Interesting case this weekend. Sick patient ?metformin toxicity with profound AGMA, AKI, Bicarb 5 pH <6.8. lactate >20. May have element of euglycemic DKA (on dapa). On levo 1mcg/min. Intubated dt Kussmauling. Needs RRT. What would you choose?

Some great ID pearls

Conclusions: 💥Vasopressin assoc with better kidney outcomes in critically ill pts 💥Preferential efferent vasoconstriction may explain the above. Can use this in certain cases of DR 💥RPP (MAP-CVP) should be considered in all pts 💥May be particularly useful in RV failure END.

It may be surprising, but this isn’t the first study to show procalcitonin guidance to be associated with lower mortality, which may be due to the use of PCT leading to earlier, more accurate diagnoses and less exposure to unnecessary antibiotics and their adverse effects. 1/5

Trama-dont! But don’t take it from me. Listen to the expert.

1️⃣You’re probably wondering how we got here with bicarb in ACLS? 🤔 Back in ‘74, JAMA’s first ACLS guidelines made it a star for acidosis in cardiac arrest. Who knew baking ingredients could be so heart-stirring? #ACLS #EMRx

Keppra ppx is safe. Higher doses (750-1000mg BID or ~20mg/kg/day) may be more effective than lower doses (500mg BID).

Rahul Ganatra Judith Strymish Truism of every diagnostic test This is a slide I made from Todd C. Lee & team's meta analysis - best study I found I use for pneumonia but not SSTI where I practice since we see lots of it

Safety and Efficacy of 25 mg/kg and 35 mg/kg vs 10 mg/kg Rifampicin in Pulmonary TB: A Phase IIb Randomized Controlled Trial 🔓 Open Access bit.ly/3ITo0Rv

When academics do wedding invitations 😅

The more arms of SNAP that I hear about the more I’m thinking it’s gonna be more hype than BLING III

Most drug interactions aren’t that clinically relevant. This one is even after just a single dose of a penem. Don’t try and increase VPA dose, just accept that you need an alternative ASM.

So, if you expose strains that are resistant to an abx to that abx, you will still increase the resistance over time. Even if those strains are already "resistant" per CLSI breakpoints. You can easily watch an MIC of 16 (already resistant) go to 512 with more abx exposure.

Boris Jegorović, MD, PhD, DTM&H Eduardo R Argaiz Edgar V. Lerma 🇵🇭 Swapnil Hiremath @hswapnil.medsky.social Juan Carlos Q Velez Chirag Parikh Swetha Kanduri NephroPOCUS Nick Mark MD M. Bota the EMCrit Crew common mistake here is to do nothing or provide inadequately aggressive tx, because neither of these problems will usually resolve on their own simultaneously fixing these two problems is hard work but absolutely can be done recently had icu pt on 250 ml/hr free water😛 (#2/2)

Nick Mark MD Worth noting that the mean MAP in the permissive hypotension group was 66 mm Hg…not surprising, in my experience, targeting a MAP > 65 mm Hg typically leads to mean approx 70 mm Hg

I have a feeling we will debunk the practice of secondary SBP prophylaxis in the next 5 years. I also think we will revisit the benefits of GIB prophylaxis with antibiotics for patients with cirrhosis at the same time.

🧵 Thread: Emotions & behaviors that will quietly poison your life - professionally and personally. They feel justified. They feel righteous. But they will eat you alive if you let them.

Cefazolin vs (flu)cloxacillin for MSSA BSI ⭐Non-inferior 90-day mortality ⭐⬇️AKI Also: ⬇️dosing frequency ⬇️phlebitis ?inoculum effect➡️no proven impact on clinical outcome ?CNS penetration➡️myth debunked Is there any reason why (flu)cloxacillin should still be used?

Can you safely use propofol in patients with egg or soy allergies? See the answer below in my latest #PharmacyEducationBoard

MedTox Fellows: a little ICU pharmacology quiz.