Podcasts about tmp smx

AKI Tips and Tricks from Joel Topf MD, Kashlak's Chief of Nephrology Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak's Chief of Nephrology! We've put together an AKI highlight reel - focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium. Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode's release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written (including CME questions) and Produced by: Cyrus Askin, MD Infographic by: Cyrus Askin, MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Joel Topf, MD Time Stamps 00:00 Sponsors - VCU Health CE and Pediatrics On Call podcast by APP 00:30 Intro, disclaimer, guest bio 03:00 Guest one-liner, Picks of the Week*: Zoe Keating albums (Cellist); Mrs. America (TV series) on FX; The Last of Us (Videogame); 08:45 Sponsor - Pediatrics On Call podcast by APP 09:15 Definition of acute kidney injury (AKI) and fundamentals 11:00 Cardiorenal syndrome 12:24 Schema for AKI 17:30 Establish an etiology, determine urine output and address electrolyte abnormalities 21:22 AKI in the otherwise-healthy patient; 32:20 Rhabdomyolysis
38:21 Vancomycin 41:43 Acute interstitial nephritis (AIN) 44:52 Contrast induced nephropathy (CIN) 50:37 Gadolinium in AKI and/or CKD 52:53 Timing of dialysis 
 56:37 AKI in the out-patient setting and how to handle home meds e.g. TMP-SMX, RAAS inhibitors; 62:01 Is Ultrasound necessary in AKI
 64:58 Dr. Topf's take home points and Plug for Seminars in Nephrology 68:45 Outro and Sponsor - VCU Health CE Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Panacea Financial If you're ready to join the thousands of doctors who have declared independence from traditional banks, visit panaceafinancial.com today. Sponsor: Locumstory Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts.

Contributor: Meghan Hurley MD Educational Pearls: What is Cellulitis? A common and potentially serious bacterial skin infection. Caused by various types of bacteria, with Streptococcus and Staphylococcus species being the most common. What is Preseptal Cellulitis and why is it more serious than facial cellulitis? Preseptal Cellulitis, also known as Periorbital Cellulitis, is a bacterial infection of the soft tissues in the eyelid and the surrounding area. This requires prompt and aggressive treatment to avoid progression into Orbital Cellulitis. How is Preseptal Cellulitis treated? Oral antibiotics for five to seven days. In the setting of trauma (scratching bug bites) Clindamycin or TMP-SMX (for MRSA coverage) and Amoxicillin-clavulanic acid or Cefpodoxime or Cefdinir. If there is no trauma, monotherapy with amoxicillin-clavulanic acid is appropriate. Check immunization status against H.influenzae and adjust appropriately. What is Orbital Cellulitis, how is it diagnosed, and why is it more serious than Preseptal Cellulitis? Orbital cellulitis involves the tissues behind the eyeball and within the eye socket itself. Key features include: Eye pain. Proptosis (Bulging of the eye out of its normal position). Impaired eye movement. Blurred or double vision. This can lead to three very serious complications: Orbital Compartment Syndrome. This can push eye forward, stretch optic nerve, and threaten vision. Meningitis given that the meninges of the brain are continuous with optic nerve. Endophthalmitis, which is inflammation of the inner coats of the eye. This can also threaten vision. If suspected, get a CT of the orbits and/or an MRI to look for an abscess behind the eyes. How is Orbital Cellulitis treated? IV antibiotics. Cover for meningitis with Ceftriaxone and Vancomycin. Add Metronidazole until intracranial involvement has been ruled out. Drain the abscess surgically. Usually this is performed by an ophthalmologist or an otolaryngologist. Admit to the hospital. References Bae C, Bourget D. Periorbital Cellulitis. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261970. Chaudhry IA, Shamsi FA, Elzaridi E, Al-Rashed W, Al-Amri A, Al-Anezi F, Arat YO, Holck DE. Outcome of treated orbital cellulitis in a tertiary eye care center in the middle East. Ophthalmology. 2007 Feb;114(2):345-54. doi: 10.1016/j.ophtha.2006.07.059. PMID: 17270683. Seltz LB, Smith J, Durairaj VD, Enzenauer R, Todd J. Microbiology and antibiotic management of orbital cellulitis. Pediatrics. 2011 Mar;127(3):e566-72. doi: 10.1542/peds.2010-2117. Epub 2011 Feb 14. PMID: 21321025. Wong SJ, Levi J. Management of pediatric orbital cellulitis: A systematic review. Int J Pediatr Otorhinolaryngol. 2018 Jul;110:123-129. doi: 10.1016/j.ijporl.2018.05.006. Epub 2018 May 8. PMID: 29859573. Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII  

