Table of Contents
From the Editor
- Decongesting heart failure with diuretics: Easier to prescribe than to fully understand
Digging deep into the pathophysiology of diuretic resistance reveals complex interacting pathways. But none of these pathways can fully explain or be used to safely reverse diuretic resistance.
The Clinical Picture
- Blue sclera: An overlooked finding of iron deficiency
The pathogenesis is thought to involve thinning of collagen fibers of the sclera due to iron deficiency, allowing the bluish color of the underlying uvea to become visible.
- Scaly plaques in a malnourished patient
A markedly low serum zinc level and the characteristic location of the rash in a patient with long-standing alcohol use disorder and cirrhosis led to the correct diagnosis.
- Mucormycosis presenting as dental pain
A root canal procedure failed to relieve the pain, and 1 week later the patient developed mobility of the left upper teeth.
1-Minute Consult
- How do I interpret and use quantitative buprenorphine and norbuprenorphine urine levels?
Confirmatory testing of urine samples can be useful in outpatient settings where buprenorphine dosing is not directly observed. But retaining and engaging the patient in effective treatment should be the ultimate goals of testing.
- How do we maximize diuresis in acute decompensated heart failure?
The initial goal is to maximize loop diuretic therapy using urine output or urinary sodium for guidance. Combination therapy can be used when patients respond poorly to escalating loop diuretic doses.
Atrial fibrillation: Rate control or rhythm control?Rate control has been preferred as the primary approach, but the pendulum is swinging in favor of rhythm control.
Symptoms to Diagnosis
- A 65-year-old man with melena and a blood disorder
The patient had chronic anemia related to primary myelofibrosis and was being treated with epoetin alfa and ruxolitinib, with blood transfusions every other week.
Guidelines to Practice
- Diagnostic stewardship for urinary tract infection: A snapshot of the expert guidance
New guidance on ordering, processing, and reporting urine cultures focuses on reducing unnecessary antibiotic use and the misdiagnosis of urinary tract infection.
Symptoms to Diagnosis
- Confusion in a 22-year-old woman, and diagnostic uncertainty
The patient had been complaining of gradual-onset and progressive headache and neck and back pain for 3 weeks.
Correction
- The role of GLP-1 receptor agonists in managing type 2 diabetes
The following article in the August 2022 issue contained an error: Nachawi N, Rao PP, Makin V. The role of GLP-1 receptor agonists in managing type 2 diabetes. Cleve Clin J Med 2022; 89(8): 457–464. doi:10.3949/ccjm.89a.21110
