Ryan O'Keefe
@rokeefemd.bsky.social
MD/MBA PennMedicine/Wharton | Hospitalist | Onc, Pall Care, MedEd | Creator Point of Care Medicine | Clinical threads and pearls
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
November 17, 2025 at 1:30 AM
New Substack post!
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
IM + Hospital Medicine Recap
Clinical Reviews - October, Part 1
The top lessons and pearls from clinical reviews featuring MGUS, inpatient hyponatremia, dermatologic emergencies, tinea infections, and hair loss in women!
See the post and subscribe here:
rokeefemd.substack.com/
Check out the @pointofcaremed page to learn more about ADHF and inpatient diuresis!
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
October 29, 2025 at 9:00 PM
Check out the @pointofcaremed page to learn more about ADHF and inpatient diuresis!
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
www.pointofcaremedicine.com/cardiology/...
www.pointofcaremedicine.com/blog-post/d...
STEP-HFpEF trial demonstrated that Glucagon-like peptide-1 (GLP-1) receptor agonists significantly improve symptoms, physical function, and weight in patients with obesity-related HFpEF
October 29, 2025 at 9:00 PM
STEP-HFpEF trial demonstrated that Glucagon-like peptide-1 (GLP-1) receptor agonists significantly improve symptoms, physical function, and weight in patients with obesity-related HFpEF
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) - Entresto - also have a class 2b recommendation, having missed the primary endpoint in the PARAGON-HF trial, episode suggests it may be considered, particularly for patients with lower-range ejection fractions or persistent hypertension.
October 29, 2025 at 9:00 PM
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) - Entresto - also have a class 2b recommendation, having missed the primary endpoint in the PARAGON-HF trial, episode suggests it may be considered, particularly for patients with lower-range ejection fractions or persistent hypertension.
Mineralocorticoid Receptor Antagonists (MRAs) like spironolactone hold a class 2b recommendation; TOPCAT trial was neutral but subgroup analyses of patients from the Americas showed a benefit in reducing hospitalizations; the Jury is still out though
October 29, 2025 at 9:00 PM
Mineralocorticoid Receptor Antagonists (MRAs) like spironolactone hold a class 2b recommendation; TOPCAT trial was neutral but subgroup analyses of patients from the Americas showed a benefit in reducing hospitalizations; the Jury is still out though
Sodium-glucose cotransporter-2 (SGLT2) inhibitors were the first drug class to meet primary endpoints in RCTs, reducing the composite of cardiovascular death and heart failure hospitalizations. (EMPEROR-Preserved Trial)
October 29, 2025 at 9:00 PM
Sodium-glucose cotransporter-2 (SGLT2) inhibitors were the first drug class to meet primary endpoints in RCTs, reducing the composite of cardiovascular death and heart failure hospitalizations. (EMPEROR-Preserved Trial)
You can also read it on the Point of Care Medicine website!
www.pointofcaremedicine.com/blog-post/q...
www.pointofcaremedicine.com/blog-post/q...
October 29, 2025 at 4:00 PM
You can also read it on the Point of Care Medicine website!
www.pointofcaremedicine.com/blog-post/q...
www.pointofcaremedicine.com/blog-post/q...
Questions from the Wards!
Check out the most recent Substack post published this AM!
After each month working in the hospital, I try to do a deep dive into a few topics / questions that came up. Here are a few of my recent favorites!
Zero fluff, high-yield. Subscribe for more to come.
Link below
Check out the most recent Substack post published this AM!
After each month working in the hospital, I try to do a deep dive into a few topics / questions that came up. Here are a few of my recent favorites!
Zero fluff, high-yield. Subscribe for more to come.
Link below
October 29, 2025 at 4:00 PM
Questions from the Wards!
Check out the most recent Substack post published this AM!
After each month working in the hospital, I try to do a deep dive into a few topics / questions that came up. Here are a few of my recent favorites!
Zero fluff, high-yield. Subscribe for more to come.
Link below
Check out the most recent Substack post published this AM!
After each month working in the hospital, I try to do a deep dive into a few topics / questions that came up. Here are a few of my recent favorites!
Zero fluff, high-yield. Subscribe for more to come.
Link below
Check out the @pointofcaremed page to learn more about syncope and LOC for guidance on HPI intake, treatment, and pearls!
www.pointofcaremedicine.com/inpatient/s...
And listen to our podcast episode on the topic!
creators.spotify.com/pod/profile...
www.pointofcaremedicine.com/inpatient/s...
And listen to our podcast episode on the topic!
creators.spotify.com/pod/profile...
October 22, 2025 at 9:00 PM
Check out the @pointofcaremed page to learn more about syncope and LOC for guidance on HPI intake, treatment, and pearls!
www.pointofcaremedicine.com/inpatient/s...
And listen to our podcast episode on the topic!
creators.spotify.com/pod/profile...
www.pointofcaremedicine.com/inpatient/s...
And listen to our podcast episode on the topic!
creators.spotify.com/pod/profile...
IM and Hospital Medicine Recap - Best of Podcasts and YouTube from September 2025!
Check out the most recent Substack post!
