musings of a salt whisperer
Hi Dr. Topf, I hope you’re doing well! I was reviewing S11: Sodium Metabolism, and I think I’m having some trouble understanding why euvolemic hyponatremia is non-edematous while hypervolemic hyponatremia is edematous. I was wondering if you could please help me correct my thought process. Voume status is a total body sodium issue (more sodium, Continue reading "OUWB Question about SIADH and…
Occam’s razor: when evaluating multiple competing theories, the simpler explanation of an entity is to be preferred. Solid logic, but not infallible. This week I took care of a patient with a serum calcium of 17.5 mg/dL. Calciums that high are almost always malignant in nature. But we did the internal medicine thing and ran Continue reading "Occam Denied"
Note: This post first ran on Roon. Roon is a physician only (and US only, for now) social media site. It is growing and you should check it out. Every nephrology fellowship has the same challenge. Every July 1, fresh fellows walk through the door. They’re smart, motivated, and terrified of upcoming responsibilities. And every Continue reading "Just finished the third annual Nephrology Fellowship…
On Saturday, I saw a post by Rahul Ganatra on Roon about NEJM retracting their Image in Clinical Medicine due to it being altered with AI. I immediately jumped over to Twitter to post this juicy tidbit and it took off. 200k impressions in three days. That s the most impressions I have had for a Continue reading "The retracted NEJM Image in Clinical Medicine"
Kidney COn is a great conference and one of the highlights are the nights. Thursday night is the faculty dinner. This year it included the students who got scholarships from KIDNEYcon to attend. This year we went for dinner at Southern Tail Brewing and had endless appetizers followed by a pretty decent facsimile of a Continue reading "One of the lesser known reasons to go to KIDNEYcon"
Norris Jackson is something of a hero around Detroit. He was the first security guard at the Detroit Symphony Orchestra and remained their security guard for 34 years until he retired in 2023. https://www.cbsnews.com/detroit/news/beloved-detroit-symphony-orchestra-security-guard-retires-after-34-years-of-service Retirement didn’t slow him down. His Motor City Rams just won the Player Football…
Note: This was one of my first posts on Roon.com If you are an American physician who likes to chat about medicine, you should sign up. There are so few prospective randomized trials in hyponatremia that we cherish every one, even the quirky, underpowered ones. So let s take our hats off and salute the Royal Continue reading "Proactive vs Reactive DDAVP: The Clamp Finally Faces an RCT"
A study by Dr. Chienwichai highlights challenges in diagnosing hyponatremia due to undisclosed intravenous saline administration. While saline infusion does not obscure urine biochemical tests, it reveals distinctions between hypovolemic hyponatremia and SIAD. Urine sodium is valuable, yet it cannot solely determine diagnosis.
The Hyponatremia Interventional Trial (HIT) has been published in NEJM Evidence. The results were unveiled at the Late-Breaking and High-Impact Clinical Trials session at ASN Kidney Week 2024 in San Diego, and we’ve been waiting 15 months for the manuscript to drop. Last week, it finally did. https://evidence.nejm.org/doi/full/10.1056/EVIDoa2500086 The NEJM Evidence Journal has now published…
PISCES showed a striking cardiovascular benefit with fish oil in hemodialysis. Lovaza closely matches the trial’s ethyl-ester formulation, is FDA regulated, EHR friendly, and offers a practical, reliable option while we wait for the exact formulation to come to market.
