable with them.  This makes it even more important that we have a […]