𝐑𝐚𝐥𝐩𝐡 𝐌𝐨𝐡𝐭𝐲 𝐌𝐃 𝐌𝐏𝐇

@GarySingerMD @Buck1486 @hswapnil @kramer_holly @OttawaRenal I revisited this the other day and decided to have a #BakingSodaCoffeeChallenge. The residents found it very tolerable. Imaging 1/2 tsp of baking = 6 NaHCO3 pills! 2/3 thumbs up. @RushDOIM @Rush_Nephrology #RushRenalRules

The July 2026 Airway of the Month is here! 🫁 (2nd try the first seemed out of order) The cords are visible. The ETT is…less convinced. 😅 This case shows why laryngoscopy must be optimized not only to see the glottis—but to create a path for tube passage. 🎥 kumc.hosted.panopto.com/Panopto/Pages/…⁠� A glottic view can look “good” and still be poor for tube delivery. 👀 Here, a right-lateral, oblique blade position creates competing angles between the blade, glottis, and ETT. First optimize the laryngoscopy. Then troubleshoot the tube. The ETT stops. That’s feedback—not a challenge to push harder. 🛑 After 1–2 gentle attempts, withdraw and change something meaningful: re-center, suction, rotate, restyle, use a bougie, downsize the ETT, or reset Repeated pushing can turn a geometry problem into a trauma problem: bleeding, less working space, a contaminated view—and then a “sundowning” epiglottis. 🩸🌅 When the view deteriorates, pause and rebuild the pathway. July’s airway sequence: CLEAN → CENTER → ALIGN → PASS → PIVOT 🔄 A view is not a pathway. Keep pushing airway education forward—just don’t keep pushing the ETT. 😉 #DifficultETTpassage #Sundowning #LeadWithSuction #FOAMed

NEW EDITORIAL—The end for avacopan In our August editorial we discuss the ongoing controversy surrounding avacopan that could spell the end for the drug thelancet.com/journals/lanrh…

Very well written perspective Like the clarity this proposed naming convention offers journals.lww.com/jasn/fulltext/…

Important caveat to the “3mmHg/min” rule of thumb is the observation that pCO2 rises by 3-6 mmHg/min in apnea comes from anesthetized healthy eucapnic individuals averaged over several minutes. In a hypocapneic individuals the rate of rise in pCO2 rise will be non-linear and somewhat faster in the first minute: more like 12 mmHg. In someone who is critically ill, with massive work of breathing, the rate of rise will be even greater.

20 patients indicated that they preferred incremental HD to conventional (thrice-weekly) HD. I am not surprised. How much should this preference be valued?

@ABsteward So again, out of touch with reality. You got a staph bacteremia with embolic infarcts. What possible TEE result would lead you to conclude, i don’t need to treat for IE? It won’t change my management so i don’t get the test unless it’s needed for surgical planning.

@medrants Love this One thing "threshold below which nothing happens" Challenged by Marciniak as a function of log graphs pubmed.ncbi.nlm.nih.gov/31270527/

Today we are starting a series on diuretic use. This section is physiology and pharmacokinetics - we have a short version and then a long version - you decide. Next will be HFrEF. Comments please Understanding Diuretics, Part 1: The Site-of-Action Map open.substack.com/pub/leadingrou…

1/ A case of a 56 yom with Hx of cirrhosis, UGIB, delerium tremens & normal recent echo comes to the ED with hypotension BP 82/53(61) mmHg. HR 70s. There is 1+ edema in the legs & normal cap refill.

Avacopan retracted nejm.org/doi/full/10.10…

The full story — the emails, the two database locks, the securities litigation machinery that accidentally became a public health accountability mechanism, the revolving door, and what it means for rare disease drug approvals — is at the link. open.substack.com/pub/anishkokam…

@ClinChemMD @medrants We actually studied this question using a national database a few years ago. There is no evidence of increase in bad outcomes in July. Data beats myth. See journals.lww.com/journalpatient…

Cylinder effect IVC #POCUS The short-axis view avoids the cylinder effect, but comes with site ambiguity. Always evaluate the IVC in both long- and short-axis views. #FOAMed #Nephpearls

Donepezil overdose can closely mimic organophosphate poisoning, making medication history critical to avoiding diagnostic error and unnecessary oxime therapy tandfonline.com/doi/full/10.10…

@PulmCrit Thanks for citing the editorial @PulmCrit! For those looking, the link is: jamanetwork.com/journals/jaman…

This systematic review found that supratherapeutic loperamide can cause potentially fatal cardiotoxicity, with life-threatening arrhythmias reported at doses as low as 20–40 mg/day. tandfonline.com/doi/full/10.10…

Mixed cellular cast within fibrin matrix - brightfield, unstained - from pt with MPA - #UrineMicroscopy #UrinarySediment

I’m so exhausted with this BS about piptazo being nephrotoxic. I’ve written blogs on this since 2016 There was never a plausible mechanism for nephrotoxicity The ACORN RCT validated this Great example of academics publishing bad studies that cause harm Please stop. #1/2

Mixed cellular cast , containing a few RBC's and many viable WBC's (glitter cells) - phase contrast, unstained - from pt with AKI and proteinuria - serologies and bx c/w GPA - #UrineMicroscopy #UrinarySediment

A sad day for vasculitis, patients and caregivers. A relevant tool has been taken away - however, data integrity of clinical trials is key! Nonetheless, we need to start moving away from BVAS as endpoint! It is time … ema.europa.eu/en/news/ema-re…