General Hospital Medicine&nbsp;&nbsp;&nbsp;

Do you use lactulose in acute liver failure, particularly in patients on continuous renal replacement therapy (CRRT) for ammonia or toxin clearance?

How do you consider sending fungal studies in a patient with pneumonia?

Considering the recent article in CHEST that describes the increasing incidence of fungal pneumonia Azar. Chest 2024

How do you manage anticoagulation/antiplatelet therapies with strong indications for uninterrupted therapy in setting of urgent procedures?

For example, anticoagulation for recent, significant PE or dual antiplatelet therapy for recent MI, but requiring urgent procedures such as biopsy of ...

6 Answers available

How do you counsel patients on the risks vs benefits of naltrexone for alcohol use disorder with persistently elevated liver enzymes?

Is there an absolute cutoff for AST/ALT that you use where the risks outweigh the potential harm reduction benefits of using the medication? &nbs...

How do you decide when to use acid-suppressive medications for GI prophylaxis when patients are on prolonged corticosteroid therapy?

Do you prescribe it universally or based on specific risk factors?

How would you approach the management of asymptomatic ALT and GGT elevation in an older adult patient with depression with psychosis and without history of hepatitis who recently had dose of quetiapine increased and new initiation of SNRI?

How do you manage symptomatic ascites in a patient with SBP?

At what point do you feel comfortable using diuretics or performing a therapeutic paracentesis?

Do you have any concerns about lower extremity compression (e.g., compression stockings, intermittent pneumatic compression, etc.) worsening ascites in a patient with portal hypertension?

How do you decide when to initiate or restart diuretics in a cirrhotic patient with ascites if they are receiving a therapeutic paracentesis?

In what clinical scenario would you consider the use of budesonide over prednisone as part of the pharmacologic management of autoimmune hepatitis?

When giving albumin challenge, for acute kidney injury with suspected hepatorenal syndrome, do you administer a single dose daily or split the dose of albumin?

What is your approach to the use of GLP-1 agonists in older adults with diabetes with or at risk of sarcopenia?

How do you determine whether to limit volume removal during therapeutic paracentesis in a patient without acute or chronic kidney disease?

How do you decide whether or not to pursue inpatient workup of an incidental liver mass?

What clinical, system, and/or social factors play into this decision?

How do you decide whether to use pharmacologic VTE prophylaxis in hospitalized patients with decompensated cirrhosis?

How do factors like the presence of varices, severity of coagulopathy, etc., play into your decision?

What is your approach to a situation where DILI is suspected secondary to an important medication (e.g., anticoagulation, antibiotics, etc.), but the diagnosis is uncertain and the liver injury is relatively mild?

Are there situations in which you would continue the possible offending agent with close monitoring?

How do you rule out spontaneous bacterial peritonitis in a patient with minimal ascites that is not amenable to paracentesis?

What is your approach to managing concurrent severe SIADH and large-volume malignant ascites when aggressive volume removal appears to exacerbate both symptoms and hyponatremia?

For example, would you consider alternatives to paracentesis (Denver shunt placement, CART therapy, or permanent tunneled catheters) that might better...