Wednesday, January 8, 2014

Fluid and Electrolyte Curriculum for Residency

I give monthly lectures to the residents at three hospitals. I bill the lectures as a comprehensive, year-long, fluid and electrolyte course. I have never established a fixed curriculum for the lectures, here is one take:
  1. Body water, IV fluids and diuretics
  2. Rapid interpretation of ABGs
  3. Acute Kidney Injury
  4. Osmoregulation and hyponatremia
  5. Hypernatremia
  6. Anion Gap metabolic acidosis
  7. Potassium
  8. Metabolic alkalosis and hypokalemia
  9. Non-anion gap metabolic acidosis
  10. Calcium and phosphorous and metabolic bone disease
  11. Electrolyte emergencies
  12. Board review practice
The curriculum starts with the basic mechanics that interns need to function in the hospital. How to order IVs, and intelligently use diuretics. This includes a review of body fluid compartments so that it is not just practical pearls but is based on physiologic foundation.

Electrolyte emergencies is a lecture that is not entirely written and needs to be. It would be a practical handbook style lecture to walk interns and residents through what I think is the best way to handle: metabolic acidosis and alkalosis, hypo- and hypernatremia, hypo- and hyperkalemia, hypo- and hypermagnasemia, hypo- and  hypercalcemia.

The introductory curriculum ends with the rapid interpretation of ABGs. After that I turn the intensity up a bit and focus on more physiologic based and less practical aspects of electrolytes. This allows deep dives on metabolic acidosis with separate lectures on anion and non-anion gap. I separate out metabolic alkalosis and potassium to provide time to do a deep dive on the monogenic causes of hypertension.

The board review session is a quiz session to review all the concepts of the year.
I have one spare month because a lecture always gets lost along the way.

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