In this episode, I’ll discuss the dose–response of intravenous calcium in surgical ICU patients. Subscribe on iTunes, Android, or Stitcher How much does the ionized calcium value of a patient with hypocalcemia change when given a replacement dose of IV calcium? A group of authors published a retrospective cohort study in the International Journal of […]

In this episode, I’ll discuss why the administration of glucose without thiamine might precipitate or worsen Wernicke’s encephalopathy. Subscribe on iTunes, Android, or Stitcher Wernicke-Korsakoff syndrome is actually a combination of 2 different syndromes, both the result of severe thiamine deficiency. Wernicke’s encephalopathy is an acute disorder that has significant mortality and neurologic morbidity associated with […]

In this episode, I will discuss how I would treat Wernicke’s Encephalopathy if I were completely out of IV thiamine. Subscribe on iTunes, Android, or Stitcher Wernicke’s encephalopathy is an acute disorder that has significant mortality and neurologic morbidity associated with it.  Usual treatment for Wernicke’s involves high doses IV thiamine. At the time of […]

In this episode, I’ll discuss an article about clinical outcomes when dexmedetomidine is given to patients who have agitation from drug overdose or withdrawal. Subscribe on iTunes, Android, or Stitcher Dexmedetomidine fills a crucial role in the management of agitated patients given that it usually provides sedation without interfering with respiratory function. It is frequently […]

In this episode, I’ll discuss delayed QTc prolongation in overdose patients. Subscribe on iTunes, Android, or Stitcher   Patients who present to the ED with acute drug overdose and a QTc above 500 msec are known to have an increased risk of adverse cardiac event and are therefore proactively monitored for this development. However some […]

In this episode, I’ll discuss when to use octreotide for upper GI bleeding. Subscribe on iTunes, Android, or Stitcher Octreotide is a long-acting analog of somatostatin. It inhibits the release of many endocrine peptides including insulin and glucagon. In addition, it inhibits the release of gastric acid.  Because glucagon is a vasodilator, octreotide indirectly decreases […]

In this episode, I’ll discuss an article about the storage and safety of hypertonic saline. Subscribe on iTunes, Android, or Stitcher One of the oldest systems-based efforts to improve patient safety in hospitals has been to control the storage and administration of concentrated electrolytes. The greatest focus since the 1980s was on removing concentrated potassium […]

In this episode, I’ll discuss famotidine as a potential cause of delirium. Subscribe on iTunes, Android, or Stitcher Depending on which meta-analysis you read, famotidine is an option for stress ulcer prophylaxis in ICU patients. However, famotidine also has the potential to cause CNS related side effects and carries the warning: Central nervous system (CNS) […]

In this episode, I’ll discuss recommendations on the dose of cefazolin for a CNS infection. Subscribe on iTunes, Android, or Stitcher When a CNS infection such as meningitis, ventriculitis, or a brain abscess is due to methicillin susceptible staph aureus, an antistaphylococcal penicillin such as nafcillin has been considered the first-line therapy. With the long […]

In this episode, I’ll discuss a web-based program to estimate vancomycin AUC from a single trough value. Subscribe on iTunes, Android, or Stitcher Vancomycin guidelines published in March of 2020 have recommended AUC based monitoring over trough-based monitoring due to a reduction in AKI events when AUC based monitoring is used. However, methods to dose vancomycin […]

In this episode, I’ll discuss oral antihypertensive timing for hypertensive urgency. Subscribe on iTunes, Android, or Stitcher A hypertensive urgency is defined as a SBP reading of ≥180 mm Hg or DBP reading of ≥120 mm Hg without the presence of any end organ damage (such as but not limited to stroke, pulmonary edema, NSTEMI, […]

In this episode, I’ll discuss the therapeutic monitoring of cefepime to avoid neurotoxicity. Subscribe on iTunes, Android, or Stitcher Cefepime has the potential to cause severe neurotoxicity including seizures, myoclonus, or encephalopathy. The incidence of this neurotoxicity is variable however the risk is increased with excessive dosing or decreased clearance from renal impairment. Because high […]