#NephJC Transcript
Healthcare social media transcript of the #NephJC hashtag.
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See #NephJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Nephrology Journal Club @NephJC Here we go! #nephjc |
| Nephrology Journal Club @NephJC As always Please introduce yourself & declare any conflicts of interest (COIs), also we all do it, but don’t forget the hashtag #NephJC |
 | Michelle Rheault @rheault_m RT @hswapnil: Excellent tweetorial for tonight’s #NephJC Happening in 3 minutes |
 | Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD Hi! Diana here, private practice nephrologist in Dallas. Getting caught up on rest after an exciting #NKFClinicals in Boston. Ready to discuss how to treat hypernatremia. No COI #NephJC |
 | Nathaniel Reisinger @nephrothaniel Nathaniel #nephjc no COI |
 | Mya Htwe Nge @mhtwenge Hi, Mya from 🇲🇲, no COI, lurking #NephJC |
 | Arshad Ali @aldorenin @NephJC @bthomas215 Hi . Arshad Ali Clinical Nephrology, Michigan No COI, #NephJC |
 | Edgar V. Lerma 🇵🇭 @edgarvlermamd Edgar Lerma, Chicago-based Nephrologist #NephJC Photo Credit: Barry Butler Photography 📸 https://t.co/eWMVI6KFon https://t.co/dDH3gszQ0a |
 | James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC James Novak, @HFNephrology TPD and #NSMC intern ‘18. COI: I’m an anti-salter. #NephJC |
 | Swapnil Hiremath @hswapnil@bsky.social @hswapnil Swapnil Hiremath Not a salt whisperer Nephron from @OttawaHospital #nephjc Pic by @rolandbastphoto https://t.co/q8W9XFGmQu |
 | L. Parker Gregg @LParkerGregg1 Hi everyone! Parker Gregg, nephrologist in Dallas. No COI. #nephjc |
| Michelle Rheault @rheault_m @NephJC Michelle here. PedNeph. Kids get hyponatremia too. Wonder if results are different in little brains. COI in bio. #NephJC |
 | Steven Coca @scoca1 #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil Senior author in house #NephJC |
| Nephrology Journal Club @NephJC Great to see @nephrothaniel @edgarvlermamd, @hswapnil , @rheault_m , @LParkerGregg1 and all of you! #NephJC |
| Nephrology Journal Club @NephJC Special shout out to @scoca1, @girish_nadkarni, and @ISMMSKidney! Thanks for joining @scoca1 #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @rheault_m @NephJC Kids are definitely different in this case, right? #NephJC |
| Diana Mahbod, MD, CPE, FASN, FNKF @DiMiRenalMD RT @hswapnil: Senior author in house #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients ca. 2019 from @scoca1 @CJASN #NephJC #Nephpearls #VisualAbstract by @whatsthegfr 👉🏼 https://t.co/AAAJfvcAIs https://t.co/968kOCfGHa |
| Steven Coca @scoca1 @rheault_m @NephJC Maybe different in kids. Will not pretend to make any assumptions or extrapolations to kids with these data. #NephJC |
 | Niralee Patel, MD, MEd, FASN @nephralee @NephJC Hi everyone, I'm Niralee Patel - clinical fellow from Mount Sinai and one of the authors. It's my first time on nephJC - :) #nephjc |
 | Girish Nadkarni @girish_nadkarni Girish Nadkarni. No COI except for author on the paper #nephjc |
| Nephrology Journal Club @NephJC Welcome all! Does slow and steady always win the race? Or do we need speed in that ‘last hour’. Tonight, get behind the wheel and join us as we discuss if rate of sodium correction in hypernatremia affects clinical outcomes. https://t.co/DQTeDDnPov #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @rheault_m @NephJC I remember reading that babies used to die from infusions of 0.25% saline. Much less resilience to water toxicity. #NephJC |
 | Bhavnish @Buck1486 Greetings from Columbus, OH. Looking forward to this discussion tonight. Going to admit that I have questioned myself regarding the potential harm of rapid correction over the past 2 years. While I have seen ODS, yet to see cerebral edema. #nephjc |
 | Ian McCoy, MD, MS @NephroNinja Hi! Ian here. Neph fellow and fellow MIMIC researcher. No COI. #nephjc |
| Nephrology Journal Club @NephJC Welcome @nephralee, special shout to @girish_nadkarni another author oh it's getting good in here! #nephjc |
 | Justin Davis @jbda19 @NephJC Hi! Justin #NSMC intern. We’re in the middle of a busy transplant clinic, so more lurking for me today. Have happily corrected hypernatremia fast without concerns before after looking at the evidence available at that time. #nephjc |
| Girish Nadkarni @girish_nadkarni @NephJC @scoca1 @ISMMSKidney Girish Nadkarni here. No COI relevant to this article #NephJC |
 | Joel M. Topf, MD FACP @kidney_boy Joel Topf here on the plane home from Boston. No COI. #NephJC Co-creator. Sodium Geek. |
| Steven Coca @scoca1 @nephralee @NephJC It was actually @nephalee who inspired this whole project from when she was on service and then presented this clinical question in our clinical conf @ISMMSKidney #NephJC |
| Michelle Rheault @rheault_m @nephralee @NephJC Welcome Dr. Patel! #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @nephralee @NephJC Welcome - also @girish_nadkarni We have 3 authors in on the #NephJC chat! |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Welcome all! Does slow and steady always win the race? Or do we need speed in that ‘last hour’. Tonight, get behind the wheel and join us as we discuss if rate of sodium correction in hypernatremia affects clinical outcomes. https://t.co/DQTeDDnPov #NephJC |
 | Cathy Quinlan @CathyQuinlan.bsky.social @KidneyCathy Running to #nephjc 🏃♀️ |
 | Tiffany Caza @Tiff_Caza @NephJC Hello everyone! I'm Tiff. I'm a kidney pathology fellow and #NSMC intern (pod ⚡). No COI. Looking forward to learning! #nephjc |
 | Angel Cesar Ortiz @AngelCesarOrtiz Hi everyone. This Angel, nephrologist from 🇲🇽 No COI #NephJC |
| Nephrology Journal Club @NephJC We know @kidney_boy and @Tiff_Caza ! #NephJC |
| Girish Nadkarni @girish_nadkarni @scoca1 @nephralee @NephJC @Nephalee @ISMMSKidney Kudos to @nephralee for coming up with this clinical question! Sometimes the best research is born of a simple clinical conundrum. #NephJC |
 | Raymond Hsu @DrRaymondHsu Hi everyone! Nephrologist in SF here no COI #nephjc |
 | Eric Au @ericau @NephJC Hi everyone, Eric - nephrologist from Sydney. #nsmc intern No COI #NephJC |
 | Jay Koyner @jaykoyner Hi - Jay Koyner, Nephrologist from Chicago - No COI - here to learn about Na+ #nephjc |
| Michelle Rheault @rheault_m @kidney_boy Did you get one of those @delta flights with the promised free wifi trial? #NephJC |
| Nephrology Journal Club @NephJC Speical shout to @nephralee another author! Thanks for joining! #NephJC |
| Joel M. Topf, MD FACP @kidney_boy It’s raining authors! @scoca1 @nephralee @ girish_nadkarni ! Amazing! #NephJC |
