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IBCC chapter & cast – Hyponatremia
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 […]
Tox and Hound – Don’t Be A Goofball
by Dan Rusyniak No doubt the plateau in opioid deaths in many towns across America has led to a collective sigh of relief. And to be sure, fewer people dying is a very good thing. But, like the game Whac-A-Mole™, as soon as one epidemic decreases, another emerges. In the mid ’90s to the early […]
PulmCrit- Hyperdiuresis: Using hypertonic saline to facilitate diuresis
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 […]
IBCC chapter & cast – Hypokalemia
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 […]
Tox and Hound – We Need to Talk About Charcoal
by David Juurlink We need to talk about activated charcoal. Why? Because we sometimes give it when we probably shouldn’t, and we sometimes don’t when we probably should. I’ll explain what I mean by this. But first, some background. What is activated charcoal? Activated charcoal (AC) is a gritty black substance that, when administered to […]
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