Episode Notes In what has been described on Twitter as the “doing your own taxes of medicine,” Drs. Emily Heil (@emilylheil) and Andrew Fratoni (@AFratty) join Dr. Jillian Hayes (@thejillianhayes) to break down the ins and outs of sulfamethoxazole/trimethoprim dosing! Tune in for a discussion on the use of this agent for methicillin-resistant Staphylococcus aureus, gram-negatives, pneumocystis, and Stenotrophomonas maltophilia. References: Twitter Thread re: Bactrim dosing: https://twitter.com/IDdocAdi/status/1661174505702674432?s=20 PJP OI Guidelines: https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/pneumocystis-0 IDSA Resistant Gram Negative Guidance Document: https://www.idsociety.org/globalassets/idsa/practice-guidelines/amr-guidance/1.0/idsa-amr-guidance-v3.0.pdf (Lower doses of PJP Treatment): Butler-Laporte G, Smyth E, Amar-Zifkin A, Cheng M, McDonald E, Lee T. Low-dose TMP-SMX in the Treatment of Pneumocystis jirovecii Pneumonia: A Systematic Review and Meta-Analysis. Open Forum Infectious Diseases, Volume 7, Issue 5, May 2020, ofaa112, https://doi-org.proxy-hs.researchport.umd.edu/10.1093/ofid/ofaa112 (DS Vs SS for PJP PPX): Schneider MM, Nielsen TL, Nelsing S, et al. Efficacy and toxicity of two doses of trimethoprim-sulfamethoxazole as primary prophylaxis against Pneumocystis carinii pneumonia in patients with human immunodeficiency virus. Dutch AIDS Treatment Group. J Infect Dis. 1995;171(6):1632-1636. Available at: http://www.ncbi.nlm.nih.gov/pubmed/7769306. General Bactrim PK/PD: Trubiano JA, Grayson ML. Trimethoprim and Trimethoprim-Sulfamethoxazole (Cotrimoxazole). Chapter 92, Kucers' The Use of Antibiotics (7th Edition). Taylor & Francis, 2017. (2014 IDSA SSTI Guidelines). PMID 24973422 Cadena J, Nair S, Henao-Martinez AF, Jorgensen JH, Patterson JE, Sreeramoju PV. Dose of trimethoprim-sulfamethoxazole to treat skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2011 Dec;55(12):5430-2. doi: 10.1128/AAC.00706-11. Epub 2011 Sep 19. PMID: 21930870; PMCID: PMC3232808. Halilovic J, Heintz BH, Brown J. Risk factors for clinical failure in patients hospitalized with cellulitis and cutaneous abscess. J Infect. 2012 Aug;65(2):128-34. doi: 10.1016/j.jinf.2012.03.013. Epub 2012 Mar 21. PMID: 22445732. Paul M, Bishara J, Yahav D, Goldberg E, Neuberger A, Ghanem-Zoubi N, Dickstein Y, Nseir W, Dan M, Leibovici L. Trimethoprim-sulfamethoxazole versus vancomycin for severe infections caused by meticillin resistant Staphylococcus aureus: randomised controlled trial. BMJ. 2015 May 14;350:h2219. doi: 10.1136/bmj.h2219. PMID: 25977146; PMCID: PMC4431679. Lasko MJ, Gethers ML, Tabor-Rennie JL, Nicolau DP, Kuti JL. In Vitro Time-Kill Studies of Trimethoprim/Sulfamethoxazole against Stenotrophomonas maltophilia versus Escherichia coli Using Cation-Adjusted Mueller-Hinton Broth and ISO-Sensitest Broth. Antimicrob Agents Chemother. 2022 Mar 15;66(3):e0216721. doi: 10.1128/aac.02167-21. Epub 2022 Jan 10. PMID: 35007135; PMCID: PMC8923228. Lasko MJ, Tabor-Rennie JL, Nicolau DP, Kuti JL. Trimethoprim/sulfamethoxazole pharmacodynamics against Stenotrophomonas maltophilia in the in vitro chemostat model. J Antimicrob Chemother. 2022 Oct 28;77(11):3187-3193. doi: 10.1093/jac/dkac304. PMID: 36101486. Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ SIDP welcomes pharmacists and non-pharmacist members with an interest in infectious diseases, learn how to join here: https://sidp.org/Become-a-Member Listen to Breakpoints on iTunes, Overcast, Spotify, Listen Notes, Player FM, Pocket Casts, Stitcher, Google Play, TuneIn, Blubrry, RadioPublic, or by using our RSS feed: https://sidp.pinecast.co/ Check out our podcast host, Pinecast. Start your own podcast for free with no credit card required. If you decide to upgrade, use coupon code r-7e7a98 for 40% off for 4 months, and support Breakpoints.