 | Samira Farouk, MD, MSCR @ssfarouk Samira, transplant nephrologist and APD @ISMMSKidney. So proud of our chief fellow for the upcoming year and co-author on this study @nephralee #NephJC |
 | Dr. Pankaj Gote @Bindhastpankaj After long time! #nephjc |
| Michelle Rheault @rheault_m @scoca1 @nephralee @NephJC @Nephalee @ISMMSKidney That's how some of the best research gets started! #NephJC |
| Nephrology Journal Club @NephJC Check out the great summary from @aldorodrigo https://t.co/nb2kPvRXHA #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Nice review of Hypernatremia ca. 2000 from @NEJM #NephJC #Nephpearls 👉🏼 https://t.co/2lbFvUWFwH https://t.co/wqqzhIYshM |
| Nathaniel Reisinger @nephrothaniel RT @NephJC: Check out the great summary from @aldorodrigo https://t.co/nb2kPvRXHA #NephJC |
| Cathy Quinlan @CathyQuinlan.bsky.social @KidneyCathy Paed neph in Melbourne. Joining with team. No COI but generally concerned about over correction so flummoxed by this trial! #nephjc |
| Nephrology Journal Club @NephJC A wonderful VA (Visual Abstract) for CJASN done by my NSMC Class of ‘18 co-inter @whatsthegfr #NephJC https://t.co/JKDB99xsAK |
 | Matthew Sparks, MD @Nephro_Sparks Hi @nephralee good to see you at #NKFClinicals and congrats 🙌🙌 #NephJC |
| Nephrology Journal Club @NephJC But thanks to @AbaRenua, the NSMC Class of ‘19 is well represented with this amazing VA!#NephJC https://t.co/afUsO87Tod |
| Arshad Ali @aldorenin RT @NephJC: Check out the great summary from @aldorodrigo https://t.co/nb2kPvRXHA #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @KidneyCathy As @rheault_m & @scoca1 said: probably not wise to extrapolate this to kids #NephJC |
| Nephrology Journal Club @NephJC @kidney_boy as always, delivers informative slides on hypernatraemia #NephJC https://t.co/pQNIp75W7G |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: A wonderful VA (Visual Abstract) for CJASN done by my NSMC Class of ‘18 co-inter @whatsthegfr #NephJC https://t.co/JKDB99xsAK |
 | Juan Carlos Q Velez @VelezNephHepato JCVelez here, Ochsner nephrologist, COI: member of Steve Coca’s secret society #NephJC just lurking |
| Eric Au @ericau RT @NephJC: Check out the great summary from @aldorodrigo https://t.co/nb2kPvRXHA #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Treatment and limits of correction of severe Hypernatremia ca. 2015 from @NEJM #Nephpearls #NephJC 👉🏼 https://t.co/oPJLyFuAaZ https://t.co/ck5Y4BD7Rl |
| Nephrology Journal Club @NephJC T0a: No clear guidelines on sodium correction rate for hypernatremia in adults. How do you decide rate of correction in clinical practice? #NephJC https://t.co/1HYe1uQTUc |
| Girish Nadkarni @girish_nadkarni I have to admit. Its my first time on #NephJC but having a blast so far. Thanks @NephJC |
| Nephrology Journal Club @NephJC Welcome @VelezNephHepato #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @girish_nadkarni @NephJC Hope you like it enough to come back 😎#NephJC |
| Joel M. Topf, MD FACP @kidney_boy I love when the clouds look like pillows #NephJC |
| Nephrology Journal Club @NephJC T0b: Expert opinion suggest reduction rate should not to exceed 0.5 mmol/L per hour however, this is based on data in children. #NephJC https://t.co/5KeNxl2RFy |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T0b: T0b: Expert opinion suggest reduction rate should not to exceed 0.5 mmol/L per hour however, this is based on data in children. #NephJC https://t.co/5KeNxl2RFy |
| Nephrology Journal Club @NephJC T0b: Wall et al completed a 2011 study that suggested if we stick to recommended rate of 0.5 mmol/L per hour only ¼ of patients are corrected after 72 hours with 30d mortality of 37%. #NephJC |
 | Mario Funes, MD @MarioFunesMD Mario Funes. IM PGY-2 New Brunswick NJ. Lurking. Sorry I'm late but still in the hospital. #NSMC intern #NephJC |
| Nephrology Journal Club @NephJC What is your own experience, have you seen complications from correcting too slowly? #NephJC https://t.co/1DalaRZV1V |
 | Silvi Shah, MD, MS @silvishah Hi this is Silvi. Checking from Denver. No coi #nephJC |
| Michelle Rheault @rheault_m RT @NephJC: T0b: T0b: Expert opinion suggest reduction rate should not to exceed 0.5 mmol/L per hour however, this is based on data in children. #NephJC https://t.co/5KeNxl2RFy |
| Nephrology Journal Club @NephJC Hey @silvishah #nephjc |
| Nephrology Journal Club @NephJC Welcome @MarioFunesMD #nephjc |
 | James C. Fletcher, MD @jfletchermd RT @edgarvlermamd: Rate of Correction of Hypernatremia and Health Outcomes in Critically Ill Patients ca. 2019 from @scoca1 @CJASN #NephJC #Nephpearls #VisualAbstract by @whatsthegfr 👉🏼 https://t.co/AAAJfvcAIs https://t.co/968kOCfGHa |
| James C. Fletcher, MD @jfletchermd RT @edgarvlermamd: Nice review of Hypernatremia ca. 2000 from @NEJM #NephJC #Nephpearls 👉🏼 https://t.co/2lbFvUWFwH https://t.co/wqqzhIYshM |
| Arshad Ali @aldorenin RT @NephJC: But thanks to @AbaRenua, the NSMC Class of ‘19 is well represented with this amazing VA!#NephJC https://t.co/afUsO87Tod |
 | Phillip Madonia @PMNax2 @NephJC Phillip Madonia Private practice Bham AL No COI Never was worried about overcorrection with hyperNa. Used the Bill Stone formula #NephJC |
| Nephrology Journal Club @NephJC Welcome @cnavadr #nephjc |
| Steven Coca @scoca1 @NephJC Very slow correction. Doubt the rate of correction is associated with mortality, but why leave them hanging up there so long, especially if they have a sliver of thirst sensation left #NephJC |
| Michelle Rheault @rheault_m @cnavadr Welcome to #NephJC, Carlos. |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC It seems logical and symmetrical that the safe hypoNa correction rate of “6 per day makes sense for safety” should apply to hyperNa...but it doesn’t seem to be the case, necessarily. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @cnavadr Hi Carlos, welcome back #NephJC |
| Jay Koyner @jaykoyner @VelezNephHepato @scoca1 has a secret society? I wish to hear more - but am afraid of the entry criteria #nephjc steve - can i get grandfathered in? |
| L. Parker Gregg @LParkerGregg1 @PMNax2 @NephJC Bill Stone from Nashville VA????? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @scoca1: @NephJC Very slow correction. Doubt the rate of correction is associated with mortality, but why leave them hanging up there so long, especially if they have a sliver of thirst sensation left #NephJC |
| Nephrology Journal Club @NephJC T0c: A 2014 study looked at treatment of hypernatraemia in ED found that under-treatment of sodium correction is common and associated with increased mortality #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @NephJC Not even children we are talking about infants less than 6 months olds. #NephJC They were assessing fontanelles! |
