Monday, August 22, 2016

Question from the OUWB M2s

This question came via e-mail:
A couple of my classmates and I had a question regarding one of your slides (slide 39 on the Potassium, Metabolic Alkalosis presentation). We were unsure of the mechanisms that prevented bicarbonate excretion with hypokalemia, specifically decreased NaK2Cl activity in the loop of Henle and decreased NaCl resorption in the distal convoluted tubule. Could you please give us an explanation for these mechanisms?
So the reason you can't remember a mechanism is I gave the old "just because" mechanism without much explanation.

The first step of why the the Na-K-2Cl transporter slows own in response to a low K is pretty sraight forward. Tubular potassium will fall as patients get hypokalemia. As the plasma potassium falls, less and potassium is filtered and then less potassium will be available to cycle the Na-K-2Cl pumps. The decreased activity in the loop of Henle results in more distal delivery of sodium and that drives move acid secretion and maintenance of the metabolic alkalosis.

The distal convoluted tubule is a bit more complex. Here is a diagram:

The hypokalemia stimulates the hydrogen-potassium exchanger. This generates intracellular acidosis, even though the patient has alkalosis. In order to correct the acidosis the cell slows sodium-chloride co transport so more sodium washes down stream and stimulates the hydrogen secretion, maintaining the alkalosis.

If you are looking for a deeper dive into metabolic alkalosis I recommend this review by Galla in JASN

Wednesday, August 10, 2016

OUWB Resources 2016

Here is the PDF of today's Acid-Base Workshop

There is a typo on slide 111 of the the acid-base lecture:

here is the correct table. Sorry.

8 AM Tuesday lecture

Potassium metabolic alkalosis and hypertension:

Introduction to potassium lecture:


part 1:

part 2:
Greatest Potassium Lecture Ever...part 2 from joel topf on Vimeo.

Part 3:
Greatest Potassium Lecture Ever...part 3 from joel topf on Vimeo.

Monday's Lecture:

  • Introduction to Acid Base, deep dive into metabolic acidosis (keynote | PDF)

Wednesday's lecture in Keynote format

The reading material for the TBL

More links to be added shortly.

Monday, July 18, 2016

My talk on the evolution of the medical textbook and the role of social media

One of the most exciting thing I have ever done was speak at dotMed this past February. I blogged about it. My talk just got pushed out to youtube.

The idea underlying the talk is that the medical textbook holds a central role in the education of physicians. Over the years, the textbook evolved from a single author text like Osler's to the multi-author textbook like Harrison's, to the online, digital solution like UpToDate.

I speculate that the next evolution will incorporate mobile and social elements and then proceed to show how the nephrology social media collective is using social tools to deliver compelling medical education. Enjoy.

Wednesday, June 8, 2016

Two new lectures: diabetic kidney disease and mild hyperkaemia

Diabetic kidney disease


The survey on the treatment of mild hyperkalemia:

Results of the survey:

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