Steve Feldman on THE DEFAULT OPTION - TMP/SMX and ARDS - Tame the EHR inbox - Menopause and derm: Part 2 - Dupi -> less ADHD - Check out our video content on VuMedi!: https://www.vumedi.com/channel/dermasphere/ Luke's PDPC course and the Intermountain Derm Society meeting: ⁠⁠⁠https://registration.socio.events/e/idspdpc23/promo-codes/ATTENDEE⁠⁠ The University of Utah's Dermatology ECHO: ⁠⁠https://physicians.utah.edu/echo/dermatology-primarycare⁠⁠Connect with us! - Web: ⁠https://dermaspherepodcast.com/⁠ - Twitter: @DermaspherePC - Instagram: dermaspherepodcast - Facebook: https://www.facebook.com/DermaspherePodcast/ - Check out Luke and Michelle's other podcast, SkinCast! ⁠https://healthcare.utah.edu/dermatology/skincast/⁠ Luke and Michelle report no significant conflicts of interest… BUT check out our friends at: - ⁠Kikoxp.com⁠(a social platform for doctors to share knowledge) - ⁠https://www.levelex.com/games/top-derm⁠ (A free dermatology game to learn more dermatology!)

A 34-year-old woman presents with uncomplicated UTI. Her last menstrual period ended approximately 5 days ago and has a history of bilateral tubal ligation approximately 5 years ago. She is otherwise healthy, has not received a systemic antimicrobial in the past year, denies drug allergies, and is not taking any medications. Per local antibiogram,  E. coli resistance rate to TMP/SMX is about 25%. Which of the following is the best choice for her therapy? A. Prescribe a course of 3-day oral trimethoprim-sulfamethoxazoleB. Order a single dose of IM ceftriaxoneC. Prescribe a 5-day course of oral nitrofurantoinD. Advise that a 1-week course of oral ciprofloxacin therapy is needed---YouTube: https://www.youtube.com/watch?v=lJA8_3zR5Ls&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=10Visit fhea.com to learn more!

