Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
Do you reduce the steroid regimen for patients with acute interstitial nephritis who have a high risk for developing side effects from glucocorticoid therapy?
No, generally not. AIN needs adequate treatment that isn't that long anyway. You could not treat and just stop the offending drug, but the long-term outcome is worse. I think you just need to treat and then taper.
Would you anticoagulate an SMV thrombosis caused by malignant obstruction in the setting of metastatic colorectal cancer?
Superior Mesenteric Vein Thrombosis is a rare phenomenon, within the category of Splanchnic thrombosis. While portal vein thrombosis is most often associated with cirrhosis (though also seen in many patients without cirrhosis), SMV thrombosis is more commonly seen in the context of either local prov...
What are some indications that might lead you to pursue a kidney biopsy in a patient with presumed diabetic kidney disease?
Rapid deterioration of kidney function Rapid worsening of proteinuria especially if there is severe nephrosis, hypoalbuminemia with edema Active nephritic pattern of kidney injury Virtually any other glomerulonephritis can happen on a background of diabetic nephropathy. So when suspicion for anothe...
Do you find adding fludrocortisone helpful in treating persistent hypotension in HD patients already on midodrine and without evidence of adrenal insufficiency?
That is not my practice. I doubt it would be helpful.
How do you determine if a pyoderma gangrenosum lesion is “burned out"?
The first sign is it becomes much less exudative.
Do you correct the synovial fluid white blood cell count for red blood cells, and if so, is there a rough approximation/equation you use?
In a rheumatology practice, under most circumstances, there is no need to make a correction of the synovial fluid white blood cell count. The fluid is either translucent, transparent, or opaque and the count will help to establish the presence or absence of an infectious or inflammatory process and ...
Do you use steroids in the management of PJP pneumonia with severe hypoxia in HIV negative patients?
I only saw about 4 (non-HIV) patients with PJP before AIDS hit the US in 1981. Like others caring for AIDS patients in the 1980s, PJP was incredibly common I saw at least 200 cases over the years. Until AIDS, there were never enough non-HIV patients to do a RCT to look at steroids. Thanks to the wel...
Do you prefer cinacalcet or etelcalcetide for patients with hyperparathyroidism in the setting of kidney disease?
In a group of vintage ESKD patients, assuming compliance is not an issue and hypocalcemia handled and Parsabiv utilized when approved, PTH still not controlled often. Over few thousands. The main reason is that the parathyroid hyperplasia turns to be nodular and encapsulated. And it’s time for surgi...
Are adults with IDD at increased risk for adverse events like NMS or central anticholinergic syndrome?
Thanks so much for your question. There is no doubt that individuals with IDD may often exhibit aberrant behaviors including those with autism. The use of various psychopharmacologics is very prevalent. The risks of side effects and particular complications is certainly higher in this cohort. Check ...
How would you interpret a temporal artery biopsy demonstrating focal chronic inflammation in the adventitia associated with small adventitial vessels and nerves without inflammation of the intima and media and without giant cells?
Peri-adventitial inflammation seen in temporal artery biopsies is generally a non-specific finding. This was demonstrated nicely in a recent histopathological study from Mayo Clinic evaluating temporal artery samples from autopsy cases. Over 40% of temporal arteries from older individuals (with no h...