pseudo-pseudohyperaldosteronism

I have primary amenorrhea.



...and this guy has two of them.

ER v IM

As always, sodium at root of these battles.

I went on vacation and gave a lecture

My family took a vacation to Chicago and a friend asked if I could give an acid-base lecture. So I dropped  in as an electrolyte sharpshooter and delivered my non-anion gap metabolic acidosis lecture. The revised lecture is in the usual place.

The biggest linked transplant to date

Make sure you don't miss the Wonderful story of Chain 124 and the National Kidney Registry form Sunday's New York Times.

She came from a land down under...

Today I had a new patient from Australia, she came in with a few years worth of laboratory results all in SI units.

I knew how to convert mmol/L of creatinine to mg/dl: divide by 88. But converting mmoles/L of urea to BUN? No idea. Converting nmol/L of vitamin D to ng/ml?  Stumped.

Thank the maker for Dr. Google.

• To convert from creatinine mmol/L to mg/dL divide by 88
• To convert from mmol/l Urea to mg/dL BUN multiply by 2.8
• To convert nmol/L 25 OH Vitamin D to ng/ml divide by 2.496
• To convert mmol of creatinine to mg of creatinine (needed to interpret a 24-hour urine) multiply by the molecular weight, 113

Hat tip to Wikipedia, Dr. Shah at AllExperts and GlobalRPh

Useful online tool: PDF2JPG

Convert PDFs to a series of JPGs with this free online tool. Cleverly called PDF2JPG.

Kidometer is creeping up on one point oh!

If you are interested in testing out the beta of Kidometer for iPhone please drop me a line. We are up to 0.6x and are recruiting a beta army. Check out the teaser page: kidometer.com.

Citrate or Heparin for CRT

As part of my other blogging job (eAJKD) I had the opportunity to interview Drs. Mei-Yi Wu and Ka-Wai Tam who performed a meta-analysis looking at anticoagulation. They examined filter life and other complications of CRT. The interview was conducted by Facebook IM, which was pretty cool and helpful with a significant language and time-zone barrier.

Check out the interview and the article.

By the way Jhaveri, Sparks and the rest of the team have been killing it at eAJKD and have really built a solid blog. Amazing how far they have come in a couple of months. Solid work.

Metabolic Alkalosis: the lecture. Updated

Just gave the metabolic alkalosis lecture. Turned out pretty good. The lecture was about 50 minutes.

Keynote | PDF

Updated: Now with less errors.

Don Seldin, Licorice, and the New York Times. Updated x2

The association of licorice, hypokalemia and hypertension is a medical pearl that delights me even though I have never seen a convincing case. However, Ted Lynch had a case in 1987 and presented it to Don Seldin, one of the Gods of nephrology (pdf). The interaction was documented in the New York Times for some reason. It is a well written story.

For those of you fuzzy on the connection between licorice, hypokalemia and hypertension this post by Neil Kurtzman (one of Seldin's protégées) does a beautiful job explaining it.

And yes, I am working on a metabolic alkalosis lecture.

Update: Here is the FDA warning regarding licorice that was published October 2011 and here is the skinny on American licorice from the good people at Hershey:

Traditionally, "licorice candy" referred to a chewy candy with a distinctive flavor which came from licorice root extract. Today, consumers recognize licorice more as a general description of candy that may be available in a variety of flavors. 

Not all of today's licorice-type candies are flavored with licorice root extract. Some licorice-flavored candies may be flavored with anise oil instead of licorice extract. Other fruit-flavored candies may be commonly referred to as licorice candy, but do not contain any licorice extract. For example, while people may consider all TWIZZLERS Candy to be licorice candy, the strawberry, chocolate, and cherry-flavored TWIZZLERS Candy do not contain licorice extract. TWIZZLERS Black Licorice Candy is flavored with both licorice extract and anise oil. 

Those licorice candies which contain licorice root extract will typically declare either "licorice extract" or "licorice root extract" as an ingredient on the package.

Hat tip to pkovachmd

Update 2: Here is the link from Melanie regarding the unsuccessful suit involving over-indulgance in licorice and hypokalemia.