jovora.bsky.social
60% Internal Medicine 40% Nephrology 100% POCUS
66 posts
610 followers
975 following
Active Commenter
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I guess you are being sarcastic….Unfortunately it’s not a question of routine vaccination but a question of leading people away from false propaganda….i have absolutely no idea how we could achieve that.
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You are right. I understand you now.
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I would say it makes a big difference. If your buffer capacity is spend you are turning instantly from being not good but alive into being dead…..
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You haven’t calculated in the produced methane gas in your bowels 😉
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„Rule out“ is seldom true in medicine but in my experience a high urine creatinine/high osmolarity and a urine sodium <20 seldom comes with a severe ATN.
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The next thing will be GLP-1 users are more likely to win the lottery…
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And if you measure bicarb and ends up with a discrepancy…you still don’t know which value you should trust more. So in general I do trust the calculation and wouldn’t make a big fuzz about that the value is „just calculated“
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It’s probably more an academically question and I don’t want to be too nerdy, but…the calculated bicarb is not en estimation it is a calculation based on the physiological principles of our acid base handling….maybe @kidneyboy.bsky.social can wade in to give us steering…
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Wow, never thought about that. Thanks a lot!
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I can look it up if you want, but I think it was a young patient with a diabetic keto acidosis and obviously well functioning lungs…
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Interesting, so what was your theory why his values were so deranged? It’s hard to imagine a patient with values like this after a normal dialysis session.
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Beware of the units…I live in a kPa region….pCO2 of 1 is not that seldom either.
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This patient must have a recirculation value from hell in his dialysis access. Fistula or catheter?
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If you believe in Henderson Hasselbalch…I can’t think of a Szenario where the values can have a discrepancy. Please explain!
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I can trump that…not that seldom I am afraid.
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Right you are. Let’s call it Vitamin D‘ont
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discussion of it and an online calculator:
emcrit.org/squirt/vanco/
the clearance of vanc is proportional to the GFR as discussed here:
pmc.ncbi.nlm.nih.gov/articles/PMC...
I'll build a formula embed to calculate GFR from two vanc levels into the IBCC when I get a chance
we should do this more
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🙏👏
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📌
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You are right. It’s not that everyone is throwing jokes around. If you work several years with the same group of people you get a sense who might be humorwise on the same page and who is not (not judging). So at my shop it’s more a group of friends making fun of each other.
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I think you are right, there is certainly a substantial toxicity potential. Partly because I was always privileged (or lacking the sensors to feel humiliated) or because I was surrounded by real good people, I never experienced the dark side of the institutionalised hospital banter.
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I think that’s true statement and I probably or certainly underestimate the privilege being born with my skin colour. To my defence I might add that it is very easy to forget because diversity in skin colour is nearly non-existent in my part of the world….
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The way my colleagues and me are making fun of each other has nothing to do with insulting, because there is no intention to harm the other person. But I understand you. It is always difficult when the “ toxicity” depends on the people involved.
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I think you’re right, actually. My thinking about privilege was coined in a way that I always felt privileged to be in that profession, to get the exceptional training I got and I felt privileged to be in a position where I am able to care for patients and being involved in medical education.
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Interesting, I didn’t read it like that. I had the impression he/she wanted to stress the fact that doctors are a privileged group of people and therefore supposed to feel more gratitude towards the education being offered.
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That was supposed to be a joke….of course i don’t consider any specialty (or human being) as inferior. I put it deliberately there as a joke.
The whole point of banter is that every joke is wrapped in mutual respect.
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You might be right. There is a gray area between toxic work culture at one side and a hypersensitive non functional system on the other side. I am trying to stay in the middle lane.
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🤣
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No, he is joking. Normal banter between colleagues
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Well, that’s part of the fun. No? Everybody is making fun of everyone. Our haematologist is making constantly fun about me and I can’t walk pass a cardiologist without a joke about their inferior profession. It’s a big (and maybe) silly hospital-game since the beginning of time.
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Kudos for his post. His point is valid and his rant is funny in my eyes. I can’t see the problem
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Unfortunately, I can’t explain it better…urea can move relatively freely over the cell membrane -> most of the time an ineffective osmole.
In the disequilibrium urea is cleared so fast from the vascular compartment, that for a short period of time it works as an effektive osmole. -> cerebral edema
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You’re not supposed to create a relevant sodium gradient during dialysis. The sodium content of your dialysis fluid is +/- matched to the sodium content in your blood.
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📌
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📌
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Urea ist an ineffective osmole because it can permeate cell membranes. But this process needs a little bit of time. If you remove urea via dialysis (very fast) you can end up with a gradient between plasma and brain cells. This gradient is forcing water into the cells and you will get cerebral edema
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Never felt comfortable with the concept.
pubmed.ncbi.nlm.nih.gov/14654728/
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Well, the post-truth era is really a big thing in America….
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I’m very much disappointed in the Rumänien Public….
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🤦♂️
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📌
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😉
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I am sorry, I didn’t meant to provoke you. I was probably triggered by the hint that patient with ADPKD can influence their disease in a relevant way. After all I have seen 6 months old babies from ADPKD Families already with bilateral kidney cysts…
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I am not a trained geneticist but doesn’t the referenced paper support my argument that the key lies in the genetic differences?
“Refined genotype-renal disease correlation coupled with targeted next generation sequencing of PKD1 and PKD2 may provide useful clinical prognostication for ADPKD”
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would have translated into a Darwinian advantage during our evolution. I would argue that the reproduction cycle already happened before diets could have a deleterious effect.
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I respectfully disagree. The major function of the kidney is to keep homeostasis in a certain range. I would guess that the Kidneys haven’t changed much from the beginning of the human evolution up till now. Additionally I don’t think that the way the kidneys reacted to different diets