I missed this when it came out: 2024 HHS/DKA guidelines:
No more "the gap has closed".
Following the anion gap is no longer recommended.
Instead, follow plasma ketones directly, venous pH, and/or bicarbonate.
Brian Locke, MD MSCI
2,952 posts
Brian Locke, MD MSCI
@doc_BLocke
Research @ Intermountain PCCM. 🧐 about the pH, PaCO2, & why it’s so. Also, numeracy in MedEd, m-mi-lab.github.io/about/ & theMTN.ai
- Undifferentiated preclinical medical students outperform incoming CCM fellows on relevant pulm physiology questions d/t knowledge decay. Evidence the primacy of physiology in early med school is a waste (or worse) to me, tho the authors take the opposite view & call for more.
- Replying to @srrezaieInteresting historical perspective - this used to be the natural history of "malignant hypertension" - as an example in the case of FDR's death. From the presidential physician's notes: acpjournals.org/doi/10.7326/00…
- Replying to @SpencrGreenbergPeople immediately feel better without a fever and any potential difference in outcome is delayed and imperceptibly small (both from a clinical trial perspective - ncbi.nlm.nih.gov/pmc/articles/P… - and certainly to an individual healthcare provider) so the practice is reinforced.
- Full disclosure of residency applicant ranking criteria. I admire the transparency, but also,Yale IM residency program rank list for 2025 match season posted by the program director Ranking equation according to PD is =F2:F567*100+(G2:G567^2)*50+((H2:H567)/2)^1.25+(I2:I567^1.75)*15+(J2:J567^1.75)*15+(K2:K567^1.75)*5+ L2:L567*5+ M2:M567*10+ N2:N567*10+
en.wikipedia.orgGoodhart's law - Wikipedia - Replying to @Aidan_BaronConstant struggle to get people to think through whether they really need the abg (almost never). Does anyone have literature they reference when this comes up? Nice discussion here around challenges to generating data. Wonder if there’s anything new
- Replying to @sargsyanzThe first step to any real-world hyponatremia algorithm is “what happened after the bolus of fluid given in the ER?”
- Invasive Candidiasis in 2025 - summarized. Echinocandins first line for most. Role of molecular tests and biomarkers still a bit murky.
- SCCM Stress Ulcer PPx Guideline: ☑️ Enteral nutrition ☑️ Use either PPI or H2 Blocker in pt w/ coagulopathy (4.8% ⬆️ abs risk of UGIB), shock (2.6% ⬆️ risk), or chronic liver dz (7.6% ⬆️ risk) 🚫 Mech Vent is not an indication 🚫 Stop when coagulop., shock, or liver dz resolves
- Replying to @doc_BLocke(I think it’s worse than a waste because it gives students the wrong impression that they’ll be able to divine what treatments work w convincing physiologic stories. Teach principles of practice & science first, relevant phys after clinical exposure, imo)
- I am confused as to why people continue to flog patients who have HRS-AKI with albumin, day after day, even after they do not respond to the diagnostic 48h-volume expansion challenge. Renal perfusion pressure = MAP - CVP CVP through the roof ➡️ NE and Lasix ➡️happy kidneys 🤷♂️
- Reasons to extubate to BiPAP: - CHF - COPD / CO2 RF - NM dz Add obesity? RCT including 623 pt's at risk of ext failure, all wts. Non-prespecified HTE by BMI (P_interaction=0.007). 7 vs 20% in overwt/obese, no diff in nl weight Sensible, P_pl ⬆️ w wt
- Replying to @jeremyfaustAdverse events (no causation implied; a happened after b) vs Side effects aka adverse reactions (causative; a caused b) - for folks wondering what this is all about. All events compiled, causation determined by subsequent analyses cdc.gov/vaccinesafety/…
- Weight the evidence appropriately. Meta-analysis of the predictive value of lung auscultation for various pulmonary diagnoses. nature.com/articles/s4159…