Çocuklarda ateş yüksekliği acil servislerde sık karşılaştığımız bir durum olup, çoğunlukla viral enfeksiyonlara bağlıdır. Ancak tedavi yönünü tamamen değiştirecek bakteriyel enfeksiyonlara bağlı nedenleri de gözden kaçırmamak gerekir. Çocuklarda ateşin yaklaşık % 7'si idrar yolu enfeksiyonlarından (İYE) kaynaklanır. Uzun dönemde böbrek hastalıklarına da yol açabilecek bu tabloya acilci gözüyle yaklaşmak istedim. Yazıda yenidoğan dönemi dışındaki çocukluk çağı idrar yolu enfeksiyonlarından bahsedilmiştir. Keyifli okumalar dilerim. ​1​ ​2​ ​3​ Giriş İYE'nin genel prevalansı ateşli çocuklar arasında yaklaşık % 7 olsa da özellikle üç aydan küçük sünnetsiz erkek çocuklarda en yüksektir. Kız çocuklarda İYE sünnetli erkek çocuklara kıyasla iki ila dört kat daha fazla görülür. E. coli, % 80 oranıyla İYE'nin en yaygın bakteriyel nedenidir, diğer gram negatif bakteriyel patojenler arasında Klebsiella, Proteus, Enterobacter ve Citrobacter bulunur. Gram-pozitif bakteriyel etkenler arasında Staph. saprophyticus, Enterococcus ve nadiren Staph. aureus yer alır. E. coli dışındaki bir nedenle enfeksiyon, daha yüksek renal skar (dolayısıyla hipertansiyon ve son dönem böbrek hastalığı) olasılığı ile ilişkilidir. Virüsler ve mantarlar çocuklarda İYE'nin yaygın olmayan nedenleridir. Viral İYE genellikle alt üriner sistemle sınırlıdır. Fungal İYE için risk faktörleri, immünsüpresyon, geniş spektrumlu antibiyotik tedavisinin uzun süreli kullanımı ve kalıcı üriner kateter varlığıdır. Kime Test Yapalım? Nasıl Değerlendirelim? Verilmesi gereken ilk karar kimden idrar testi isteyeceğimizdir. Bu konudaki ilk zorluk küçük çocukların karın ağrısı, sırt ağrısı, dizüri, sık idrara çıkma gibi İYE ilişkili semptomları tanımlayamamasıdır. Bu gruptaki çocuklarda ateş, kusma ve huzursuzluk gibi non-spesifik semptomlar görülür. İYE olasılığını tahmin edebilen ve Pittsburg Üniversitesi'ne ait ‘UTICalc' hesaplayıcısı, idrar testi isteme konusundaki yardımcılardan biridir. Peki kimlerde risk fazladır ve dolayısıyla test eşiği düşük tutulmalıdır? Geçirilmiş İYE öyküsü Kadın cinsiyet Küçük yaş 1 yaşından küçük sünnetsiz erkekler > 39 derece ateş 48 saati geçen ateş Kusma Başka net bir ateş kaynağı olmaması Bağırsak ve mesane disfonksiyonu (kronik kabızlık dahil) VUR başta olmak üzere genitoüriner anormallikler Peki örnek nasıl alınmalıdır? Tuvalet eğitimi olmayan çocuklarda dipstick analizi, mikroskobik inceleme ve idrar kültürü için tercih edilen idrar toplama yöntemi kateterizasyon veya suprapubik aspirasyondur. Deneyimli personel varlığında quick-wee gibi teknikler kullanılabilir. Steril idrar poşeti ile örnek alınacaksa kültür için kullanılmamalıdır. Poşet örnekleri, dipstick analizi ve mikroskobik inceleme için ilk adım olarak kullanılabilir. Tuvalet eğitimi olan çocuklarda tüm bu tetkikler için orta akım idrarı kullanılabilir. Tüm idrar örnekleri alındıktan sonra yanlış sonuçlara sebebiyet vermemek için mümkün olan en kısa sürede incelenmelidir. İYE tanısı için kullanılan karakteristik testler. Kaynak: uptodateLE: lökosit esteraz Kimi Hastaneye Yatıralım? Kimi Taburcu Edelim? Hastaneye yatırılması gereken hasta grupları şu şekilde özetlenebilir: Yaş

The JournalFeed podcast for the week of May 30th to June 3rd, 2022. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. IV APAP = less morphine? Spoon Feed: A 1g dose of IV acetaminophen (APAP) had no additional effect on pain control or reduction in overall morphine dosage. Good And Bad of Abx Spoon Feed Antibiotics have a good and bad side for women with uncomplicated cystitis.  Use of trimethoprim-sulfamethoxazole (TMP-SMX) and other antibiotics, when compared to nitrofurantoin, had higher risk of adverse events.

