Hospital Medicine
- 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.
- 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.
- A clinical trial and another clinical practice bites the dust, or should there not be an appendix?
Studies over the past 2 decades have assessed an alternative approach to acute appendicitis: treatment with systemic antibiotics and observation.
- Appendicitis management: Is it time for a change?
Antibiotic therapy has been a successful alternative to surgery for more than 60 years, but surgery is still the primary treatment.
- Dyspnea and cough in a lung transplant recipient
The patient developed sudden shortness of breath at rest, a decline in home spirometry values, and dry cough and fatigue.
Anticoagulation management of post-cardiac surgery new-onset atrial fibrillationA review of studies and recommendations for this condition.
- Hampton hump in acute pulmonary embolism
A 50-year-old patient presented with worsening dyspnea and cough with bilateral swelling of the lower extremities, with left-side swelling greater than right-side swelling.
- Treating anemia: It’s not just the EPO
Long-term effects of treatment with the new oral inhibitors of prolyl hydroxylase will need to be carefully monitored, as prolyl hydroxylase is a key structural component of diverse proteins.
- The devil is in the details: Approach to refractory hypokalemia
The authors illustrate a stepwise approach to the evaluation of acid-base disturbances.
- Glycemic targets in the ICU: A look back, and ahead
Much work is still needed to understand the nuances of glycemic targets in critically ill patients, and to learn how to take advantage of evolving technology to improve glycemic control.