Had a blast as a @NBCWeakestLink contestant but hoping for more #Nephrology questions next time

An interesting case of wine-red/raspberry chromaturia and CRRT effluent coloration following hydroxocobalamin administration for refractory vasoplegia

Blazing-fast image creation – using just your voice. Try Grok Imagine.

RT @TransplantPulse: Communication and defining roles and duties are key points of transition of care. Wonderful discussion by @DerekSLarso….

When should patients be sent back to their general nephrologist to manage after a transplant? I’m giving a talk surrounding this and interested in your thoughts.

While practicing multiplication with my 9 y/o daughter, she asked if you can ever use multiplication and division together. Anyway, she now knows FeNa. Incidentally, her poor doll has a wicked case of ATN.

Photo of included pin for reference. @Nephro_Sparks

Welp, just finalized my costume.

Gracie has been covering my call this weekend. #NephroCentric .#GoldensOfTwitter

🚩Benefit of HD is the correction of metabolic acidosis more than the removal of Metformin .🚩CVVH/CVVHD can be considered if clinically unstable, although clearance is less than with conventional HD (per case reports).🚩PRRT also has been described in retrospective reports. fin.

Indications for extracorporeal removal (Calello, Crit Care Med. 2015).🔹Severely elevated serum lactate (>20mmol/L).🔹Severe metabolic acidosis (pH<7.0).🔹Failure to improve with supportive care/bicarbonate therapy in 2-4 hours (by pH, lactate, clinical status).

Kinetics of Metformin.🔸Absorbed in the upper intestine.🔸Negligible protein binding.🔸Vd ranges from 63-276L.🔸Half life 5-7 hours (w/ normal kidneys).🔸Excreted unmetabolized via the proximal tubule.

Mechanism of MALA.🔹Metformin promotes conversion from glucose ➡️ lactate in the splanchnic bed of the small intestine.🔹 Also inhibits mitochondrial respiratory chain complex 1 leading to ⬇️ hepatic gluconeogenesis from lactate and pyruvate. This = additional lactate/substrate.

Patient with T2DM and chronic alcoholism presented with 2 weeks of poor PO intake, N/V, abdominal pain, and diarrhea. ⬇️BP +⬆️RR in the ER. Risk factors for MALA:.🔸CKD.🔸Liver Disease.🔸Active Alcohol Use.🔸Heart Failure.🔸Series Acute Illness.🔸Hemodynamic Instability.

A case of Metformin-induced lactic acidosis (MALA) including a brief thread covering risk factors, kinetics, and indications for hemodialysis 🧵 1/6

Congo red positive amyloid deposit with apple-green birefringence in a kidney arteriole #RenalPath #MedTwitter

A case of Valproic Acid toxicity (>1000mg/L after dilution) associated with acute hyperammonemia, encephalopathy, and respiratory depression. VPA:.⬇️ MW (144 Da).⬇️ Vd .⬆️ protein-binding saturation w/ toxicity = higher concentration of free drug available for HD clearance

So:.✅ Dialysis patients are exposed to ~150L of dialysis solution each treatment.✅ Providing clean water for dialysis is critical for patient safety and positive patient outcomes.✅ The components of H20 treatment need to be monitored closely to ensure optimal performance. Fin.

⭐️Deionization removes ionic contaminants when the RO fails or when additional purification is necessary.⭐️H+ exchanged for➡️Cations.⭐️OH- exchanged for➡️Anions.⭐️H+ and OH- combine to become water.⭐️Followed by an endotoxin filter since DI systems promote bacterial growth. 11/12

⭐️Reverse osmosis (RO) removes substances such as metal ions/salts, chemicals, and microbial elements (bacteria, endotoxins, and viruses).⭐️Organic contaminant removal is largely based on size; those with a molecular weight >200 Da are filtered.⭐️Uses Hydrostatic pressure!. 10/12

⭐️Just before water reaches the Reverse Osmosis unit, a pre-filter clears out any particulate matter that may damage the membrane. 9/12