| Mario Funes, MD @MarioFunesMD @NephJC Thank you #NephJC |
| Nephrology Journal Club @NephJC T0c: However the age was about 80 y/o, 55 % institutionalized and 28% had dementia, so is it all just about the sodium number or is it part of a constellation of risk factors that portend a bad outcome? #NephJC |
| Phillip Madonia @PMNax2 @NephJC 2x kg = rate of D5W 2 x desired change = hrs of drop #NephJC |
| Girish Nadkarni @girish_nadkarni @NephJC Not complications per se from slow correction but definitely delay in discharge. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @jaykoyner @VelezNephHepato @scoca1 heavy metal? #nephjc |
| Steven Coca @scoca1 @jaykoyner @VelezNephHepato Sure @jaykoyner We will doing the swearing in via High Valerian. Brush up. #NephJC #GoTS8 |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @kidney_boy: @NephJC Not even children we are talking about infants less than 6 months olds. #NephJC They were assessing fontanelles! |
 | TEJAS PATEL MD, FACP, FASN @GenNextMD @NephJC Expert opinion is the lowest level of evidence in the hierarchy! Good topic to do nice studies like this..#nephjc ☺️ |
| Bhavnish @Buck1486 Wondering if high osmolar load infusion (e.g tube feeds) blunted the potential harmful effect of rapid NA correction in these ICU patients. #nephjc |
| Phillip Madonia @PMNax2 @NephJC *drip #NephJC |
| Niralee Patel, MD, MEd, FASN @nephralee I had secretly polled my attendings re. their rates of correction...everyone had different definitions of "slow" but that seemed to be the theme with most of them. #nephjc |
| Nephrology Journal Club @NephJC T0d: To avoid over- or under-treatment do you calculate water deficit? Check out this nephrology web episode from @Maximal_Change on free water deficit. Any other clinical pearls?#NephJC https://t.co/c1jrXGwev6 |
 | Jia Ng, MD MSCE 🚢 @jiahweing @NephJC Hi, Jia from Philadelphia. No COI #nephjc |
| Steven Coca @scoca1 @NephJC It's 99.9% the risk factors. I don't think correcting faster is going to make one once of difference in their outcome, except, like I mentioned earlier, maybe less thirst if they have some cognitive function. #NephJC |
 | Hector Madariaga, MD FASN 🇲🇽 @HecmagsMD Hey guys! Hector Madariaga. No COI. From #PatriotsNation. Sorry I’m late to the party... #NephJC |
 | Timothy Yau @Maximal_Change Tim Yau from @WUNephrology Late to the #NephJC party, lurking tonight. |
| Tiffany Caza @Tiff_Caza @nephralee @NephJC Congrats on your new paper! Looking forward to hearing your insights. Keep asking awesome clinical questions and pushing the field forward 😎 #nephjc |
| Girish Nadkarni @girish_nadkarni @nephralee @nephralee has a great slide on that #NephJC |
| Michelle Rheault @rheault_m @nephralee Ask 10 nephrologists how to do something and you're likely to get 10 different answers. #NephJC |
| Nephrology Journal Club @NephJC Welcome @GenNextMD, @jiahweing , and @Maximal_Change #nephjc |
| Joel M. Topf, MD FACP @kidney_boy @nephralee I want to go on the record that fellows should not be secretly polling attendings. #NephJC |
| Steven Coca @scoca1 @NephJC So, it's about quality of life factor for the patient (maybe less thirst) and because the rate of correction doesn't matter even if too fast, it means less blood draws (better for patient) and less calls with lab results (better for housestaff and fellows). Win win win. #NephJC |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @nephralee Stay calm! You are learning quickly that we all think differently and are very opinionated! #NephJC |
| Nephrology Journal Club @NephJC Welcome @HecmagsMD #nephjc |
| Phillip Madonia @PMNax2 @LParkerGregg1 @NephJC The same. And hello again. I remember you interviewing with us...#nephjc |
| Joel M. Topf, MD FACP @kidney_boy RT @scoca1: @NephJC So, it's about quality of life factor for the patient (maybe less thirst) and because the rate of correction doesn't matter even if too fast, it means less blood draws (better for patient) and less calls with lab results (better for housestaff and fellows). Win win win. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @girish_nadkarni @nephralee we would like to see that slide....suitably anonymized :-) #NephJC |
| Nephrology Journal Club @NephJC Great start! Moving on to T1 and methods. #NephJC https://t.co/dgsG6nca7P |
 | Alex Chang, MD, FASN, FAHA @alexchangmd Alex Chang, nephrologist in central PA, mostly lurking in a weird tiny airport pod hotel in Dulles. (Missed a flight to Ottawa because I forgot Canada was another country and had to go back home for my passport) #NephJC https://t.co/bZBJM65nbV |
| Nephrology Journal Club @NephJC T1a: Patient population - This study used the single centre data from data Medical Information Mart for Intensive Care-III (MIMIC-III) database to identify patients with hypernatremia.#NephJC https://t.co/liz0nL8hLW |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @scoca1 @NephJC So, the argument could be made that there’s nothing to lose with slower correction, except possibly increased length of stay. #NephJC |
| Nephrology Journal Club @NephJC T1a: All patients managed in ICU. Study included patients admitted with hypernatremia and hospital acquired hypernatraemia.#NephJC |
| Jay Koyner @jaykoyner @scoca1 @VelezNephHepato I believe its Valyrian and I am all in valar morghulis . #nephJC #GoTS8 #teamarya |
| Nephrology Journal Club @NephJC T1a: In intensive care units patients are different and hypernatremia is frequently iatrogenic. Do you manage all hypernatremia in ICU at your hospital? #NephJC |
 | Brandi Wynne, MS PhD FAHA @brandimwynne Brandi from @EmoryNephrology. COI @ILSI_NA. Salt is my friend. #nephjc |
| Cathy Quinlan @CathyQuinlan.bsky.social @KidneyCathy #nephjc |
| Girish Nadkarni @girish_nadkarni @JamesNovakNeph @scoca1 @NephJC No its increased LOS, worsened thirst and worse QoL for no clinical benefit #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC afraid not - mostly intensivists...rarely call us if they are really struggling and Na is very high #NephJC |
| L. Parker Gregg @LParkerGregg1 @PMNax2 @NephJC Wow, I can't believe you remember that! #NephJC |
| Steven Coca @scoca1 @JamesNovakNeph @NephJC And maybe more thirst for patient. I've asked almost every hypernatremic patient that survived mechanical ventilation if they were thirsty, and universally the answer is something like "as thirsty as being in the desert" #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Hypernatremia: Cellular adaptation and relations of serum and urine osmolaliy ca. 2019 from @CJASN #NephJC #Nephpearls 👉🏼 https://t.co/g1TriggEj3 https://t.co/o6H5cKovAW |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T1a: T1a: In intensive care units patients are different and hypernatremia is frequently iatrogenic. Do you manage all hypernatremia in ICU at your hospital? #NephJC |
