The StethoSCOOP - University of Cincinnati College of Medicine

UCMC
INTERNAL
MEDICINE
The StethoSCOOP
RESIDENCY
V O L U M E
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A U G U S T
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Weekly Calendar
SPECIAL
POINTS OF
INTEREST:
8/10: Noon Report: Yellow team Research Pathway
 High Yield
8/11 Noon Report: Red Team
Review!
 Neurohormonal
what?
8/12: Grand Rounds: Anumeha Gupta, MD: “Incorporating palliative care in Oncology: A new
paradigm in comprehensive cancer care
8/13: Weesner Prep: Anemia with Courtney
Academic Half-Day: High Yield Topics with Dr. Mathis
 Optimizing care of
patients with
Sickle Cell
8/14: Intern and Senior Noon Reports: Heme/Onc Team
Big thanks to Dr. Warm and his family for providing for an
awesome ice cream social. Thanks to everyone who turned
out to enjoy it! Suggestions for next month?
Disease
INSIDE
THIS ISSUE:
Heart Failure
2
NO SPORTS
2
Hyponatremia
3
Board Review
4
Sickle Cell
Updates
4
Weekend to-do 6
Medical Trivia
6
Shoutouts
6
Anonymous Feedback
Our website has a section for anonymous feedback. Think of this like an electronic suggestion box that you can use at any time. The message will be sent directly to Dr. Warm, and is
completely anonymous. If you have constructive feedback that you would like to share,
please use this tool. The link is: http://intmed.uc.edu/education/residency/feedback.aspx
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Heart Failure
QUICK HITS!
1. Quick hemodynamic assessment
2. Neurohormal pathophysiology
model
3. 5 things you can do for the
heart
No sports this Sunday, but start preparing for the annual
RESIDENT v. FACULTY SOCCER game. Look to take the
field sometime in September.
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Hyponatremia!
Plasma Na+ concentration is a measure of concentration and NOT of VOLUME
Disorders of plasma sodium concentration reflect an underlying disorder involving water homeostasis: an impaired ability of the kidneys to excrete free water due to the action of ADH
Urine Osmolarity: the appropriate response to hypo-osmolar serum (<275) is to excrete a
maximally dilute urine (Uosm <100); non-dilute urine (Uosm> 100) is evidence of impaired
free water exchange via appropriate or inappropriate ADH
Urine Na: appropriate renal response is to enhance Na reabsorption (UNa <10); when UNa
>20– evidence of either normal effective circulating volume or an intrinsic Na-wasting problem
Hyponatremia. Horacio J. Adrogué, M.D., and Nicolaos E. Madias, M.D. N Engl J Med 2000; 342:1581
-1589May 25, 2000DOI: 10.1056/NEJM200005253422107
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BOARD REVIEW WITH THE CHIEFS
DUST OFF THOSE OLD STETHOSCOPES, FOLKS. IT’S TIME TO START GEARING UP FOR
BOARDS. HERE IS A QUICK PEARL WE LEARNED THIS WEEK:
Q: 76 y/o female is admitted for a 1-week history of progressive weakness, nausea, and
anorexia. She lives independently but has become bedridden and confused during the
past 3 days. Her past medical history is notable for hypertension for which she takes
enalapril and chlorthalidone, which was started 2 weeks ago. Physical exam and
laboratory studies are consistent with hypotonic hyponatremia with a serum sodium of
111 meq/L. Therapy with 3% saline initiated and her mentation rapidly improves to
baseline.
Repeat labwork 10 hours later reveals the following: Serum Na of 121, Urine Na of 48
(from 82 on admission), Urine osmolality of 206 (from 486 on admission) and a urine
output of 400mL/h since admission. What is the next most appropriate treatment?
5% dextrose in water. This patient has hypotonic hyponatremia associated with altered
mentation, which typically warrants prompt correction with 3% saline. However, the increase in her
serum sodium level following treatment exceeds the recommended initial target of 4 to 6 meq/L (4-6
mmol/L) over the first 24 hours. The high urine volume and decreasing urine osmolality following
hypertonic saline administration reflect a rapid water diuresis and suggest that the serum sodium
level will likely continue to increase, placing the patient at increased risk for osmotic demyelination
syndrome (ODS). Therefore, hypotonic solutions such as 5% dextrose in water should be
administered with close follow-up of the serum sodium level, with the goal of maintaining the serum
sodium level in the range of 114 to 116 meq/L (114-116 mmol/L) in the first 24 hours.
Sterns RH, Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney Int. 2009;76
(6):587-589. PMID: 19721422
Sickle Cell Care
Updates
1. Watch for Epic patient alerts describing
individualized care plans unique to some
patients
2. The recommended safe maximum bolus of
IV hydromorphone is 2mg every 30
minutes for up to 4 doses
3. Keep an eye out for a new
and improved order set
coming soon.
Please direct questions about
care of patients with Sickle Cell
Disease at UCMC to Dr. Hyon
Kim at kim2ho@ucmail.uc.edu.
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Weekend To-Do:
Aug. 7-9: Lumenocity, 4-11 p.m. Friday, 3-11 p.m. Saturday, 3-11 p.m. Sunday, Washington Park,
1230 Elm St.,Over-the-Rhine. Live illuminated concert experience. Features music, new animations,
LumenoCity Village and more. Show tickets are sold out. 513-744-3372; lumenocity2015.com.
Aug. 7: Shakespeare in the Park, 7 p.m., Cottell Park, 5847 Irwin Simpson Road,Deerfield
Township. New production of “Romeo and Juliet.” Bring lawn chairs or blankets. Presented by Cincinnati Shakespeare Company. Free. 513-683-5805;www.cincyshakes.com.
Aug. 8-9: Slide the City, 9 a.m. Saturday-Sunday, University of Cincinnati, 2624 Clifton
Ave., University Heights. Event organizers set up 1,000-plus feet of padded vinyl to transform city
into one giant party. Food vendors and live music. $45, $40 advance. Spectators free. No
phone; www.slidethecity.com.
Aug. 8: Northside Second Saturdays, noon-midnight, Hamilton Avenue, Northside. Promotional
deals, art, exhibits, fashion, food and music. Free. 513-721-0200.
Aug. 9: Second Sunday on Main, noon-5 p.m., Main Street, 14th and Main streets, Over-theRhine. Street fair on Main featuring craft and food vendors, entertainment, demonstrations and
more. EcoMAINia. Free. 513-910-8845; www.secondsundayonmain.org.
TRIVIA
How does the
compound derived
from the plant at
right execute its
mechanism of
action?
Congratulations
to Leslie
Applegate for
identifying
mycosis
fungoides!
First correct answer to Stephen wins a
Starbucks or Copper Moon gift card!
SHOUT OUTS!!! (Let us know who Rocks)
-Shout out to Leila Borders for doing awesome work as our nocturnal cardiology
resident this past week!
-Shout out from the AOD: night float seniors for making an AOD's job easy? Robin
Wright, Darek Sanford, and Denada Palm were great and we ran some smooth
rapids together last weekend. Thanks!
-Shout out to Cody Lee for running his first code ever like a boss.
THE
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