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grepmeded's profile
GrepMed
GrepMed
GrepMed
@grepmeded

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GrepMed

@grepmeded

Image Based Medical Reference: Sharing crowd-sourced checklists, algorithms, decision aids, #PhysicalExam #POCUS, and more - by @GeraldMDMD + @k00bideh

Sacramento, CA
grepmed.com
Joined March 2018

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    1. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      In addition to glucose, you can also see this with mannitol.https://onlinelibrary.wiley.com/doi/full/10.1111/j.1445-5994.2007.01561.x …

      1 reply 1 retweet 19 likes
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    2. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      So in my patient I checked the serum glucose, 80 mg/dL and did a thorough review of systems that confirmed to me that he had not received any mannitol in the recent past.

      2 replies 1 retweet 17 likes
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    3. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      There may be other osmotically active solutes that cause hypertonic hyponatremia but I can’t think of any. (Please @ me if you have one)pic.twitter.com/Hd0uLS2uPc

      5 replies 1 retweet 19 likes
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    4. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      So that leaves the actual diagnosis, the patient had hyponatremia with an excess of an osmotically inactive solute. This can be seen with ethanol or BUN (kidney failure) (BUN).

      3 replies 1 retweet 33 likes
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    5. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      Since ethanol and BUN diffuse across the cell membrane (they osmotically inactive) they do not cause water to move out of the cell (the hall mark of true hypotonic hyponatremia).

      1 reply 2 retweets 23 likes
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    6. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      Joel Topf, MD FACP Retweeted Joel Topf, MD FACP

      The elevated osmolality is also not the cause of the hypontremia and the hyponatremia still has to be diagnosed and treated in the usual way.

 The best article on this ishttps://twitter.com/kidney_boy/status/1092595492108812288?s=21 …

      Joel Topf, MD FACP added,

      Joel Topf, MD FACPVerified account @kidney_boy
      The sweet flavor @NephroMD mixed with the savory goodness of @ChristosArgyrop wrapped together in one paper. It’s the Reece’s Peanut Butter Cup of nephrology! pic.twitter.com/j5XyekrjzN
      1 reply 9 retweets 43 likes
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    7. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      So we explained the elevated osmolality, but that doesn't explain the hyponatremia which still needs to be diagnosed and treated. This is different from hyponatremia with elevated osmolality from an osmotically active solute, where you should focus on treating the hyperosmolality

      1 reply 1 retweet 13 likes
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    8. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      Looking at the labs what do you think the diagnosis is? Serum osmolality 303 Urine osmolality 103 Urine Na < 20 Urine K 6

      2 replies 2 retweets 14 likes
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    9. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      Look at the urine osmolality. It is low Look to the ADH independent causes of hyponatremia.pic.twitter.com/cn1uQX0K8B

      3 replies 19 retweets 81 likes
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    10. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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      This was the diagnosis. The patient had been on a beer only bender for weeks and had no essentially no other nutrition. Fin.

      37 replies 5 retweets 228 likes
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      GrepMed‏ @grepmeded 7 Feb 2019
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      Replying to @kidney_boy

      Great tweetorial. I have a hate-love relationship with hypoNa. Don't think I've ever ordered uric acid for HypoNa workup- do you find this particularly helpful? Off-topic but I've always wondered- why do some hypovolemic patients develop hypoNa without AKI and vice versa?

      8:15 AM - 7 Feb 2019
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      • Miguel Galán de Juana 🏳️‍🌈
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        1. New conversation
        2. Joel Topf, MD FACP‏Verified account @kidney_boy 7 Feb 2019
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          Replying to @grepmeded

          Because the key factor in hypovolemic hyponatremia is increased ADH reducing the volume of urine so that water intake > water output. No need for AKI as long as ADH is lowering urine output.

          1 reply 0 retweets 1 like
        3. GrepMed‏ @grepmeded 7 Feb 2019
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          Replying to @kidney_boy

          Thanks- intuitively that makes sense I guess what surprises me is the profound hypoNa we sometimes see without AKI versus others seem to bump their Cr immediately without the same compensation.

          0 replies 0 retweets 1 like
        4. End of conversation

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