| Cathy Quinlan @CathyQuinlan.bsky.social @KidneyCathy How often was the sodium checked throughout correction? #nephjc |
 | Chi Chu @cdchu @Buck1486 interesting…i would think it would have to be tonic though (or be given very quickly) in order to have a significant blunting effect to protect against dropping Na, so possible? #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @scoca1: @JamesNovakNeph @NephJC And maybe more thirst for patient. I've asked almost every hypernatremic patient that survived mechanical ventilation if they were thirsty, and universally the answer is something like "as thirsty as being in the desert" #NephJC |
| Nephrology Journal Club @NephJC T1b: Rapid hypernatremia correction defined as an serum sodium correction rate of > 0.5 mmol/l/hr 0.5 and slow hypernatremia correction <0.5mmol/l/hr. #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @JamesNovakNeph @scoca1 @NephJC I’m not ready to accept the findings yet. I have questions. For one I am concerned that people that got incompetent care, I.e. sodium not corrected at all or minimally get grouped with people with guideline based therapy of exactly 0.5 mEq/l/hr #NephJC |
| Nephrology Journal Club @NephJC T1c: Table showing selection of patients over timeframe 2001-2012.#NephJC https://t.co/BUbqwsnEpI |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @NephJC Is this BIDMC database? #NephJC |
| Cathy Quinlan @CathyQuinlan.bsky.social @KidneyCathy @hswapnil @NephJC But are they all in ICU? #nephjc |
| Chi Chu @cdchu @LTummalapalli @ISMMSKidney Chi Chu, UCSF Fellow, very excited to discuss sodium! #nephjc |
| Steven Coca @scoca1 @NephJC The previous small studies had the median correction at around 0.22 mEq/l/hr. Way too slow. #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC We try to, but are usually limited by the amount of free water the primary team is willing to give. There’s a lot of erroneous conflation of “water” with “fluids.” #NephJC |
| Girish Nadkarni @girish_nadkarni @GenNextMD @NephJC Yes from the MIMIC-III database from BIDMC #NephJC |
| Steven Coca @scoca1 @KidneyCathy @hswapnil @NephJC Yes, they had to be in ICU at one point in their hospitalization. That is a limitation, and we need data on non-ICU patients. #NephJC |
 | Gates Colbert, MD @DoctorGates Dallas nephrologist. Checking in late. My 2 cents is HyperNa can be as deadly as HypoNa. Must be intentional with treatment #NephJC |
| L. Parker Gregg @LParkerGregg1 @NephJC I always give recs but find that they are followed infrequently. #NephJC |
| Girish Nadkarni @girish_nadkarni @kidney_boy @JamesNovakNeph @scoca1 @NephJC @scoca1 Good point @kidney_boy. But the argument could be made that the standard of care was reasonably consistent since this was a single center and not over that long over a period of time #NephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @NephJC: T0b: T0b: Expert opinion suggest reduction rate should not to exceed 0.5 mmol/L per hour however, this is based on data in children. #NephJC https://t.co/5KeNxl2RFy |
| Girish Nadkarni @girish_nadkarni @scoca1 @KidneyCathy @hswapnil @NephJC We are working on it!!!! #NephJC |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @girish_nadkarni @NephJC Nice! Recall a robust one, never used though! #nephJC |
| Angel Cesar Ortiz @AngelCesarOrtiz RT @AbaRenua: |
| Nephrology Journal Club @NephJC Here is another important figure #nephjc https://t.co/Fjie8oc4D5 |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @scoca1 @NephJC Not to mention the PTSD from being in the ICU, intubated, and ventilated. #NephJC |
| Matthew Sparks, MD @Nephro_Sparks @LTummalapalli Always saw hyperNa as marker of poor care. Need to water 💦 the plants #NephJC |
| Girish Nadkarni @girish_nadkarni @JamesNovakNeph @scoca1 @NephJC The thirst doesnt help for sure!!!! #NephJC |
| Ian McCoy, MD, MS @NephroNinja @LTummalapalli Incidence was much lower in this cohort (1.3%) than in the references cited in the introduction (3-9%) #NephJC |
| Alex Chang, MD, FASN, FAHA @alexchangmd @scoca1 @NephJC My observation is that it is not necessarily the fear of overcorrection, but the unfounded belief that giving lots of H2O in the ICU will cause worsening pulmonary edema. Is this at all possible? #NephJC |
 | Jenn @Jentan7477 RT @NephJC: T1a: T1a: In intensive care units patients are different and hypernatremia is frequently iatrogenic. Do you manage all hypernatremia in ICU at your hospital? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Here is another important figure #nephjc https://t.co/Fjie8oc4D5 |
| Steven Coca @scoca1 @alexchangmd @NephJC Agree that is unfounded fear. Probably very low risk of this, given the distribution of water and amount that would be needed. #NephJC |
| Nephrology Journal Club @NephJC Still on track, onto the results #NephJC |
| Juan Carlos Q Velez @VelezNephHepato One thing that stood out for me @scoca1 is that you found 30% of hospital acquired hyperNa corrected faster than 5 mEq/L/hr. My experience is that if we get to convince the ICU team To give a bit of H2O and reduce sNa by 2 per day it’s a colossal success #NephJC |
 | Hassan Mahmoud @hassan_mohamud RT @NephJC: Here is another important figure #nephjc https://t.co/Fjie8oc4D5 |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd STERNS: Hyponatremia & hypernatremia are both disorders of plasma Na, but the similarities end there ... we cannot apply what we know about Na levels that are too low to the management of Na levels that are too high‼️ #NephJC #Nephpearls 👉🏼 https://t.co/JZz76GWdKZ https://t.co/lg3KY2jYYr |
| Nephrology Journal Club @NephJC T2a: Baseline characteristics. Note patients admitted with hypernatremia were more likely to be managed in medical ICU. #NephJC https://t.co/R3nBuaOX1D |
| Raymond Hsu @DrRaymondHsu T1: interesting that admission hyper-Na group is older (median age 80+). always thought of age as risk factor 4 hypo-NA. prob both. #nephjc |
 | Derek Larson, MD, FASN @DerekSLarson Late and lurking (while grilling) to the #NephJC party - no COI |
| Nephrology Journal Club @NephJC T2b: Patients with hypernatremia on admission that underwent Rapid Correction were more likely to be female and less likely to have CKD. Would you adjust rate of correction for patients with co-morbidities such as CKD or CHF? What about younger patients? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T1b: T1b: Rapid hypernatremia correction defined as an serum sodium correction rate of > 0.5 mmol/l/hr 0.5 and slow hypernatremia correction <0.5mmol/l/hr. #NephJC |
