Saturday, January 24, 2015

ASN Quiz and Questionnaire 2014: Acid-Base and Electrolyte Disorders

CJASN just published two answers to the Electrolyte quiz from ASN Kidney Week, unfortunately they have the answers right next to the questions, so you can't take the test honestly, Here are the questions, without the answers. Get the article here.

Case 1: Mitchell H. Rosner (Discussant)
A 60 year-old man with a history of a heart transplant and stage 4 CKD was diagnosed with a gout flare 6 days ago and was prescribed prednisone, 30 mg daily; allopuri- nol, 100 mg daily; and colchicine, 0.6 mg three times daily, for the first 2 days and then colchicine, 0.6 mg twice daily thereafter. Before the gout attack, the patient had been feel- ing well and his baseline creatinine was 2.9 mg/dl with an eGFR of 29 ml/min per 1.73 m2. Other medications in- cluded mycophenolate mofetil, cyclosporine, pravastatin, carvedilol, calcitriol, and furosemide.
After 48 hours of taking the allopurinol, colchicine, and prednisone, the patient developed nausea, intermit- tent vomiting, and profuse diarrhea. This continued in- termittently over the next 2 days. However, during the past 2 days, he has developed worsening lethargy; muscle aches; and continued nausea, diarrhea, and abdominal pain. His family brings him to the emergency depart- ment (ED).
In the ED, he was found to be confused, tachycardic, and hypotensive, with a BP of 76/42 mmHg and pulse of 120
beats/min. He then sustained respiratory arrest and was successfully intubated; he was also started on vasopressin, norepinephrine, and intravenous fluids to support his BP. Laboratory results at the time of admission are shown in Table 1.

Question 1a
The acid-base abnormality in this patient is:
     A. Aniongapandnon–aniongapacidosis
     B. Respiratoryacidosisandaniongapacidosis
     C. Respiratoryalkalosisandaniongapacidosis
     D. Respiratory acidosis and anion gap and non–anion gap acidosis
     E. Respiratory alkalosis and anion gap and non–anion gap acidosis 

Question 1b
Which of the following drug interactions were likely responsible for the patients presentation?
     A. Allopurinol,pravastatin,andmycophenolatemofetil 
     B. Allopurinol,pravastatin,andcyclosporine
     C. Colchicine,allopurinol,andmycophenolatemofetil
     D. Colchicine,pravastatin,andcyclosporine 
     E. Colchicine,prednisone,andpravastatin 

Case 2: Mitchell H. Rosner (Discussant)
A 37-year-old woman with a 3-year history of severe sinus disease and headaches is referred to you after several laboratory abnormalities were found. Her medical history is significant for two episodes of nephrolithiasis (no stone analysis was per- formed). On questioning she notes that pain and redness develop in her hands in cold weather. She takes no medications except for occasional antibiotics for her sinus problems. Her BP is 108/50 mmHg and her physical examination is unremarkable except for some fullness over her parotid glands. Her laboratory studies are shown in Table 2. On further questioning, she reports no drug abuse.

Question 2a

Which one of the following laboratory tests would you order next?
     A. Serumandurineproteinelectrophoresis 
     B. Plasmareninandaldosteronelevels
     C. 24-hoururinecortisol
     D. Stool screen for laxative abuse
     E. Anti-SSA,Anti-SSBserologies 

Aggressive intravenous potassium chloride and oral potas- sium citrate supplementation are administered. Laboratory tests repeated 1 week later reveal the following: potassium, 3.5 mEq/L; bicarbonate, 15 mEq/L; and anion gap, 6. The patient is seen by a neurologist for her chronic headaches, and topiramate, 200 mg daily, is started.

Question 2b
Which of the following changes would be expected if lab- oratory work was repeated several weeks after initiation of topiramate?
    A. Potassium,2mEq/L; bicarbonate, 5mEq/L; aniongap,8 
    B. Potassium,4mEq/L; bicarbonate, 20mEq/L; aniongap,8
    C. Potassium, 4 mEq/L; bicarbonate, 5 mEq/L; anion gap, 15 
    D. Potassium, 2 mEq/L; bicarbonate, 5 mEq/L; anion gap, 15
    E. Nochangeinelectrolytesfrompriorvalues 

Tuesday, January 13, 2015

What am I going to do with all of these draft posts?

I have been blogging at PBFluids since 2008 and have 737 posts. What has been slowly growing is the number of unpublished drafts. Mostly this is clever ideas not fully realized like this evocative title:

There are others that if published would be career suicide like my completely overly honest reviews of the ASN Board review with letter grades for each of the speakers. The GPA was 3.7 but there were some clunkers in the mix:

The number of drafts is as of now 70 posts. I am going to try to salvage some of these posts and put them on the blog.

The first is a post titled "Epic ASN Post" This is from Kidney Week 2011. The post was written 12/1/11.

Landed in Philly and went to the AirBnB room I found. Seventy-five bucks a night and only a mile from the conference center. Awesome!

FourSquare, remember when that was a thing? 



Monday, January 12, 2015

ASN #NephWorkForce TwitterChat on Tuesday January 13 at 9pm EST

Mark Parker, the chair of the ASN Workforce Committee, will be on Twitter next Tuesday to discuss the latest report. This report is the second done by Ed Salsberg and his colleagues at GWU. This report is all about the fellow experience in getting a job.

The report is available here.

Dr. Parker answered some questions to stoke the fires of discussion, that interview can be seen on Medium.

ASN Nephrology Workforce Report

The first workforce report stimulated some discussion on Twitter, that discussion is saved here:

A summary of the discussion about the second report so far is available here:

My summary of the report:

  • The survey was distributed to 1,530 ASN Nephrology fellow and trainee members in June and July of 2014.
  • 441 responded. Response rate of 28.8%.
  • There are 930 fellows in ACGME accredited programs and they received 333 responses from this sub-group. 
  • What is up with the 600 trainees not in ACGME spots? DO programs?
Interesting gender differences:
How about this eye opening stat:
USMGs had a median debt of $100,000 to $149,999. IMGs were significantly different with a median debt of $0 and 65% having no debt.

Career plans

Nephrology breaking barriers, has higher starting salaries for women compared to men:
Female respondents had a slightly higher median anticipated base income than male respondents, who had a median anticipated base income of $150,000 to $174,999.
Job hunting troubles were much more common among IMGs with only 22% finding a satisfactory job compared to 56% of USMGs. Visa problems and unappealing locations were leading problems in job hunting. 71% reported no or very few jobs within 50 miles of their training location.

Happily 72% of respondents indicated they would recommend nephrology to medical students and internal medicine residents.

It's an interesting report, take a look and...
Please join Dr. Parker to talk about #NephWorkForce Tuesday, January 13 at 9pm
Related Posts Plugin for WordPress, Blogger...