PulmCrit (EMCrit)

introduction The neutrophil/lymphocyte ratio (NLR) has been gaining increasing attention across many fields of medicine within the past five years.  Currently, there are 2,230 publications about this in PubMed, mostly within the past few years.  This post will attempt to create a framework for understanding this ratio. overview definition & physiology The NLR is simply […]

Background Kimberly Blumenthal and colleagues at the Massachusetts General Hospital have been performing groundbreaking work on beta-lactam allergies.  Their work forms the foundation for much of the IBCC chapter on beta-lactam allergies (you might want to read it before this post, but if you don’t have time, a one-minute synopsis is below). One fundamental technique […]

Before writing this chapter I though I understood rhabdomyolysis fairly well.  I had treated many cases, read about it in a few books, and heard a lecture or two on it.  However, writing this chapter has forced me to realize that I didn’t really understand rhabdo well at all.  This disease is generally poorly understood, […]

Phosphate is the forgotten electrolyte of critical care.  Unlike other electrolytes, phosphate doesn’t participate in the generation of electrochemical gradients (like calcium, magnesium, and potassium) or govern tonicity (like sodium).  Thus, moderate perturbations in phosphate are generally asymptomatic.  However, phosphate does participate in many essential cellular processes, so true intracellular hyphophosphatemia can cause severe symptoms.  […]

Background Septic shock is generally conceptualized as a state of pathological immune hyperactivity.  Consequently, decades of work on immunomodulation in sepsis have focused on immunosuppressive medications (e.g. steroid, TNF-inhibitors, IL-1 inhibitors).  Although most of these interventions haven’t worked, steroid offers some benefits and IL-1 receptor antagonism shows promise for a subset of patients.1 The natural […]