Tony Breu
@tonybreu.bsky.social
Hospitalist, VA Boston Healthcare System. Co-host, Curious Clinicians Podcast
Reposted by Tony Breu
1/9
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
November 28, 2024 at 2:40 AM
1/9
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
Reposted by Tony Breu
If Tony breu is here we are in the right place
1/9
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
November 28, 2024 at 3:18 AM
If Tony breu is here we are in the right place
Reposted by Tony Breu
Glucose IS an effective osmole in the absence of insulin or insulin resistance. So hyperglycemia does lead to polydipsia (and polyuria due to osmotic diuresis)
November 28, 2024 at 12:42 PM
Glucose IS an effective osmole in the absence of insulin or insulin resistance. So hyperglycemia does lead to polydipsia (and polyuria due to osmotic diuresis)
Reposted by Tony Breu
1/
Does the tryptophan in turkey really cause a food coma?
I've heard this repeatedly, while also being told that it is a myth. Let's have a look at the physiology of a Thanksgiving meal...
Does the tryptophan in turkey really cause a food coma?
I've heard this repeatedly, while also being told that it is a myth. Let's have a look at the physiology of a Thanksgiving meal...
November 17, 2024 at 11:35 PM
1/
Does the tryptophan in turkey really cause a food coma?
I've heard this repeatedly, while also being told that it is a myth. Let's have a look at the physiology of a Thanksgiving meal...
Does the tryptophan in turkey really cause a food coma?
I've heard this repeatedly, while also being told that it is a myth. Let's have a look at the physiology of a Thanksgiving meal...
1/9
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
November 28, 2024 at 2:40 AM
1/9
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
🤔 Why doesn't an elevated BUN lead to extreme thirst? If increased serum osmolarity compels us to seek water, uremia should be a significant driver of this craving.
And yet, it isn't.
Let's examine why.
Reposted by Tony Breu
Sigh. Only about half of veterans with cirrhosis hospitalized with SBP received guideline-directed IV albumin:
journals.lww.com/ajg/abstract...
Rates increased from 2008 to 2022, but disparities persistent: black patients were less likely to get albumin than white patients.
Lots of work to do.
journals.lww.com/ajg/abstract...
Rates increased from 2008 to 2022, but disparities persistent: black patients were less likely to get albumin than white patients.
Lots of work to do.
Albumin for Spontaneous Bacterial Peritonitis: Care... : Official journal of the American College of Gastroenterology | ACG
ated trends and patient, practice-, and facility-level factors associated with use among patients with cirrhosis hospitalized for SBP confirmed with ascitic fluid criteria.
Results:
Among 3,871 Vet...
journals.lww.com
November 22, 2024 at 1:47 PM
Sigh. Only about half of veterans with cirrhosis hospitalized with SBP received guideline-directed IV albumin:
journals.lww.com/ajg/abstract...
Rates increased from 2008 to 2022, but disparities persistent: black patients were less likely to get albumin than white patients.
Lots of work to do.
journals.lww.com/ajg/abstract...
Rates increased from 2008 to 2022, but disparities persistent: black patients were less likely to get albumin than white patients.
Lots of work to do.
Reposted by Tony Breu
I'm in favor of still calling them #tweetorials as well. It feels delightfully anachronistic and points to the roots/history on the other platform. #MedSky, who is with me?
I agree, Liz.
I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread).
Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread).
Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
November 21, 2024 at 11:57 AM
I'm in favor of still calling them #tweetorials as well. It feels delightfully anachronistic and points to the roots/history on the other platform. #MedSky, who is with me?
Reposted by Tony Breu
Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia
This systematic review and meta-analysis evaluates the association of sodium correction rates with mortality among hospitalized adults with severe hyponatremia.
jamanetwork.com
November 19, 2024 at 4:51 AM
Honey, stop what you're doing, new hyponatremia research just dropped!
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
What's it say?
It looks like slow correction is associated with worse outcomes, like death and length of stay!
Was it just a small study?
No, it was a meta-analysis of almost 12,000 patients!
jamanetwork.com/journals/jam...
1/4
What is the mechanism of pruritus/itching in Hodgkin Lymphoma (HL)?
For today's Morning Report, Chief Resident Carter Baughman shared a case of HL that presented with months of pruritus. I was surprised to learn that up to 30% of patients with HL present with this symptom.
t.ly/RU2Qj
What is the mechanism of pruritus/itching in Hodgkin Lymphoma (HL)?
For today's Morning Report, Chief Resident Carter Baughman shared a case of HL that presented with months of pruritus. I was surprised to learn that up to 30% of patients with HL present with this symptom.
t.ly/RU2Qj
November 19, 2024 at 4:10 PM
1/4
What is the mechanism of pruritus/itching in Hodgkin Lymphoma (HL)?
For today's Morning Report, Chief Resident Carter Baughman shared a case of HL that presented with months of pruritus. I was surprised to learn that up to 30% of patients with HL present with this symptom.
t.ly/RU2Qj
What is the mechanism of pruritus/itching in Hodgkin Lymphoma (HL)?
