Monday, July 30, 2012

Wednesday, July 11, 2012

Consult team with their new Renal Merit Badges

Custom dialysate solutions

I get nervous when I need to dialyze someone who is severely hyponatremic. Dialysis has the power to change the sodium concentration very fast. Patients with chronic, compensated hyponatremia need their sodium corrected slowly. Experts recommend increasing the sodium by less than 12 mEq/L/day and to actually undertarget only 6 mEq/L/day to give you some margin for error.

Over the week-end we were consulted on a patient with a sodium of 106 and acute renal failure. By the time we were forced to dialyze the patient the sodium was up to 112. To do this safely we selected CVVHD and then diluted our dialysate down to 120 mEq/L.

Here is a Keynote (100 mb), PDF (155 kb) and a narrated version of that presentation (118 mb) where I walk through the algebra on how to mix a dialysate of any final sodium concentration.

The movie available for download is very high quality. Below is a YouTube conversion of that video to save you the 118 mb download.

This is some serious Sodium Jujitsu and I awarded my team the first Nephrology Merit Badge: Sodium Ninja (pages | pdf). Designed for Avery 5163 2x4 labels.
Nephrology Merit Badge, updated for the 21st century as a sticker for your iPad

Tuesday, July 10, 2012

PBFluids breaks into the medical literature.

The first time PBFluids was referenced in the medical literature was in Matt Sparks' article on nephrology internet resources.

Today I received an e-mail from Tom Oates. Apparently, when he is not researching the unique genetic predisposition of the WKY rat to crescentic glomerulonephritis he is an avid reader of both Hemodialysis International and PBFluids. He sent me this article in Hemodialysis International regarding the highest creatinine ever. The key sentence in the article:
Extremely high levels of serum creatinine have been reported in the literature.3 The highest level of serum creatinine reported was 37 mg/dL.3
So what is the highest previous creatinine reported in the literature? Well according to the author, Said Abuhasna, it's 37 from this post at PBFluids. Nice to see blogs being included in the canon of medical literature. Though it would be even nicer if they spelled my name right.

Tuesday, July 3, 2012

The death of MobileMe and a whole mess of broken links at PBFluids--Updated

One of the best stories about Steve Jobs was his tirade is response to the MobileMe disaster.

He gathered the MobileMe team together and asked,
"Can anyone tell me what MobileMe is supposed to do?”
Having received a satisfactory answer, he continues,
“So why the f*** doesn’t it do that?"
He then picked another executive to run the project on-the-spot. Ultimately, this resulted in the service being shuttered and replaced with iCloud.

I never had any problems with MobileMe; it always worked fine for me. However, I foolishly relied on it to host files for PBFluids. This includes all of the presentations and handouts that are the highest trafficked pages of the site. Well, MobileMe stopped accepting new subscriptions a year ago and as of June 30th the hosted files are no longer accessible. I have downloaded all of the material and will start re-uploading the files to DropBox.  The problem is rewiring all of the past links to the new file locations. This will take some time.

As I looked through the collection of files that used to be hosted at MobileMe I found a lot of journal articles and other copyrighted works. I have no idea how popular these links were but I remember when I uploaded them, PBFluids was a lonely backwater, where I was the sole source of traffic. I put the files the files online for my own use in teaching and on rounds. I don't plan on replacing these files.

7/3/12 Lecture tab is ported to DropBox
7/3/12 Handout tab is ported to DropBox through Adventures in Renal Imaging
7/5/12 Handout and Book tabs ported to DropBox

July 3, first lecture of the year

For the past few years I have had the honor of giving the July 1st morning lecture for the internal medicine residents at St John Hospital and Medical Center. Unfortunately, July 1st was a Sunday and Monday mornings are dedicated to a formal sign out rounds in our division. So July 3rd was my first lecture.

I gave my Fluids, Diuretics and Sodium for the Terrified Intern lecture. You can down load it here:

ppt | pdf
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