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Joel Topf is a nephrologist in Detroit working for St Clair Specialty Physicians. He is faculty for the Nephrology Fellowship at St John Providence.

Blog: PBFluids.com

Twitter: @Kidney_Boy

Co-creator: NephMadness, Co-creator: NephJC, Co-creator: DreamRCT

The Case

* Tweetorial on the Case

* Slides for the Case

Hyponatremia

* Topf thoughts on DDAVP in hypoNa

* DDAVP clamp in hyponatremia

* EMCrit Intro to Hyponatremia

* Curbsiders Hyponatremia Episode

* IBCC Hyponatremia

* Taking control of severe hyponatremia with DDAVP

Joel admits elderly with Na < 130

Hypernatremia

* Make sure they are not DI and then replete their free water deficit

* Acetazolamide for Nephrogenic DI1

* Hypernatremia is a marker of poor quality ICU Care2

* EMCrit Hypernatremia Episode

* IBCC Hypernatremia

Hyperkalemia

Joel's Furosemide dose is Cr x 20

* Curbsiders on HyperK with Joel

* EMCrit HyperK

* IBCC HyperK

* Recent RCT on Kayexalate3

* The odds ratio for death was 10 at a potassium of 5.5 to 6 mEq/L. It rose to 31 for potassium above 6!4

Who Needs RRT?

* Is A,E,I,O,U still the answer?

*

AEIOU mnemonic for indications for emergent dialysis (from EM Cases)

Acidemia – pH<7.1 despite medical management

Electrolyte abnormalities – hyperkalemia refractory to medical management

Ingestion – nephrotoxic drug ingestion amenable to dialysis

Overload – volume overload resulting in respiratory failure

Uremia with bleeding, pericarditis or encephalopathy

More

* Get Joel's Free Electrolyte and Acid Base Book

Now on to the Podcast...

1.

Gordon CE, Vantzelfde S, Francis JM. Acetazolamide in Lithium-Induced Nephrogenic Diabetes Insipidus. N Engl J Med. 2016;375(20):2008-2009. doi:10.1056/nejmc1609483

2.

Polderman K, Schreuder W, Strack van, Thijs L.