My favorite lessons from podcasts across various clinic topics including orthostatic hypotension, HFpEF, DOAC failure, and more!
Zero fluff, high-yield.
Link below!
Check out the most recent Substack post!
My favorite lessons from podcasts across various clinic topics including orthostatic hypotension, HFpEF, DOAC failure, and more!
Zero fluff, high-yield.
Link below!
October 22, 2025 at 4:04 PM
IM and Hospital Medicine Recap - Best of Podcasts and YouTube from September 2025!
Check out the most recent Substack post!
My favorite lessons from podcasts across various clinic topics including orthostatic hypotension, HFpEF, DOAC failure, and more!
Zero fluff, high-yield.
Link below!
Check out the most recent Substack post!
My favorite lessons from podcasts across various clinic topics including orthostatic hypotension, HFpEF, DOAC failure, and more!
Zero fluff, high-yield.
Link below!
October 21, 2025 at 8:57 PM
Check out the @pointofcaremed page to learn more about Tumor Lysis syndrome, intake, treatment, and pearls!
www.pointofcaremedicine.com/hematology-...
www.pointofcaremedicine.com/hematology-...
October 21, 2025 at 8:57 PM
Check out the @pointofcaremed page to learn more about Tumor Lysis syndrome, intake, treatment, and pearls!
www.pointofcaremedicine.com/hematology-...
www.pointofcaremedicine.com/hematology-...
Rasburicase (a recombinant urate oxidase) metabolizes existing uric acid into allantoin
It creates hydrogen peroxide as a byproduct which can lead to hemolytic anemia and methemoglobinemia in patients with G6PD deficiency - screen before giving
Image Source: emcrit.org/ibcc/tls/
It creates hydrogen peroxide as a byproduct which can lead to hemolytic anemia and methemoglobinemia in patients with G6PD deficiency - screen before giving
Image Source: emcrit.org/ibcc/tls/
October 21, 2025 at 8:57 PM
Rasburicase (a recombinant urate oxidase) metabolizes existing uric acid into allantoin
It creates hydrogen peroxide as a byproduct which can lead to hemolytic anemia and methemoglobinemia in patients with G6PD deficiency - screen before giving
Image Source: emcrit.org/ibcc/tls/
It creates hydrogen peroxide as a byproduct which can lead to hemolytic anemia and methemoglobinemia in patients with G6PD deficiency - screen before giving
Image Source: emcrit.org/ibcc/tls/
Allopurinol (xanthine oxidase inhibitor) prevents new uric-acid formation but does not clear existing urate.
Start 300 mg daily (or 100 mg three times daily)
Start 300 mg daily (or 100 mg three times daily)
October 21, 2025 at 8:57 PM
Allopurinol (xanthine oxidase inhibitor) prevents new uric-acid formation but does not clear existing urate.
Start 300 mg daily (or 100 mg three times daily)
Start 300 mg daily (or 100 mg three times daily)
Cairo-Bishop criteria distinguish between laboratory and clinical TLS
Laboratory TLS is defined by 2 or more of the following any time between 3 days prior to and 7 days after treatment:
- uric acid >8
- K > 6
- Phosphorus > 4.5
- corrected calcium < 7
Image Source: coreem.net/core/tumor-...
Laboratory TLS is defined by 2 or more of the following any time between 3 days prior to and 7 days after treatment:
- uric acid >8
- K > 6
- Phosphorus > 4.5
- corrected calcium < 7
Image Source: coreem.net/core/tumor-...
October 21, 2025 at 8:57 PM
Cairo-Bishop criteria distinguish between laboratory and clinical TLS
Laboratory TLS is defined by 2 or more of the following any time between 3 days prior to and 7 days after treatment:
- uric acid >8
- K > 6
- Phosphorus > 4.5
- corrected calcium < 7
Image Source: coreem.net/core/tumor-...
Laboratory TLS is defined by 2 or more of the following any time between 3 days prior to and 7 days after treatment:
- uric acid >8
- K > 6
- Phosphorus > 4.5
- corrected calcium < 7
Image Source: coreem.net/core/tumor-...
Spontaneous TLS can happen in highly proliferative disease even before therapy is started.
LDH is a surrogate for tumor proliferation - the higher it is at baseline, the more at risk the patient is for TLS.
Pictured: Lactate Dehydrogenase
Image Source: en.wikipedia.org/wiki/Lactat...
LDH is a surrogate for tumor proliferation - the higher it is at baseline, the more at risk the patient is for TLS.
Pictured: Lactate Dehydrogenase
Image Source: en.wikipedia.org/wiki/Lactat...
October 21, 2025 at 8:57 PM
Spontaneous TLS can happen in highly proliferative disease even before therapy is started.
LDH is a surrogate for tumor proliferation - the higher it is at baseline, the more at risk the patient is for TLS.
Pictured: Lactate Dehydrogenase
Image Source: en.wikipedia.org/wiki/Lactat...
LDH is a surrogate for tumor proliferation - the higher it is at baseline, the more at risk the patient is for TLS.
Pictured: Lactate Dehydrogenase
Image Source: en.wikipedia.org/wiki/Lactat...