The Curious Clinicians head all the way back to June, 2020 and reboot episode 3, exploring why trimethoprim/sulfamethoxazole can cause an isolated rise in creatinine.  Check out the show notes here.  Claim your CE/MOC credits here. 

Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the December 8, 2020 issue

Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak’s Chief of Nephrology! We’ve put together an AKI highlight reel - focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium.   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Written (including CME questions) and Produced by: Cyrus Askin, MD Infographic by: Cyrus Askin, MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Joel Topf, MD   Sponsors Pediatrics On Call podcast by the American Academy of Pediatrics If you provide medical care to children, Pediatrics On Call — the new podcast from the American Academy of Pediatrics — will help you do it better. Each week, hear the latest news and research on children's health, on topics from obesity and mental health to keeping the kiddos safe when they’re stuck at home. Subscribe from your favorite podcast provider or find the latest episodes here.   VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 00:00 Sponsors - VCU Health CE and Pediatrics On Call podcast by APP 00:30 Intro, disclaimer, guest bio 03:00 Guest one-liner, Picks of the Week*: Zoe Keating albums (Cellist); Mrs. America (TV series) on FX; The Last of Us (Videogame); 08:45 Sponsor - Pediatrics On Call podcast by APP 09:15 Definition of acute kidney injury (AKI) and fundamentals 11:00 Cardiorenal syndrome 12:24 Schema for AKI 17:30 Establish an etiology, determine urine output and address electrolyte abnormalities 21:22 AKI in the otherwise-healthy patient; 32:20 Rhabdomyolysis
38:21 Vancomycin 41:43 Acute interstitial nephritis (AIN) 44:52 Contrast induced nephropathy (CIN) 50:37 Gadolinium in AKI and/or CKD 52:53 Timing of dialysis 
 56:37 AKI in the out-patient setting and how to handle home meds e.g. TMP-SMX, RAAS inhibitors; 62:01 Is Ultrasound necessary in AKI
 64:58 Dr. Topf’s take home points and Plug for Seminars in Nephrology 68:45 Outro and Sponsor - VCU Health CE   Links* Dr. Topf: Nephrology & Social Media - May 2020, Vol 50, Issue 3, p 247-328 of Seminars in Nephrology Dr. Topf: Zoe Keating - cellist & composer Dr. Topf: Mrs. America a miniseries which dramatizes the women’s movement and fight for and against the Equal Rights Amendment in the 1970s Dr. Williams: Last of Us 2   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will develop a rational approach to the diagnosis and management of the patient with acute kidney injury (AKI).   Learning objectives After listening to this episode listeners will…   … be facile with the definition of AKI … have a framework for approaching AKI including an understanding of what features in a patient’s history may shed light on the diagnosis … appreciate prerenal azotemia and the relationship with ATN … develop an approach to rhabdomyolysis and AKI … be able to discuss the various types of AKI likely to be seen in the critically ill patient ... recognize the paradigm shift related to the safety when using iodinated contrast and gadolinium with regards to renal function … know common medications implicated in AKI … appreciate common AKI-related issues in the outpatient setting and have a head-start on how best to deal with them   Disclosures Dr. Topf has received honoraria from AstraZeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures.    Citation Topf J, Askin CA, Williams PN,  Watto MF. “#226 Kidney Boy on Acute Kidney Injury: Myths & Musings”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Original Air Date: July 20th, 2020.

