Kinjel Shastri, DO

@NephJC Would be interested to see chronicity #nephjc

T3f: First, the authors were not able to ascertain the cause for, or chronicity of, hyponatremia which raises the question of whether these characteristics could contribute to the overall outcomes. #NephJC

T3c: Seethapathy et al found a 36% reduction in mortality and an average of 2.2 day reduction in the length of stay with faster correction rates (>10 mEq/L/24h)! 🏥➡️🐇➡️🏠 #NephJC

@NephJC >10, not 10 but >10. Sweating already #nephjc

T2f: Correction rates >10 mEq/l/24h showed ⬇️in-hospital (OR 0.64, 95% CI 0.44-0.93) ⬇️30-day mortality (OR 0.69, 95% CI 0.50-0.96 This group also had ⬇️average LOS by 2.2 days (1.0-3.3) 🐇 Does this make anyone else nervous? #NephJC

@VijayanMD @NephJC Would not have thought this. I feel like patient's getting colonoscopy prep has recently been a risk as well #nephjc

@NephJC One of the biggest risk groups used to be women undergoing gyn procedures? #nephjc Not sure if still the case sciencedirect.com/science/articl…

T0k: But who is at high risk of CPM? Can you point to another group?? 👉⏫🧂 Will place this here for further reference #nephjc

Kinjel Shastri, Michigan, no COI. Had to dust off the keyboard for #NephJC but we back!

Tip for non-nephrologists: Tell the patient their creatinine improved after dialysis and their kidneys are therefore getting better because of dialysis. This false hope is essential for the complete ESRD experience. #dialysisfixedthekidneys #lousrules

@ZohaibHaqueDO @EM_RESUS Bruh 😎

@EM_RESUS Lil’ ANCA Vasculitis

your rap name is "lil" + the last diagnosis you made

@sdclyne Cool plants though 🪴

What did I have for lunch today, and which are my favorite pair of shoes (neither lunch or shoes are pictured)? #MedTwitter #🙄 #AskRenal

On #physiciansuicideawarenessday, we lost one of our classmates. Awareness is a step, but we need more help, and still have a ways to go. #MedTwitter gofundme.com/f/brent-furomo…

And the link! nephjc.com/news/2022/8/28…

We run a tight ship. If you are curious about our expenses follow the link. Nobody gets paid. nephjc.com/news/2022/8/28… #NephTwitter, it is #Time2StepUp.

@pod_tina Ur Na 38, Ur Cl 27, U K 57, U osm 281.

@shastriki What is the urine Na and urine Osm?

AKI/rhabdo requiring HD patient with persistent hyponatremia (Na 118-125) despite daily dialysis with large UF, fluid restriction, and diuretics (recently has some UOP ~600 cc/24 hrs), any ideas? #askrenal

Congresswoman Marjorie Taylor Greene had $183,504 in PPP loans forgiven. twitter.com/Acyn/status/15…

@nephondemand Yeah I’ve been going crazy haha, unfortunately not. Even considered taking the lab specimen myself to a different hospital 😂

@shastriki Puzzling case. I wish you could do a direct ion test. No chance of that whatsoever, right?

@nephondemand Got a bit of D5W in the ED on admission, 2 weeks ago, nothing since.

@shastriki hmm, looks like a true hyponatremia. any hypotonic fluids given to the patient during dialysis or in the ED?

@endomatter From compartment syndrome. I checked an AM cortisol as well just in case.

@GlassockJ @hswapnil Thank you! Most recent plasma osm was 282. Been on a 1 L free water restriction. I ended up giving a bolus of 3% to get the Na level up a bit to get them to the OR (to a level anesthesia was comfortable with).

@shastriki @hswapnil Check a plasma Osmolality . If not decreased, suspect pseudo-hyponatremia. If low, give hypertonic saline or be more vigorous with water restriction.

@nephondemand Osm gap was 10

@shastriki Can you do a calculated and measured serum osm? The difference may tell us if there is a dilutional component.

@NephroMD @hswapnil @signindoc @askrenal @VelezNephHepato @NephRodby 34-56 max over the last week.