| Phillip Madonia @PMNax2 @alexchangmd @scoca1 @NephJC Have seen the pulm docs balk at giving D 5 to ventilated patients...#nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T2a: T2a: Baseline characteristics. Note patients admitted with hypernatremia were more likely to be managed in medical ICU. #NephJC https://t.co/R3nBuaOX1D |
| Steven Coca @scoca1 @VelezNephHepato You mean 0.5 meq/L/hr, right? #NephJC |
| Ian McCoy, MD, MS @NephroNinja @girish_nadkarni @scoca1 @KidneyCathy @hswapnil @NephJC Is there another publicly available dataset with lab values over time and mortality? #NephJC |
| Chi Chu @cdchu RT @alexchangmd: @scoca1 @NephJC My observation is that it is not necessarily the fear of overcorrection, but the unfounded belief that giving lots of H2O in the ICU will cause worsening pulmonary edema. Is this at all possible? #NephJC |
| Joel M. Topf, MD FACP @kidney_boy @girish_nadkarni @JamesNovakNeph @scoca1 @NephJC I don’t understand what you mean? My critique is that it appears that some of the people in the slow group were not getting treatment at all due to very slow improvement. #NephJC. |
| Matthew Sparks, MD @Nephro_Sparks @LTummalapalli When I am rounding on Gen Med and see hyperNa #NephJC https://t.co/TGB4mYct6B |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @alexchangmd @scoca1 @NephJC See my previous tweet about conflating “water” with “fluids.” Water distributes mostly (54-67%) intracellularly, and only a fraction of the remainder would enter the lungs. #NephJC |
| Chi Chu @cdchu RT @JamesNovakNeph: @alexchangmd @scoca1 @NephJC See my previous tweet about conflating “water” with “fluids.” Water distributes mostly (54-67%) intracellularly, and only a fraction of the remainder would enter the lungs. #NephJC |
 | Salt @Saltwebsite joining in late! No COI. #nephjc |
| Steven Coca @scoca1 @kidney_boy @girish_nadkarni @JamesNovakNeph @NephJC Most people ignore hyperNa in the ICU. it's like problem #8. #NephJC |
| Nephrology Journal Club @NephJC welcome @aishaikh and @NephroMD #nephjc |
| Nephrology Journal Club @NephJC @Saltwebsite in the house! #nephjc |
| Nephrology Journal Club @NephJC T2b: Patients with hospital-acquired hypernatremia that underwent Rapid Correction had lower prevalence of stroke, lower serum bicarbonate and shorter hospital stay. #NephJC |
| Joel M. Topf, MD FACP @kidney_boy Amen my brother! #NephJC |
| Nephrology Journal Club @NephJC T2c: The in-hospital mortality was not significantly different between patients with admission hypernatremia with rapid correction versus slow correction (25% vs 28%; P=0.80). #NephJC |
 | Helbert Rondon, MD, MS, FACP, FASN, FNKF @NephroMD Sorry I am late. Helbert Rondon from @PITTRenal. No COI. Just lurking today #NephJC |
| Nephrology Journal Club @NephJC T2c: Similarly, the in-hospital mortality rate was not significantly different between patients with hospital-acquired hypernatremia with Rapid Correction versus Slow Correction (44% versus 40%; P=0.50). #NephJC https://t.co/xYpSCYrweK |
| Ian McCoy, MD, MS @NephroNinja Impressive manual review of 122 + 128 + 28 = 278 charts. Strong work! #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T2c: T2c: The in-hospital mortality was not significantly different between patients with admission hypernatremia with rapid correction versus slow correction (25% vs 28%; P=0.80). #NephJC |
| Nephrology Journal Club @NephJC Thoughts on this? #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @alexchangmd: @scoca1 @NephJC My observation is that it is not necessarily the fear of overcorrection, but the unfounded belief that giving lots of H2O in the ICU will cause worsening pulmonary edema. Is this at all possible? #NephJC |
| Steven Coca @scoca1 @NephroNinja Good team effort. We needed to do it, to make sure we weren't missing anything. Again, we were not expecting a mortality difference. #NephJC |
| Michelle Rheault @rheault_m RT @scoca1: @kidney_boy @girish_nadkarni @JamesNovakNeph @NephJC Most people ignore hyperNa in the ICU. it's like problem #8. #NephJC |
| Raymond Hsu @DrRaymondHsu T2 were there proportionately more pts who did not achieve Na<145 in slower correction groups? #nephjc |
| Steven Coca @scoca1 @NephroNinja More back story: Housestaff or hospitalist on overnight wanted to give a patient 3% saline to raise the serum Na back up because it fell from 158 to 153 over like 6 or 8 hours. I lost it. #NephJC |
| Ian McCoy, MD, MS @NephroNinja @NephJC No mortality difference but 95% CIs suggest possibly missed > twice increased odds of mortality. Underpowered to detect clinically significant mortality risk? #NephJC |
| Nephrology Journal Club @NephJC T2c: There was no difference in mortality between patients on rapid vs slow correction in both groups on the multivariable analysis. #NephJC https://t.co/OrajkpRFkn |
| Bhavnish @Buck1486 @Jentan7477 Yes exactly. After all what we fear is a drastic drop in intravascular osmolality which would drive water intracellulaly. So what if there are other active osmoles around? If tube feeds can cause osmotic diuresis they could somehow 'protect' against rapid correction #nephjc |
| Nephrology Journal Club @NephJC Let's hit some more pretty pics for the eyes and ramp up this discussion #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @scoca1 @NephroNinja #NephJC https://t.co/zN9HjPD5B0 |
| Nephrology Journal Club @NephJC T2d: In sub-analysis using different cut-offs, there was a trend of lower mortality rates in RC rate group versus SC rate group but not significantly different. #NephJC https://t.co/vEvsaRNpDU |
 | Aakash Shingada, DNB, MRCP(UK), FASN @aakashshingada Joining late. This is Aakash from Mumbai. Lurking today #nephjc |
| Nephrology Journal Club @NephJC T2e: The Kaplan–Meier curves for 30-day survival for the Rapid Correction vs Slow Correction Rate groups are shown. #NephJC https://t.co/GfvMECQRJp |
| Steven Coca @scoca1 @NephroNinja I was ranting hyperNa is not the inverse of hypoNa. Then @nephralee reviewed all the data for her presentation, which was meh, and we leveraged the MIMIC dataset to try to answer this. #NephJC |
| Helbert Rondon, MD, MS, FACP, FASN, FNKF @NephroMD @NephJC @Maximal_Change Always add ongoing water losses (insensible losses, CeH20). I can’t tell you how many times we have been consulted for “hypernatremia refractory to D5W” #NephJC |
| Nephrology Journal Club @NephJC Welcome @aakashshingada our host tomorrow for the India Chat #nephjc |
