In this episode, I’ll discuss what blood gas parameters can make you suspect methemoglobinemia. Episode 920: What blood gas parameters indicate possible methemoglobinemia? Subscribe on iTunes, Android, or Stitcher Methemoglobin is formed when the ferrous irons of heme are oxidized to the ferric state. The ferric hemes of methemoglobin are unable to bind oxygen, therefore, causing a functional anemia. Acquired methemoglobinemia is typically a reaction to medications. The most common medications that cause this reaction are benzocaine, prilocaine, lidocaine, and dapsone. The signs of m ..read more

In this episode, I’ll discuss why glucocorticoids have no role in reversing the acute symptoms of anaphylaxis. Episode 899: Glucocorticoids Have No Role Reversing the Acute Symptoms of Anaphylaxis. Here's Why: Subscribe on iTunes, Android, or Stitcher Despite epinephrine clearly being recommended as the first line of treatment for an acute episode of anaphylaxis, glucocorticoids continue to be given by many providers. The mechanism of action for glucocorticoids is to form a complex with receptors on cell membranes, translocate this complex to the nucleus, and inhibit the production of new infl ..read more

In this episode, I’ll discuss whether ICU patients benefit from daily QTc interval monitoring during antipsychotic use for delirium. Episode 897: Is It Necessary To Monitor QTc of ICU Patients Receiving Antipsychotics for Delirium? Subscribe on iTunes, Android, or Stitcher QTc prolongation is a known side effect of antipsychotic use. While the QTc itself is only a number on a sheet of paper, a prolonged QTc is often used as a surrogate marker for an increased risk of torsades. Therefore daily monitoring of the QTc interval is frequently suggested when ICU patients are started on antipsychotics ..read more

In this episode, I’ll discuss how correction of hypokalemia in a hyponatremic patient makes inadvertent overcorrection of hyponatremia more likely. Episode 894: Correction of hypokalemia in a hyponatremic patient makes inadvertent overcorrection of hyponatremia more likely Subscribe on iTunes, Android, or Stitcher Shout out to “Pharmacy Alex” for inspiring this episode! During the correction of hyponatremia, care is taken to not correct the serum sodium too quickly. This is because the over-correction of sodium levels carries a risk of osmotic demyelination and permanent brain damage. The reco ..read more

In this episode, I’ll discuss when to use a cold or warm compress to treat extravasation. Episode 892: Should hot or cold compresses be used to treat extravasation? Subscribe on iTunes, Android, or Stitcher Extravasation is a complication of IV therapy that refers to the infiltration of tissues with a medication that is an irritant or vesicant. The only difference between infiltration and extravasation is that the former is done with therapeutic intent (such as lidocaine for local anesthesia) and the latter is an unintended event with a harmful medication. Nonpharmacologic treatment of extrava ..read more

In this episode, I’ll discuss whether standard doses of apixaban are as effective as warfarin in severe obesity. Episode 912: Are Standard Doses of Apixaban as Effective as Warfarin in Patients With Severe Obesity? Subscribe on iTunes, Android, or Stitcher Initial studies for apixaban such as ARISTOTLE had a median weight of 82 kg and did not focus on determining efficacy in a severely obese patient population. Because of the lack of inclusion of patients with a BMI 40 and above in the initial approval studies for apixaban, many clinicians avoided use, and guidance statements by professional o ..read more

In this episode, I’ll discuss how to guarantee you pick a great article for the journal club. Episode 890: How to Succeed at Journal Club Without Really Trying Subscribe on iTunes, Android, or Stitcher There are two important criteria that are essential to fulfill when presenting an article to a journal club: 1. The article should be of high quality 2. The article should be relevant to clinical practice When an article meets these criteria, all parties at the journal club should benefit. Preceptors and other Health Care Providers benefit from being exposed to high-quality articles they may not ..read more

In this episode, I’ll discuss the risk of bacteremia in patients with asymptomatic bacteriuria and altered mental status. Episode 911: But They Have Altered Mental Status So We Have To Treat Subscribe on iTunes, Android, or Stitcher Perhaps one of the most frustrating scenarios dealing with antimicrobial stewardship is that of a patient with asymptomatic bacteriuria (meaning no systemic signs of infection) but altered mental status. Many clinicians will still want to treat with antibiotics in this case, despite IDSA guidelines giving a strong recommendation to assess “for other causes [of alte ..read more

In this episode, I’ll discuss how to judge whether a journal is reputable. Episode 910: How to judge whether a journal is reputable? Subscribe on iTunes, Android, or Stitcher There are dozens of well-established journals that when we read an article in them, the thought never comes to mind “Is this journal reputable?” But there are also journals with little or even no peer review, low or non-existent academic standards, and scant credibility that exist only to collect author fees from unsuspecting researchers. Here are some ways that an unknown journal can be evaluated to decide whether or not ..read more

In this episode, I’ll discuss how fluid overload affects the pharmacokinetics of extended infusion meropenem in critically ill patients with sepsis. Episode 888: The Effects of Fluid Overload On the Pharmacokinetics of Extended Infusion Meropenem in Critically Ill Patients with Sepsis Subscribe on iTunes, Android, or Stitcher Therapeutic monitoring of beta-lactams has not yet reached everyday practice in most hospitals, owing both to a lack of data and a lack of in-house test results that would be available in a practical timeframe. Researchers recently published in the journal Critical Care a ..read more