In this episode, I’ll discuss the rare case when a very hypotonic solution may be indicated. Subscribe on iTunes, Android, or Stitcher A recent commentary published in AJHP argues for abandoning the use of extremely hypo-osmolar intravenous solutions to treat hypernatremia. The authors consider extremely hypotonic solutions to be 0.225% sodium chloride (also called one-quarter […]

In this episode, I’ll discuss oral vs IV phosphate replacement for critically ill patients with mild to moderate hypophosphatemia. Subscribe on iTunes, Android, or Stitcher IV phosphate is frequently used to replace low serum phosphate levels in critically ill patients. However this often requires the administration of significant amounts of IV fluid, which can complicate […]

In this episode, I’ll discuss the efficacy tradeoff when reducing apixaban dose in patients with end-stage renal disease. Subscribe on iTunes, Android, or Stitcher The prescribing information for apixaban recommends not reducing the dose when being used in patients with end-stage renal disease and atrial fibrillation. However, renal elimination accounts for 27% of apixaban clearance. […]

In this episode, I’ll discuss whether standard doses of apixaban are as effective as warfarin in severe obesity. Subscribe on iTunes, Android, or Stitcher Initial studies for apixaban such as ARISTOTLE had a median weight of 82 kg and did not focus on determining efficacy in a severely obese patient population. Because of the lack […]

In this episode, I’ll discuss the risk of bacteremia in patients with asymptomatic bacteriuria and altered mental status. Subscribe on iTunes, Android, or Stitcher Perhaps one of the most frustrating scenarios dealing with antimicrobial stewardship is that of a patient with asymptomatic bacteriuria (meaning no systemic signs of infection) but altered mental status. Many clinicians […]

In this episode, I’ll discuss how to judge whether a journal is reputable. Subscribe on iTunes, Android, or Stitcher There are dozens of well-established journals that when we read an article in them, the thought never comes to mind “Is this journal reputable?” But there are also journals with little or even no peer review, […]

In this episode, I’ll discuss a novel metric for antibiotic stewardship. Subscribe on iTunes, Android, or Stitcher Days of Therapy (DOT) is probably the most common metric to track antimicrobial stewardship efforts related to antibiotic consumption. DOT is not a perfect metric as it is calculated by calendar day regardless of the number of doses […]

In this episode, I’ll discuss the consolidated CHEST guidelines on antithrombotic therapy for venous thromboembolism disease. Subscribe on iTunes, Android, or Stitcher The CHEST guidelines on venous thromboembolism disease are an invaluable resource, but one flaw that has persisted since 2016 has made referencing the guidelines awkward and inconvenient. When the 1st updated to the […]

In this episode, I’ll discuss what predicts critical care pharmacist intervention – patient acuity or medication regimen complexity? Subscribe on iTunes, Android, or Stitcher It makes intuitive sense that both scenarios of high patient acuity and high medication regimen complexity would be legitimate ways of identifying ICU patients who are more likely to need pharmacist […]

In this episode, I’ll discuss the mortality rate for critically ill patients when ketamine vs etomidate is used as an induction agent for intubation. Subscribe on iTunes, Android, or Stitcher Out of the available induction agents for intubation, ketamine is considered to have the best cardiovascular risk profile, as it typically has a neutral to […]

In this episode, I’ll discuss which antibiotic should be given first in sepsis – the beta-lactam or the vancomycin? Subscribe on iTunes, Android, or Stitcher Quickly administering appropriate empiric antibiotic therapy is essential in the treatment of severe infections. If multiple antibiotics are required for empiric therapy to treat a severe infection (such as for […]

In this episode, I’ll discuss whether patients taking beta-blockers require increased doses of epinephrine for anaphylaxis. Subscribe on iTunes, Android, or Stitcher Animal data suggests that patients taking beta-blockers have more severe anaphylaxis, possibly by decreasing the threshold for mast cell activation. With beta-blockers interfering with the same receptors epinephrine needs to activate in order […]