bright red blood - the irreverent MD

First I recall time served on the inpatient Cardiology service in residency. Then we review the evidence for salt and fluid restriction in acute and chronic heart failure.   Aliti GB, Rabelo ER, Clausell N, Rohde LE, Biolo A, Beck-da-Silva L. Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial. JAMA Intern Med. 2013 Jun 24;173(12):1058-64.  Her...

More salt! Wait, less salt. Or at least the management of less salt. Let's review the evidence supporting the management of hyponatremia (or not)... Aegisdottir H, Cooray C, Wirdefeldt K, Piehl F, Sveinsson O. Incidence of osmotic demyelination syndrome in Sweden: A nationwide study. Acta Neurol Scand. 2019 Nov;140(5):342-349. Ayus JC, Moritz ML, Fuentes NA, Mejia JR, Alfonso JM, Shin S, Fral...

This spring is all about salt!!! In part 1 I relive the saltiness of the emergency department while I was in residency and then get super nerdy about the pathophysiology of hyponatremia.  Verbalis JG, Goldsmith SR, Greenberg A, Korzelius C, Schrier RW, Sterns RH, Thompson CJ. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013 Oct;126(10 Suppl 1):S1-4...

First there is more fun on the Oncology service to be had by all. Then we discuss a landmark trial assessing the benefit of exercise as adjunctive therapy for colon cancer. Most pertinent articles:   Bozzetti F. Potential Benefits from Physical Exercise in Advanced Cancer Patients Undergoing Systemic Therapy? A Narrative Review of the Randomized Clinical Trials. Curr Oncol. 2024 Dec 1;31(12):7631-...

Join me as I first discuss annoying people, followed by a lot of annoying Medicine. Bajaj JS, Pyrsopoulos NT, Rahimi RS, Heimanson Z, Allen C, Rockey DC. Serum Ammonia Levels Do Not Correlate With Overt Hepatic Encephalopathy Severity in Hospitalized Patients With Cirrhosis. Clin Gastroenterol Hepatol. 2024 Sep;22(9):1950-1952.e1. Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is...

After arguing that Geriatrics really is a worthy subspecialty, I recount all of the poop I just can’t get away from… even after the patient is technically dead… Then prepare to be bombarded by the mounting evidence against and festering frustration with fecal occult blood tests being used just for funzies. Lee MW, Pourmorady JS, Laine L. Use of Fecal Occult Blood Testing as a Diagnostic Tool for C...

After exploring the healing powers of dog saliva we dig into some evidence about one of the most common diagnoses we see in clinic and the hospital--cellulitis. It may be simple, but it's far from easy. Prevalence of misdiagnosis of cellulitis: A systematic review and meta-analysis. J Hosp Med. 2023 Mar;18(3):254-261.   Misdiagnosis of Uncomplicated Cellulitis: a Systematic Review and Meta-an...

What's worse than bleeding relentlessly out of your butt because you're on oral anticoagulation for your afib and antiplatelet therapy for your cardiovascular disease? An intracranial hemorrhage for the same reason! But the times they are a changin'. Today we follow a personal journey of bleeding by Dr. Sam's dad. And then we review 4 RCTs that prove it never should have happen...

After exploring some of humankind's basest instincts we delve into the true benefits and risks of testosterone therapy for older hypogonadal men, and are left feeling impotent... Main publications: Cardiovascular Safety of Testosterone-Replacement Therapy. N Engl J Med. 2023 Jul 13;389(2):107-117. Effects of Testosterone Treatment in Older Men. N Engl J Med. 2016 Feb 18;374(7):611-24. And a w...

What's more fun than public displays of urination? Discussing the benefits and risks of SGLT2 inhibitors! Then we review a recent article that tries to answer the question everyone has on their minds these days, is it safe to restart the SGLT2i after my patient has a UTI?  And fails miserably... Urinary tract infection and continuation of sodium-glucose cotransporter-2 inhibitors in diabetic...