⚕️September IM and Hospitalist Recap!⚕️
Tumor Lysis Syndrome (Review, NEJM)
Fun to read this update to their 2011 review! Always good to remind ourselves why some patients are getting q8 labs, and when to pull the trigger on rasburicase!
- Thread 🧵 -
Tumor Lysis Syndrome (Review, NEJM)
Fun to read this update to their 2011 review! Always good to remind ourselves why some patients are getting q8 labs, and when to pull the trigger on rasburicase!
- Thread 🧵 -
October 21, 2025 at 8:57 PM
⚕️September IM and Hospitalist Recap!⚕️
Tumor Lysis Syndrome (Review, NEJM)
Fun to read this update to their 2011 review! Always good to remind ourselves why some patients are getting q8 labs, and when to pull the trigger on rasburicase!
- Thread 🧵 -
Tumor Lysis Syndrome (Review, NEJM)
Fun to read this update to their 2011 review! Always good to remind ourselves why some patients are getting q8 labs, and when to pull the trigger on rasburicase!
- Thread 🧵 -
Some practical tips for taking care of patients with CKD in the hospital!
#TipsForHospitalists #MedEd #POCM
#TipsForHospitalists #MedEd #POCM
October 20, 2025 at 9:01 PM
Some practical tips for taking care of patients with CKD in the hospital!
#TipsForHospitalists #MedEd #POCM
#TipsForHospitalists #MedEd #POCM
IM and Hospital Medicine Recap - Best of Podcasts and YouTube from September 2025!
Check out the most recent Substack post!
My favorite lessons from podcasts across various clinic topics including orthostatic hypotension, HFpEF, DOAC failure, and more!
Zero fluff, high-yield.
Link below!
Check out the most recent Substack post!
My favorite lessons from podcasts across various clinic topics including orthostatic hypotension, HFpEF, DOAC failure, and more!
Zero fluff, high-yield.
Link below!
October 18, 2025 at 4:00 PM
IM and Hospital Medicine Recap - Best of Podcasts and YouTube from September 2025!
Check out the most recent Substack post!
My favorite lessons from podcasts across various clinic topics including orthostatic hypotension, HFpEF, DOAC failure, and more!
Zero fluff, high-yield.
Link below!
Check out the most recent Substack post!
My favorite lessons from podcasts across various clinic topics including orthostatic hypotension, HFpEF, DOAC failure, and more!
Zero fluff, high-yield.
Link below!
October 16, 2025 at 8:59 PM
Check out the @pointofcaremed page to learn more about outpatient CKD intake, treatment, and pearls!
www.pointofcaremedicine.com/outpatient/...
www.pointofcaremedicine.com/outpatient/...
October 16, 2025 at 8:59 PM
Check out the @pointofcaremed page to learn more about outpatient CKD intake, treatment, and pearls!
www.pointofcaremedicine.com/outpatient/...
www.pointofcaremedicine.com/outpatient/...
Goal of ESA treatment is to address symptoms.
The TREAT trial showed Hgb >13 did not lead to reduction in cardiovascular events, but did increase risk of stroke.
Thus, general goal is Hgb 10-11.5 and NOT normalization. Its a balance between addressing symptoms while maintaining safety.
The TREAT trial showed Hgb >13 did not lead to reduction in cardiovascular events, but did increase risk of stroke.
Thus, general goal is Hgb 10-11.5 and NOT normalization. Its a balance between addressing symptoms while maintaining safety.
October 16, 2025 at 8:59 PM
Goal of ESA treatment is to address symptoms.
The TREAT trial showed Hgb >13 did not lead to reduction in cardiovascular events, but did increase risk of stroke.
Thus, general goal is Hgb 10-11.5 and NOT normalization. Its a balance between addressing symptoms while maintaining safety.
The TREAT trial showed Hgb >13 did not lead to reduction in cardiovascular events, but did increase risk of stroke.
Thus, general goal is Hgb 10-11.5 and NOT normalization. Its a balance between addressing symptoms while maintaining safety.
Anemia is a near universal complication of advanced CKD, driven by decreased EPO production and impaired iron metabolism.
Image Source: www.ccjm.org/content/83/...
Image Source: www.ccjm.org/content/83/...
October 16, 2025 at 8:59 PM
Anemia is a near universal complication of advanced CKD, driven by decreased EPO production and impaired iron metabolism.
Image Source: www.ccjm.org/content/83/...
Image Source: www.ccjm.org/content/83/...
Guidelines recommend statins for nearly all CKD or ESRD patients over age 50, regardless of baseline cholesterol based on the SHARP trial
Note that it evaluated simvastatin and ezetimibe
Note that it evaluated simvastatin and ezetimibe
October 16, 2025 at 8:59 PM
Guidelines recommend statins for nearly all CKD or ESRD patients over age 50, regardless of baseline cholesterol based on the SHARP trial
Note that it evaluated simvastatin and ezetimibe
Note that it evaluated simvastatin and ezetimibe
Systolic BP target of <120 is guideline recommendation for most patients with CKD based on the SPRINT trial.
October 16, 2025 at 8:59 PM
Systolic BP target of <120 is guideline recommendation for most patients with CKD based on the SPRINT trial.