For today's Morning Report, Chief Resident Carter Baughman shared a case of HL that presented with months of pruritus. I was surprised to learn that up to 30% of patients with HL present with this symptom.
t.ly/RU2Qj
Reposted by Tony Breu
I did not realize we are 60% oxygen by weight until today
Makes sense though. Neat. 🙂
Makes sense though. Neat. 🙂
2/
To begin, it's essential to understand which elements make up the human body. Amazingly, just six compose >98% of your weight:
➤Oxygen: 61% (varies based on water composition)
➤Carbon: 23%
➤Hydrogen 10%
➤Nitrogen: 2.6%
➤Calcium: 1.0%
➤Phosphorus: 0.6%
https://buff.ly/3YU4dIY
To begin, it's essential to understand which elements make up the human body. Amazingly, just six compose >98% of your weight:
➤Oxygen: 61% (varies based on water composition)
➤Carbon: 23%
➤Hydrogen 10%
➤Nitrogen: 2.6%
➤Calcium: 1.0%
➤Phosphorus: 0.6%
https://buff.ly/3YU4dIY
November 19, 2024 at 1:39 AM
I did not realize we are 60% oxygen by weight until today
Makes sense though. Neat. 🙂
Makes sense though. Neat. 🙂
This is fascinating. When can we expect to see this in print?
This study by challenges dogma
@anandvkulkarni.bsky.social gave a tapering dose of prednisone for alcohol hepatitis instead of 40mg for 28 days
And it paid off with fewer infections
@tonybreu.bsky.social
@anandvkulkarni.bsky.social gave a tapering dose of prednisone for alcohol hepatitis instead of 40mg for 28 days
And it paid off with fewer infections
@tonybreu.bsky.social
November 18, 2024 at 11:57 PM
This is fascinating. When can we expect to see this in print?
Reposted by Tony Breu
This study by challenges dogma
@anandvkulkarni.bsky.social gave a tapering dose of prednisone for alcohol hepatitis instead of 40mg for 28 days
And it paid off with fewer infections
@tonybreu.bsky.social
@anandvkulkarni.bsky.social gave a tapering dose of prednisone for alcohol hepatitis instead of 40mg for 28 days
And it paid off with fewer infections
@tonybreu.bsky.social
November 18, 2024 at 11:42 PM
This study by challenges dogma
@anandvkulkarni.bsky.social gave a tapering dose of prednisone for alcohol hepatitis instead of 40mg for 28 days
And it paid off with fewer infections
@tonybreu.bsky.social
@anandvkulkarni.bsky.social gave a tapering dose of prednisone for alcohol hepatitis instead of 40mg for 28 days
And it paid off with fewer infections
@tonybreu.bsky.social
I used @en.blueark.app to transfer tweetorials previously posted on Twitter here to @bsky.app. Very fair price and quick process.
If you do the same, note my previous comments, particularly regarding links and search.
If you do the same, note my previous comments, particularly regarding links and search.
A few observations on BlueSky, after a week of use:
☞REPOSTS v LIKES: I don't see what others like, so reposts seem more powerful
☞LINKS: These consume the number of characters in the link, not a set amount (like Twitter)
☞SEARCH: I'm underwhelmed. It doesn't consistently result posts I know exist
☞REPOSTS v LIKES: I don't see what others like, so reposts seem more powerful
☞LINKS: These consume the number of characters in the link, not a set amount (like Twitter)
☞SEARCH: I'm underwhelmed. It doesn't consistently result posts I know exist
November 18, 2024 at 10:46 PM
I used @en.blueark.app to transfer tweetorials previously posted on Twitter here to @bsky.app. Very fair price and quick process.
If you do the same, note my previous comments, particularly regarding links and search.
If you do the same, note my previous comments, particularly regarding links and search.
Reposted by Tony Breu
Ok, #SciSky… what are we calling a thread that explains a research paper? (What used to be a tweetorial.) Skysplainer? Blutorial?? Let’s see ‘em!
November 16, 2024 at 1:24 AM
Ok, #SciSky… what are we calling a thread that explains a research paper? (What used to be a tweetorial.) Skysplainer? Blutorial?? Let’s see ‘em!
Reposted by Tony Breu
Agreed. This is smart. Musk abandoned twitter. We love Twitter. Let's reclaim the name!
I agree, Liz.
I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread).
Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread).
Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
Why not still call it a tweetorial? That other platform is “X”
We don’t have to give up tweeting because Elon and Jack did.
We don’t have to give up tweeting because Elon and Jack did.
November 17, 2024 at 11:56 PM
Agreed. This is smart. Musk abandoned twitter. We love Twitter. Let's reclaim the name!
I agree, Liz.
I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread).
Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread).
Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
Why not still call it a tweetorial? That other platform is “X”
We don’t have to give up tweeting because Elon and Jack did.
We don’t have to give up tweeting because Elon and Jack did.
November 17, 2024 at 11:44 PM
I agree, Liz.
I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread).
Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
I favor continuing to call them tweetorials or using something that applies to all platforms (e.g., MedThread or EdThread).
Using something unique to each platform makes less sense to me. If I post a GIF or video, it's called a GIF or video, regardless of the site.
A few observations on BlueSky, after a week of use:
☞REPOSTS v LIKES: I don't see what others like, so reposts seem more powerful
☞LINKS: These consume the number of characters in the link, not a set amount (like Twitter)
☞SEARCH: I'm underwhelmed. It doesn't consistently result posts I know exist
☞REPOSTS v LIKES: I don't see what others like, so reposts seem more powerful
☞LINKS: These consume the number of characters in the link, not a set amount (like Twitter)
☞SEARCH: I'm underwhelmed. It doesn't consistently result posts I know exist
November 17, 2024 at 9:17 PM
A few observations on BlueSky, after a week of use:
☞REPOSTS v LIKES: I don't see what others like, so reposts seem more powerful
☞LINKS: These consume the number of characters in the link, not a set amount (like Twitter)
☞SEARCH: I'm underwhelmed. It doesn't consistently result posts I know exist
☞REPOSTS v LIKES: I don't see what others like, so reposts seem more powerful
☞LINKS: These consume the number of characters in the link, not a set amount (like Twitter)
☞SEARCH: I'm underwhelmed. It doesn't consistently result posts I know exist
Reposted by Tony Breu
Reposted by Tony Breu
I am at the beginning of my AI journey of discovery, you know the place where you are still dumbfounded by what the machine can do. In this case it developed a pretty compelling electrolyte curriculum for nephrology fellows 😳
pbfluids.com/2024/11/ai-c...
pbfluids.com/2024/11/ai-c...
AI Curriculum
I am still in the “amazed by what AI can do” stage Here is me prompt i am teaching a class on electrolyte abnormalities for nephrologists. What would be good tricky things to teach I th…
pbfluids.com
November 17, 2024 at 6:01 AM
I am at the beginning of my AI journey of discovery, you know the place where you are still dumbfounded by what the machine can do. In this case it developed a pretty compelling electrolyte curriculum for nephrology fellows 😳
pbfluids.com/2024/11/ai-c...
pbfluids.com/2024/11/ai-c...
Reposted by Tony Breu
This radiologist applauds this thread. Btw, you can also go the other way, I’ve used air (careful where you put it!) and CO2 as “inverse” contrast in people allergic to Iodine contrast.
November 17, 2024 at 3:12 PM
This radiologist applauds this thread. Btw, you can also go the other way, I’ve used air (careful where you put it!) and CO2 as “inverse” contrast in people allergic to Iodine contrast.
Reposted by Tony Breu
one cause of hypernatremia in ICU = recovery from AKI!
[1] urea *accumulates* while kidney is failing…
[2] kidney recovers➡️ clearance of accumulated urea obligates the excretion of H2O
(similar to using oral urea to tx hypoNa)
so hypernatremia can be a sign of renal recovery 🤯
#EMIMCC #nephsky
[1] urea *accumulates* while kidney is failing…
[2] kidney recovers➡️ clearance of accumulated urea obligates the excretion of H2O
(similar to using oral urea to tx hypoNa)
so hypernatremia can be a sign of renal recovery 🤯
#EMIMCC #nephsky
November 16, 2024 at 4:57 PM
Thank you Paul!
Nobody can enliven pathogenesis and other questions in medicine better than @tonybreu.bsky.social
Latest example ⬇️:
Latest example ⬇️:
1/14
🤔 Why do we use iodine as an intravenous contrast agent?
The answer requires a review of the composition of the human body and a brief tour of one of my favorites, the Periodic Table of Elements.
🤔 Why do we use iodine as an intravenous contrast agent?
The answer requires a review of the composition of the human body and a brief tour of one of my favorites, the Periodic Table of Elements.
November 17, 2024 at 12:14 AM
Thank you Paul!
Reposted by Tony Breu
Now I feel like Bluesky has made it. I missed these. I use your tweetorial of why PWIDs develop R-sided endocarditis without *apparent* valvular damage in class 👍
November 16, 2024 at 10:07 PM
Now I feel like Bluesky has made it. I missed these. I use your tweetorial of why PWIDs develop R-sided endocarditis without *apparent* valvular damage in class 👍
1/14
🤔 Why do we use iodine as an intravenous contrast agent?
The answer requires a review of the composition of the human body and a brief tour of one of my favorites, the Periodic Table of Elements.
🤔 Why do we use iodine as an intravenous contrast agent?
The answer requires a review of the composition of the human body and a brief tour of one of my favorites, the Periodic Table of Elements.
November 16, 2024 at 9:28 PM
1/14
🤔 Why do we use iodine as an intravenous contrast agent?
The answer requires a review of the composition of the human body and a brief tour of one of my favorites, the Periodic Table of Elements.
🤔 Why do we use iodine as an intravenous contrast agent?
The answer requires a review of the composition of the human body and a brief tour of one of my favorites, the Periodic Table of Elements.