On this episode of the The Curious Clinicians, Tony, Avi, and Hannah explore why trimethoprim/sulfamethoxazole can cause an isolated rise in creatinine.  Show notes: http://curiousclinicians.com/?p=561 CE/MOC: https://ce.vcuhealth.org/CuriousClinicians

A Curbsiders classic with a fresh intro by Hannah Abrams @hannahRabrams (soon to be MD)! Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis. Get deeper into potassium physiology with a FREE pdf copy of Joel’s book The Fluid Electrolyte and Acid Base Companion here. Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Sponsor ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20 Credits Written, edited and produced by: Matthew Watto MD, FACP Intro: Hannah R Abrams Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD Infographic and Cover Art: Matthew Watto MD, FACP Guest: Joel Topf MD Time Stamps 00:00 Sponsor -ACP’s IM Meeting 2020 in LA 00:28 Disclaimer, intro and guest bio 03:00 Guest one-liner Picks of the week* —Peloton indoor bike; The Nice Guys (film) by Shane Black; Forgotten Anne (PS4 videogame), “your local library” 09:00 Sponsor -ACP’s IM Meeting 2020 in LA 09:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia 17:00 Hyperkalemia and the EKG 20:31 Threshold for treatment of hyperkalemia 24:20 Use of telemetry and the U-shaped curve for potassium and mortality 27:11 Choice of therapy for acute hyperkalemia 30:13 Albuterol for hyperkalemia 31:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring 36:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron 40:10 Fludrocortisone for hyperkalemia 42:05 Calcium for elevated potassium 45:43 SPS, potassium binding resin 49:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis 55:28 Sodium bicarbonate for acute and chronic hyperkalemia 58:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia 60:05 Threshold for admission; Diet and potassium 62:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods 65:45 Patiromer and sodium zirconium 68:51 Loop diuretics and empiric potassium supplementation 71:12 Can diet alone be used to treat HYPOkalemia? 72:26 Take home points 74:40 NephMadness is coming! March 2019 76:53 Outro 78:00 Stuart’s shares a few puns *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr Topf’s blog lists the following disclosures “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018”. The Curbsiders were sponsored by ACP’s Internal Medicine Meeting 2019 for this episode. Citation Topf J, Williams PN, Brigham SK, Watto MF. “#137 Hyperkalemia Master Class with Joel Topf MD.” The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date: January 28, 2019. 

Nonbulllous pemphigoid - TMP/SMX + spironolactone -> death - Pain perception in HS - Skin cancer in Hispanics - Refractory AD may be (partially) ACD - One dose of a PD-1 inhibitor predicts response

Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Sponsor Join us at ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there! Credits Written and produced by: Matthew Watto, MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Infographic: Matthew Watto MD Edited by: Matthew Watto MD Guest: Dr Joel Topf MD   Time Stamps 00:00 Ad disclaimer, intro and guest bio 05:11 Guest one-liner and picks of the week —Peloton indoor cycle, “your local library”, The Nice Guys (film) by Shane Black, and Forgotten Hand (PS4 game) 11:17 ACP Internal Medicine Meeting 2019 details 12:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia 19:55 Hyperkalemia and the EKG 23:38 Threshold for treatment of hyperkalemia 27:20 Use of telemetry and the U-shaped curve for potassium and mortality 30:11 Choice of therapy for acute hyperkalemia 33:13 Albuterol for hyperkalemia 34:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring 39:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron 43:10 Fludrocortisone for hyperkalemia 45:05 Calcium for elevated potassium 48:43 SPS, potassium binding resin 52:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis 58:28 Sodium bicarbonate for acute and chronic hyperkalemia 61:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia 63:05 Threshold for admission; Diet and potassium 65:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods 68:45 Patiromer and sodium zirconium 71:51 Loop diuretics and empiric potassium supplementation 74:12 Can diet alone be used to treat HYPOkalemia? 75:26 Take home points 77:40 NephMadness is coming! March 2019 79:53 Outro 81:00 More Kidney Boy!

This week we dissect a JAMA article on the whether it's necessary to add TMP-SMX to cephalexin in the treatment of uncomplicated cellulitis https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_105_0_Final_Cut.m4a Download Leave a Comment Tags: Cellulitis, IDSA, Infectious Diseases, MRSA Show Notes SSTI Flow Diagram (Stevens 2014) EM Lit of Note: Double Coverage, Cellulitis Edition Pharm ER Tox Guy: Uncomplicated Cellulitis? Consider Strep-Only Coverage Core EM: Cellulitis Stevens DL et al.

