Joel Topf is a nephrologist in Detroit working for St Clair Specialty Physicians. He is faculty for the Nephrology Fellowship at St John Providence.
Blog: PBFluids.com
Twitter: @Kidney_Boy
Co-creator: NephMadness, Co-creator: NephJC, Co-creator: DreamRCT
The Case
Hyponatremia
- Topf thoughts on DDAVP in hypoNa
- DDAVP clamp in hyponatremia
- EMCrit Intro to Hyponatremia
- Curbsiders Hyponatremia Episode
- IBCC Hyponatremia
- Taking control of severe hyponatremia with DDAVP
Joel admits elderly with Na < 130
Hypernatremia
- Make sure they are not DI and then replete their free water deficit
- Acetazolamide for Nephrogenic DI1
- Hypernatremia is a marker of poor quality ICU Care2
- EMCrit Hypernatremia Episode
- IBCC Hypernatremia
Hyperkalemia
Joel's Furosemide dose is Cr x 20
- Curbsiders on HyperK with Joel
- EMCrit HyperK
- IBCC HyperK
- Recent RCT on Kayexalate3
- The odds ratio for death was 10 at a potassium of 5.5 to 6 mEq/L. It rose to 31 for potassium above 6!4
Who Needs RRT?
- Is A,E,I,O,U still the answer?
-
AEIOU mnemonic for indications for emergent dialysis (from EM Cases)
Acidemia – pH<7.1 despite medical management
Electrolyte abnormalities – hyperkalemia refractory to medical management
Ingestion – nephrotoxic drug ingestion amenable to dialysis
Overload – volume overload resulting in respiratory failure
Uremia with bleeding, pericarditis or encephalopathy
When to Start CRRT in the Critically Ill
More
Now on to the Podcast…
Additional New Information
More on EMCrit
Podcast 187 – Hypernatremia (Uggggh!)(Opens in a new browser tab)
Additional Resources
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I enjoyed this podcast very much. A lot of good pearls in this one including the fact that hyponatremia is associated with a 5x-6x increase risk of falls, which I think is extremely important in our geriatric population. Also that conversion from soup to normal saline was like gangster nephrology
Patient on diuretics, hyponatremic, low Urine osmolality / specific gravity: how do you tell wether it is SIADH or just too much diuretics? give them a Trial of NS? If Na goes up –> no SIADH?
FeUrea may be helpful in these cases
this was a great podcast!