| Eric Au @ericau @NephJC Interesting to see the slower mortality groups generally had higher mortality (even if not significant difference) #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T2e: T2e: The Kaplan–Meier curves for 30-day survival for the Rapid Correction vs Slow Correction Rate groups are shown. #NephJC https://t.co/GfvMECQRJp |
| Steven Coca @scoca1 @ericau @NephJC Don't read too much into it. Superconfounder, maybe teams were paying more attention too, a mix. #NephJC |
| Girish Nadkarni @girish_nadkarni RT @NephJC: T2e: T2e: The Kaplan–Meier curves for 30-day survival for the Rapid Correction vs Slow Correction Rate groups are shown. #NephJC https://t.co/GfvMECQRJp |
| Steven Coca @scoca1 @ericau @NephJC Confounded #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephroMD @NephJC @Maximal_Change And, if the data are available, once can account for Na and K intake and excretion as well, tally up the Na, K, and H2O gains and losses for the next 24 h, and estimate tomorrow’s [Na] fairly accurately. #NephJC |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @ericau @NephJC U r a nephrologist! Good thinker!!! #NephJC |
| Joel M. Topf, MD FACP @kidney_boy I’m worried that this data is so full of people with DNR status and demented brains that a signal among young adults with normal neuro function might be obscured. Could danger in a healthier sub-population be lurking? #nephJC |
| Ian McCoy, MD, MS @NephroNinja Besides the ICD-9 code used for altered mental status (780.0), were others considered (e.g., 348.30 Encephalopathy, unspecified, 348.31 Metabolic encephalopathy, 349.82 Toxic encephalopathy)? #Nephjc |
| Steven Coca @scoca1 @kidney_boy But, there were no neurologic complications in ANYONE in the whole dataset. Extremely low likelihood of problems. #NephJC |
| Joel M. Topf, MD FACP @kidney_boy Just like we extrapolated danger from infants are we extrapolating safety from 80 year olds? #NephJC |
 | Maryam Saeed @maryamksaeed Renal fellow. Joining in late from Houston . Had a great journal club on the same article by @MSulemanAjmal1 today. Interesting to see everyone’s thoughts on this. No COI. #NephJC |
| Nephrology Journal Club @NephJC T2f: A manual review of AVAILABLE progress notes, imaging reports, and discharge summaries DID NOT identify any patients who developed seizures, cerebral edema and worsening mental state among admission-hypernatremia group. #NephJC |
| Nephrology Journal Club @NephJC T2f: Similarly, 47 of 122 patients with admission hypernatraemia did not have neurological outcomes. #NephJC |
| Girish Nadkarni @girish_nadkarni @kidney_boy The median age of hypernatremia would skew older though. Unlikely that young people would get hypernatremia especially if neuro intact. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @scoca1 @kidney_boy but that was adjudicated by the authors right? And charts not available for all patients? #NephJC |
| Ian McCoy, MD, MS @NephroNinja It would have been nice to see how many neurologic outcomes occurred before adjudication. Was there a difference in the raw numbers before trying to determine if related from chart review? #nephjc @scoca1 @girish_nadkarni |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Hypernatremia as a result of changes in Total Body Water (TBW) and Total Body Sodium (TBNa)ca. 2012 from @AJKDonline #Nephpearls #NephJC 👉🏼 https://t.co/kgLOWTCJ3E https://t.co/aGKUtF8ZJI |
 | Marvin Gonzalez. MD, Ph.D @MarvinGonzlez16 Marvin González from Nicaragua. No COI to declare. #NSMC #NephJC |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @kidney_boy Wouldn’t u expect older people have limited brain plasticity and may manifest adverse effects sooner, like babies! Jus sayin’ #NephJC 😌 |
| Girish Nadkarni @girish_nadkarni @hswapnil @scoca1 @kidney_boy Yes adjudicated by authors in those with charts available. #NephJC |
| Niralee Patel, MD, MEd, FASN @nephralee @NephroNinja cerebral edema and seizures. there is a list in the supplement #nephJC |
| Steven Coca @scoca1 @hswapnil @kidney_boy Some were missing notes in the dataset. we reviewed everything that was available. So, is the probablity 0% with a 95% CI of 0 to 0? No. But, the upper bound of the 95% CI has to be very low. #NephJC |
| Girish Nadkarni @girish_nadkarni @nephralee @NephroNinja Plus where charts were available, all were manually reviewed. #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph It’s been a long time since I’ve seen a Darrow Yannet diagram (except the ones I use in my hypoNa lecture). #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @girish_nadkarni @scoca1 @kidney_boy so does that leave the room open for a small possibility of harm? This is the best study we have (thanks) but data quality not as perfect as would be in a prospective study, right? Or am I nitpicking? #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @scoca1: @hswapnil @kidney_boy Some were missing notes in the dataset. we reviewed everything that was available. So, is the probablity 0% with a 95% CI of 0 to 0? No. But, the upper bound of the 95% CI has to be very low. #NephJC |
| TEJAS PATEL MD, FACP, FASN @GenNextMD @nephralee @NephroNinja That’s an extreme so difficult with small N...more 1:1 need, LoS if available would make a case for non inferiority...may not have all clinical data...#NephJC |
 | Vanessa Lerma @VanessaLerma17 Sorry I’m late ,Vanessa , Nephrology resident from Mexico. Sorry for #NSMCintern #nephjc |
| Nephrology Journal Club @NephJC Last few meters. #NephJC https://t.co/uJ7iyyFPVH |
| Helbert Rondon, MD, MS, FACP, FASN, FNKF @NephroMD @JamesNovakNeph @NephJC @Maximal_Change Thank you Izzy Edelman!@ThepHunClub #NephJC |
| Steven Coca @scoca1 @hswapnil @girish_nadkarni @kidney_boy Yes, this is not the perfect study, and maybe there is a non-zero chance. Just like in Dumb and Dumber. it's not zero. but, too much angst overall about the rate of correction. People need to chill out and get some sleep and stop poking the patient every 4 hours. 😎 #NephJC |
| Nephrology Journal Club @NephJC Never too late welcome @VanessaLerma17 #nephjc |
| Girish Nadkarni @girish_nadkarni @hswapnil @scoca1 @kidney_boy Data quality is never going to be as good as a prospective study. But unlikely anyone is going to do a RCT on this. Prospective collection is possible but unclear how the act of data collection and enrollment would confound treatment patterns. #NephJC |