This week we dissect a JAMA article on the whether it's necessary to add TMP-SMX to cephalexin in the treatment of uncomplicated cellulitis https://media.blubrry.com/coreem/content.blubrry.com/coreem/Episode_105_0_Final_Cut.m4a Download Leave a Comment Tags: Cellulitis, IDSA, Infectious Diseases, MRSA Show Notes SSTI Flow Diagram (Stevens 2014) EM Lit of Note: Double Coverage, Cellulitis Edition Pharm ER Tox Guy: Uncomplicated Cellulitis? Consider Strep-Only Coverage Core EM: Cellulitis Stevens DL et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infect...

Editor's Audio Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the May 23, 2017 issue

This week we review a number of controversial topics in SSTI management with a focus on the role of antibiotics in abscess management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_45_0_Final_Cut.m4a Download Leave a Comment Tags: Abscess, Cellulitis, Controversy, I+D, Irrigation, TMP-SMX Show Notes Core EM: Predictors of failed outpatient cellulitis treatment EM Nerd: The Case of the Pragmatic Wound REBEL EM: Trimethoprim-sulfamethoxazole for uncomplicated skin abscesses EM Lyceum: Abscess, “Answers” References Peterson D et al. Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients with Uncomplicated Cellulitis. Acad Emerg Med 2014; 21: 526-31. PMID: 24842503...

This week we review a number of controversial topics in SSTI management with a focus on the role of antibiotics in abscess management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_45_0_Final_Cut.m4a Download Leave a Comment Tags: Abscess, Cellulitis, Controversy, I+D, Irrigation, TMP-SMX Show Notes Core EM: Predictors of failed outpatient cellulitis treatment EM Nerd: The Case of the Pragmatic Wound REBEL EM: Trimethoprim-sulfamethoxazole for uncomplicated skin abscesses EM Lyceum: Abscess, “Answers” References Peterson D et al. Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients with Uncomplicated Cellulitis. Acad Emerg Med 2014; 21: 526-31. PMID: 24842503

This week we review a number of controversial topics in SSTI management with a focus on the role of antibiotics in abscess management. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_45_0_Final_Cut.m4a Download Leave a Comment Tags: Abscess, Cellulitis, Controversy, I+D, Irrigation, TMP-SMX Show Notes Core EM: Predictors of failed outpatient cellulitis treatment EM Nerd: The Case of the Pragmatic Wound REBEL EM: Trimethoprim-sulfamethoxazole for uncomplicated skin abscesses EM Lyceum: Abscess, “Answers” References Peterson D et al. Predictors of Failure of Empiric Outpatient Antibiotic Therapy in Emergency Department Patients with Uncomplicated Cellulitis. Acad Emerg Med 2014; 21: 526-31. PMID: 24842503

Stenotrophomonas maltophilia, a micro-organism which colonises plastic material was isolated in only 10 known cases of postcataract surgery endophthalmitis (PE) world-wide. We present characteristics, treatment and outcome in 26 cases of PE caused by S. maltophilia contaminated rinsing solution used during cataract surgery. Methods: 21/26 patients (81%) required pars plana vitrectomy and were treated with intravitreal, topical, subconjunctival and systemic antibiotics covering to the most likely pathogens. 2 days after surgery identification of S. maltophilia allowed change of therapy to trimethoprim/sulfamethoxazol (TMP-SMX) 960mg bid i.v. and Ciprofloxacin 400mg -750mg bid p.o. for 10 days and TMP-SMX 960mg bid p.o. and Ciprofloxacin 250mg or 500mg bid p.o. for further 20 days, complemented with i.v. Fluorcortolone and topical treatment. Vision was examined before and during, 1 and 6 months after acute PE. Results: Before cataract surgery visual acuity was