Nephrology

Critical Care

Questions discussed in this category

How do you weigh the benefit of urinary catheter placement for strict I/O measurement with the risk of avoidable CAUTI?

How does your approach vary by indication (critical illness, acute renal failure, hyponatremia, diuresis, etc.)?

1 Answer available

Are there instances when you recommend central line access when treating a patient using 3% sodium chloride for management of severe hyponatremia?

2 Answers available

Do you recommend careful correction of serum sodium to avoid osmotic demyelination syndrome in patients who are found to have isoosmolar hyponatremia in the setting of an elevated BUN level?

2 Answers available

How do you recommend incorporating B-lines on lung POCUS as part of evaluating a patient's volume status?

In particular, how do you reconcile situations where lung POCUS findings contradict other components of volume assessment (e.g. JVD, peripheral edema,...

1 Answer available

In a patient with severe hyponatremia and acute kidney injury in the setting of hypovolemic shock, would fluid resuscitation take precedence over the rate at which sodium is corrected?

3 Answers available

What strategies do you find helpful in advanced care planning with patients/families who are very "miracle" centered?

For example, prolonging life-sustaining measures as they "wait for a miracle" of an unrealistic outcome.

1 Answer available

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?

1 Answer available

Are there instances when you recommend initiation of hemodialysis for patients with severe symptomatic hypercalcemia?

2 Answers available

Has your management of severe hyponatremia changed after a recent observational study described higher in-hospital mortality for sodium correction of <6 mEq/L compared to 6-10 mEq/L in the first 24 hours?

Seethapathy et al., PMID 38320180

5 Answers available

Would you recommend starting tolvaptan at 7.5 mg per day, which is half the typical starting dose, to reduce the risk of overcorrection in an inpatient with SIADH and a serum sodium level of 122 mEq/L?

3 Answers available

In a patient with acute stroke/ICH/SDH/hyperammonemia at risk for rebound edema with new onset renal failure, do you prefer CRRT versus low and slow HD?

How frequently do you monitor osmolarity?

1 Answer available

How do you decide on the speed and target of blood pressure reduction for spontaneous intracranial hemorrhage?

4 Answers available

Do you recommend automatically starting CRRT anticoagulation when initiating CRRT if there are no medical contraindications to anticoagulation?

2 Answers available

Do you routinely use 3% sodium chloride and desmopressin to correct hypovolemic hyponatremia in an asymptomatic patient with serum sodium of less than 120 mEq/L?

3 Answers available

What are some important considerations for use of ACE inhibition in scleroderma renal crisis patients who require dialysis?

For example, is captopril dialyzable?

1 Answer available

What is your blood pressure or mean arterial pressure goal in a critically ill patient with acute kidney injury?

1 Answer available

What strategies do you use to prevent overcorrection of serum sodium in patients with severe hyponatremia and adrenal insufficiency when initiating glucocorticoid therapy?

1 Answer available

Do you administer calcium to patients with K > 6.5 without EKG changes?

3 Answers available

How do you adjust your management strategy to address the unique needs of anuric end-stage kidney disease patients when treating diabetic ketoacidosis?

1 Answer available

For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?

1 Answer available

How would you manage immune check point inhibitor induced capillary leak syndrome refractory to IVIG monotherapy?

1 Answer available

Papers discussed in this category

The American journal of medicine, 2016-05

Diagnosing and Treating the Syndrome of Inappropriate Antidiuretic Hormone Secretion.

Clinical journal of the American Society of Nephrology : CJASN, 2018-07-06

Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia.

Journal of critical care, 2023 May 13

Effects of correction rate for severe hyponatremia in the intensive care unit on patient outcomes.

The Journal of urology, 1992-06

Functional obstructive uropathy: a significant factor in the hyponatremia of psychogenic polydipsia?

American journal of kidney diseases : the official journal of the National Kidney Foundation, 2013-04

Hypertonic saline and desmopressin: a simple strategy for safe correction of severe hyponatremia.

Kidney Med, 2020 Jan-Feb

Equivalent Efficacy and Decreased Rate of Overcorrection in Patients With Syndrome of Inappropriate Secretion of Antidiuretic Hormone Given Very Low-Dose Tolvaptan.

Annals of emergency medicine, 2006-01

Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure.

The New England journal of medicine, 2013-06-20

Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage.

The New England journal of medicine, 2016 Jun 08

Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage.

The New England journal of medicine, 2024 May 16

Intensive Ambulance-Delivered Blood-Pressure Reduction in Hyperacute Stroke.

Lancet (London, England), 2023 May 25

The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial.

The New England journal of medicine, 2021 Mar 04

A Randomized Trial of Albumin Infusions in Hospitalized Patients with Cirrhosis.

The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses, 2017 Jun

Complication Rates of 3% Hypertonic Saline Infusion Through Peripheral Intravenous Access.

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2018 Mar 01

Association between continuous peripheral i.v. infusion of 3% sodium chloride injection and phlebitis in adults.

American journal of critical care : an official publication, American Association of Critical-Care Nurses, 2016 Dec

Safety of Continuous Peripheral Infusion of 3% Sodium Chloride Solution in Neurocritical Care Patients.

The Journal of emergency medicine, 2019 Feb 08

Safety of Peripheral Line Administration of 3% Hypertonic Saline and Mannitol in the Emergency Department.

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