| Raymond Hsu @DrRaymondHsu Cerebral edema "attributable to rapid hypernatremia correction" may be quite subjective tho #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @scoca1: @hswapnil @girish_nadkarni @kidney_boy Yes, this is not the perfect study, and maybe there is a non-zero chance. Just like in Dumb and Dumber. it's not zero. but, too much angst overall about the rate of correction. People need to chill out and get some sleep and stop poking the patient every 4 hours. 😎 #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @girish_nadkarni: @hswapnil @scoca1 @kidney_boy Data quality is never going to be as good as a prospective study. But unlikely anyone is going to do a RCT on this. Prospective collection is possible but unclear how the act of data collection and enrollment would confound treatment patterns. #NephJC |
| Nephrology Journal Club @NephJC T3a: The overall conclusion from authors are rapid correction of hypernatremia was not associated with a higher risk for mortality or neurological outcomes in adult patients with either admission or hospital-acquired hypernatremia. #NephJC |
| Nephrology Journal Club @NephJC T3a: It is the largest cohort study published so far comparing rate of correction in critically ill patients. Provoking our current practice. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: T3a: T3a: The overall conclusion from authors are rapid correction of hypernatremia was not associated with a higher risk for mortality or neurological outcomes in adult patients with either admission or hospital-acquired hypernatremia. #NephJC |
 | Michael Eastman, DO MFA @Eastmanov1 Mike, F1 @HennepinKidney. No COI. Lurking while on vacation on Cape Cod. #NephJC |
| Steven Coca @scoca1 @NephJC I still can't believe the pre-poll with 170+ votes said 2:1 people were worried about overcorrection in hypernatremia. #NephJC |
| Nephrology Journal Club @NephJC T3b: Limitations mentioned by authors include inability to identify exact onset of hypernatraemia among patients with admission hypernatremia. #NephJC |
| Salt @Saltwebsite neurons can rapidly rid themselves of potassium and then, in around a day, get rid of organic osmolytes. the ability of the brain to quickly do this as compared to a slower process of making organic osmolytes can somewhat explain safety in faster correction of hyperNa #nephjc |
| Girish Nadkarni @girish_nadkarni @scoca1 @NephJC Maybe this will change hearts and minds. #NephJC |
| Nephrology Journal Club @NephJC T3b: Chronic hypernatremia thought more susceptible for neurological complications and thus outcomes may not be represented in study with their definitions of chronicity. #NephJC |
| Nephrology Journal Club @NephJC Any comments? #nephjc |
| Girish Nadkarni @girish_nadkarni @alexchangmd @hswapnil @scoca1 @kidney_boy Awesome idea. We have extracted those outcomes for another project. We can check the ventilator free days. #NephJC |
| Steven Coca @scoca1 @LTummalapalli @cdchu Don't think we excluded. #NephJC |
| Cathy Quinlan @CathyQuinlan.bsky.social @KidneyCathy Any suggestions for how this study could be improved? #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @Eastmanov1 @HennepinKidney welcome to #NephJC Mike! |
| Girish Nadkarni @girish_nadkarni @scoca1 @LTummalapalli @cdchu No did not exclude. But likely that the number was small. #NephJC |
| Nephrology Journal Club @NephJC Think it has a strong chance to change opinions @scoca1 and @girish_nadkarni, after all there is data here! #nephjc |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @scoca1 @hswapnil @girish_nadkarni @kidney_boy Maybe hyperNa helps build bone (reverse of fractures caused by hypoNa leaching Na from bone)...#NephJC |
| Joel M. Topf, MD FACP @kidney_boy @GenNextMD No, I think those old people got lots of empty room in the calvaria to tolerate cerebral edema. I worry about 31 yr old with otherwise intact brain. #NephJC |
| Bhavnish @Buck1486 Excellent point! |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @scoca1 @NephJC let's see what the post poll will show! #NephJC |
| Nephrology Journal Club @NephJC T3c: Was the number of patients with severe chronic hypernatremia too small to exclude the possibility of harm following rapid correction? Adequately powered? #NephJC |
| Jenn @Jentan7477 RT @NephJC: T2f: T2f: A manual review of AVAILABLE progress notes, imaging reports, and discharge summaries DID NOT identify any patients who developed seizures, cerebral edema and worsening mental state among admission-hypernatremia group. #NephJC |
| Helbert Rondon, MD, MS, FACP, FASN, FNKF @NephroMD @Saltwebsite it is 48h vs. 5-7 days #NephJC |
| Nephrology Journal Club @NephJC Overall at a minimum, this study findings prompt us to review the evidence supporting current recommendations. #NephJC |
| Raymond Hsu @DrRaymondHsu Hey authors, are you doing a similar study with hypoNa correction? How good is evidence for current guidelines of raising 4-6 /24h #nephjc |
| Steven Coca @scoca1 @KidneyCathy Need to expand to non-ICU. would be nice to have had more info on fluids/methods used to correct. Data on fluid balance. Full set of notes on all with daily GCS scores, etc. We did review all the radiology reports in addition to the progress notes and D/C summaries. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @scoca1: @KidneyCathy Need to expand to non-ICU. would be nice to have had more info on fluids/methods used to correct. Data on fluid balance. Full set of notes on all with daily GCS scores, etc. We did review all the radiology reports in addition to the progress notes and D/C summaries. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @DrRaymondHsu: Hey authors, are you doing a similar study with hypoNa correction? How good is evidence for current guidelines of raising 4-6 /24h #nephjc |
| Nephrology Journal Club @NephJC T3d: Perhaps important take home message is emphasis on correcting sodium in timely manner. Too slow is associated with increased risk of death and too fast not as doomed as we once perceived. #NephJC |
| Nephrology Journal Club @NephJC T3d: So gotta ask and opein it up are you less terrified of using slightly faster rate than recommend 0.5mmol/l per hour? Will this study change your practice? #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Iatrogenic Hypernatremia: In two large Dutch 🇳🇱 cohorts, there was a marked shift in the incidence of dysnatremias from hyponatremia to hypernatremia over two decades #NephJC #Nephpearls 👉🏼 https://t.co/OYY8sfc28X https://t.co/2yXBi8Cb1H |
| Steven Coca @scoca1 @DrRaymondHsu @alexchangmd recently published nice paper on hyponatremia correction #NephJC |
 | Ahmed @YehiaAhmed99 RT @NephJC: The #VisualAbstract for tonight’s #NephJC chat https://t.co/ofzYGQr2lz https://t.co/UYKJg6WYi0 |
| Girish Nadkarni @girish_nadkarni @scoca1 @KidneyCathy Need to have data from multiple hospital systems and multiple time periods. Exclude iatrogenic hypeNa (like pushing bicarb during cardiac arrest). #NephJC |
| James Novak, MD PhD FACP FASN FNKF @JamesNovakNeph @NephJC Yes, but be wary of “associated with...” causality is elusive to prove. #NephJC |
