Adjuvant metolazone (zaroxalin) in loop diuretic refractory patients
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - March 26, 2019 Category: Internal Medicine Tags: nephrology pharmacology Source Type: blogs

MKSAP: 68-year-old man with heart failure
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old man is evaluated at a follow-up appointment. He has a 7-year history of heart failure secondary to ischemic cardiomyopathy. Over the past 6 months, he has had three hospitalizations for exacerbations of his heart failure. He currently has exertional dyspnea while getting dressed, and his maximal activity level is limited to riding to the store with his wife but staying in the car. Medical history is significant for disseminated prostate cancer treated with androgen deprivation therapy. Medi...
Source: Kevin, M.D. - Medical Weblog - July 7, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Source Type: blogs

Things that Bug me 1 – improper use of diuretics
This month on our VA ward team we have had 3 admissions that involved complications of over diuresis for systolic dysfunction.  We also see patients who do not have adequate diuresis. Diuretics greatly help symptoms in patients with systolic dysfunction and volume overload.  But diuretics are primarily symptom relief medications. I often ask students and residents to write this sentence, memorize it, and use it: The purpose of diuretic therapy in systolic heart failure is render the patient not wet, but not to make the patient dry. The idea here is that we should only give enough diuretic therapy to relieve sympt...
Source: DB's Medical Rants - December 22, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

The importance of listening to the patient before we develop our plans
Around 30 years ago, LRZ taught me a most important lesson.  LRZ, one of my most fondly remembered patients, was a classic blue collar guy.  He had a wonderful, gregarious personality.  He had significant systolic dysfunction, yet still worked hard for the city.  Amongst other things he did, he shoveled the salt into trucks on snow and ice days.  He functioned well most days. One day he came to see me.  In those days, prior to ACE inhibitors or the use of beta blockers, we focused on digoxin and diuretics.  As I picked up his chart I noted that he had gained 3 pounds.  From past expe...
Source: Kevin, M.D. - Medical Weblog - July 13, 2016 Category: Journals (General) Authors: Tags: Conditions Nephrology Source Type: blogs

Listening to our patients
Around 30 years ago, LRZ taught me a most important lesson.  LRZ, one of my most fondly remembered patients, was a classic blue collar guy.  He had a wonderful gregarious personality.  He had significant systolic dysfunction, yet still worked hard for the city.  Amongst other things he did, he shoveled the salt into trucks on snow and ice days.  He functioned well most days. One day he came to see me.  In those days, prior to ACE inhibitors or the use of beta blockers, we focused on digoxin and diuretics.  As I picked up his chart I noted that he had gained 3 pounds.  From past exper...
Source: DB's Medical Rants - June 21, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

I’m a stickler about words. And here’s why.
It’s metoprolol. m-e-t-o-p-r-o-l-o-l The nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metolazone, and the difference could be life altering. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 9, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Upstream Problems
He had been through this before. The patient, a 57-year-old man, had come through the doors of this emergency department many times. He had a favorite seat in triage. He knew what questions the nurse would ask him once he was in a room, and that the doctor would repeat those same questions. Then tests and labs, then moved upstairs for a couple of days before going home, hopefully feeling better. He knew all of this. Today, though, everything he thought he knew was wrong. He had once considered himself lucky. He even survived a gunshot to the chest as a young man. But that notion had faded long ago. His health had been gett...
Source: Spontaneous Circulation - May 12, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Upstream Problems
He had been through this before. The patient, a 57-year-old man, had come through the doors of this emergency department many times. He had a favorite seat in triage. He knew what questions the nurse would ask him once he was in a room, and that the doctor would repeat those same questions. Then tests and labs, then moved upstairs for a couple of days before going home, hopefully feeling better. He knew all of this. Today, though, everything he thought he knew was wrong. He had once considered himself lucky. He even survived a gunshot to the chest as a young man. But that notion had faded long ago. His health had been get...
Source: Spontaneous Circulation - May 12, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs