PulmCrit (EMCrit)

I’ve been yearning to use oral urea for euvolemic hyponatremia for years (e.g. see a post from 2015 here).  Urea has been used in Europe for decades, but until very recently it was unavailable in the United States.  It has numerous advantages compared to the vaptans (which are extremely expensive and potentially dangerous).  Recently, an […]

Hypothermia is a heterogeneous topic.  At one end of the spectrum are previously healthy people who suffer from cold exposure (for whom the rewarming is the primary focus of therapy).  At the other end of the spectrum are patients with mild secondary hypothermia (e.g. due to sepsis), for whom the primary focus is investigation and […]

Most books give bupropion a couple paragraphs, but it arguably deserves its own chapter.  With a decrease in the use of tricyclics and increasing use of bupropion XR for depression, bupropion is becoming the most common cause of life-threatening antidepressant overdose.  Bupropion has a uniquely dangerous property of blocking gap junctions between cardiomyocytes at high […]

background Pneumonia after cardiac arrest is problematic for several reasons: Many patients aspirate during cardiac arrest. Patients are intubated and mechanically ventilated, usually with poor mental status – conditions which do not promote secretion clearance. Early diagnosis of pneumonia is impossible for many reasons (inability to measure a fever due to therapeutic temperature monitoring, inability […]

Acalculous cholecystitis is a slippery beast.  It’s pretty uncommon, lurking among the myriad of sick ICU patients with moderately abnormal gallbladders.  It is likely both under-diagonsed and over-diagonsed at various times.  Indeed, since surgical cholecystectomy is currently rare, it is frequently unclear whether a patient ever had acalculous cholecystitis!  (For example, if a cholecystostomy drain […]