| Raymond Hsu @DrRaymondHsu @scoca1 @DrRaymondHsu @alexchangmd thanks totally missed this https://t.co/Wjt4zzryRX #nephjc |
| Niralee Patel, MD, MEd, FASN @nephralee @DrRaymondHsu https://t.co/FSksWnKM1a #nephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Natremia distribution at ICU admission ca. 2013 #NephJC #Nephpearls 👉🏼 https://t.co/YgaXoMNndb https://t.co/B6Pv2YrV4Q |
| Vanessa Lerma @VanessaLerma17 RT @edgarvlermamd: Natremia distribution at ICU admission ca. 2013 #NephJC #Nephpearls 👉🏼 https://t.co/YgaXoMNndb https://t.co/B6Pv2YrV4Q |
| Steven Coca @scoca1 @JamesNovakNeph @NephJC Yes, please no one assume any causality here. Read the Sterns editorial. I think it just gives us room to worry less about "over-correction". #NephJC |
| Niralee Patel, MD, MEd, FASN @nephralee @DrRaymondHsu in the manual review of charts we looked at imaging and progress notes/discharge summaries. the pt's with cerebral edema were all from primary neuro diagnoses - CVA/hemorrhage/tumor #nephJC (oops forgot the hashtag) |
| Vanessa Lerma @VanessaLerma17 RT @DrRaymondHsu: @scoca1 @DrRaymondHsu @alexchangmd thanks totally missed this https://t.co/Wjt4zzryRX #nephjc |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @DrRaymondHsu: @scoca1 @DrRaymondHsu @alexchangmd thanks totally missed this https://t.co/Wjt4zzryRX #nephjc |
| Girish Nadkarni @girish_nadkarni @scoca1 @JamesNovakNeph @NephJC Causality is impossible to prove or disprove using this kind of data. #NephJC |
| Ahmed @YehiaAhmed99 RT @Nephro_Sparks: @LTummalapalli Always saw hyperNa as marker of poor care. Need to water 💦 the plants #NephJC |
| Girish Nadkarni @girish_nadkarni RT @Nephro_Sparks: @LTummalapalli Always saw hyperNa as marker of poor care. Need to water 💦 the plants #NephJC |
| Ahmed @YehiaAhmed99 RT @NephJC: T1a: T1a: In intensive care units patients are different and hypernatremia is frequently iatrogenic. Do you manage all hypernatremia in ICU at your hospital? #NephJC |
| Bhavnish @Buck1486 This data makes me feel redundant when I see the septic patient in shock, intubated, prone, and I recommend 'slow' correction of hypernatremia. #ICUisLeastConcerned #nephjc |
| Joel M. Topf, MD FACP @kidney_boy @DrRaymondHsu I bet you could study 450 hyponatremic patients with Na < 125 and not have one case of osmotic brain damage in the 200 with fast correction. And no one would be reassured by that data. #NephJC |
| Nephrology Journal Club @NephJC Amazing how dogma in the care of the dysnatremias has been challenged in the last several years #nephjc |
| Nephrology Journal Club @NephJC Thanks for joining us today and for contributing to this important discussion! ##NephJC |
| Nephrology Journal Club @NephJC Special thank you to any authors @nephralee, @girish_nadkarni, and @scoca1 for joining us tonight #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Special thank you to any authors @nephralee, @girish_nadkarni, and @scoca1 for joining us tonight #NephJC |
| Nephrology Journal Club @NephJC Remember the European chat is tomorrow at 8 pm BST (12 noon Pacific) and the Asian chat is tomorrow at 9 pm Indian Standard Time #NephJC |
| Steven Coca @scoca1 @kidney_boy @DrRaymondHsu Good point @kidney_boy But, but, but, We have all see CPM from hypoNa over-correction. There are lots of papers. As Sterns points out, there is not one published case of cerebral edema in adults from correction of HyperNa. Have you ever seen it? #NephJC |
| Nephrology Journal Club @NephJC If you haven’t, please sign up for our weekly newsletter https://t.co/5aumn8ImwF #NephJC |
| Edgar V. Lerma 🇵🇭 @edgarvlermamd Hypernatremia in critically ill patients ca. 2013 #Nephpearls #NephJC 👉🏼 https://t.co/uZuEjKmL3D https://t.co/2R5fmq2mnX |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil @NephJC @nephralee @girish_nadkarni @scoca1 also @cjasn for making article free for a week (download now and download often at https://t.co/Qjl1SzHMaR) for #nephjc |
| Girish Nadkarni @girish_nadkarni @scoca1 @kidney_boy @DrRaymondHsu And there is limited pathophysiological basis behind this (in adults) unlike in hypoNa. #NephJC |
| Swapnil Hiremath @hswapnil@bsky.social @hswapnil RT @NephJC: Remember the European chat is tomorrow at 8 pm BST (12 noon Pacific) and the Asian chat is tomorrow at 9 pm Indian Standard Time #NephJC |
| Steven Coca @scoca1 @kidney_boy @DrRaymondHsu Has anyone ever seen a case of cerebral edema in adult due to overcorrection of hyperNa? #NephJC |
| Nephrology Journal Club @NephJC Keep the discussion going otherwie until next time goodnight #nephjc |
| Raymond Hsu @DrRaymondHsu @girish_nadkarni @scoca1 @kidney_boy I worry that guidelines for hypoNa will be slower & slower recommended rate due to a few case reports #NephJC |
| Juan Carlos Q Velez @VelezNephHepato @NephroMD @NephJC @Maximal_Change I can tell you. A zillion times. #NephJC |
 | Abraham E. Gracia R. @Abraham_RMI A classic paper |
| Juan Carlos Q Velez @VelezNephHepato I would have predicted ~ 10% #NephJC |
| Girish Nadkarni @girish_nadkarni @DrRaymondHsu @scoca1 @kidney_boy True but there at least there is a significant, quantifiable risk. Plus prediction of who will get ODS is terrible at best. #NephJC |
| Steven Coca @scoca1 @NephJC Thank you #NephJC. Was a blast. |
| Niralee Patel, MD, MEd, FASN @nephralee https://t.co/v5dOTBn9Rf Cool case of acute hypernatremia - I couldn't eat sushi for a while after reading this...cases out there of chicken noodle soup too #nephJC |
 | Abbie D. Leino @AbbieDPharmD RT @NephJC: Overall at a minimum, this study findings prompt us to review the evidence supporting current recommendations. #NephJC |
| Nathaniel Reisinger @nephrothaniel RT @NephroMD: @NephJC @Maximal_Change Always add ongoing water losses (insensible losses, CeH20). I can’t tell you how many times we have been consulted for “hypernatremia refractory to D5W” #NephJC |
| Justin Davis @jbda19 RT @edgarvlermamd: Treatment and limits of correction of severe Hypernatremia ca. 2015 from @NEJM #Nephpearls #NephJC 👉🏼 https://t.co/oPJLyFuAaZ https://t.co/ck5Y4BD7Rl |
| Raymond Hsu @DrRaymondHsu @alexchangmd @kidney_boy I find that the currently recommended 4-6mg/dL change in 24hr very difficult to achieve perfectly/not overshoot unless you do the DDAVP + 3% method (appropriateness depending on etiology of course) #NephJC |
| Arshad Ali @aldorenin RT @edgarvlermamd: Hypernatremia as a result of changes in Total Body Water (TBW) and Total Body Sodium (TBNa)ca. 2012 from @AJKDonline #Nephpearls #NephJC 👉🏼 https://t.co/kgLOWTCJ3E https://t.co/aGKUtF8ZJI |
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