Mechanism of Calcium for Hyperkalemia – Not What You Think
Spoon Feed
Giving calcium for hyperkalemia restores normal cardiac conduction velocity but does not restore resting membrane potential, as is commonly stated.
Source
Beneficial Effect of Calcium Treatment for Hyperkalemia Is Not Due to "Membrane Stabilization". Crit Care Med. Published online July 24, 2024. PMID: 39046789.
Continued Controversy Between Contrast and Kidneys
Spoon Feed
In patients with ACS and concern for STEMI/NSTEMI requiring urgent intervention, randomization to the contrast volume reduction (CVR) group reduced the rate of acute kidney injury (AKI) and sustained kidney damage.
Source
Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes. J Am Coll Cardiol. 2024;83(11):1059-1069. doi:10.1016/j.jacc.2024.01.016
Septic Kids (And Their Kidneys) Like Balanced Fluids
Spoon Feed
The use of balanced crystalloid (PlasmaLyte A) rather than normal saline (0.9% sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock.
Source
Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial. Crit Care Med. 2023 Nov 1;51(11):1449-1460. doi: 10.1097/CCM.0000000000005952. Epub 2023 Jun 9.
ACORN RCT – Piperacillin-Tazobactam or Cefepime?
Spoon Feed
In this randomized control trial of patients receiving cefepime or piperacillin-tazobactam, there was no difference in risk of acute kidney injury between the two groups. However, those who received cefepime were more likely to have neurologic side effects.
Source
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023 Oct 14:e2320583. doi: 10.1001/jama.2023.20583. Online ahead of print.
Is Nirmaltrevir-Ritonavir (Paxlovid) Safe for CKD or Dialysis Patients?
We're trying something new! Watch quick videos, with my personal take on the articles we cover each week and more! Here's the JournalFeed YouTube channel link. ~Clay
Spoon Feed
Modified dose nirmaltrevir-ritonavir is well-tolerated in patients with CKD as therapy for mild COVID-19 and effectively suppresses viral load.
Source
Safety Profile and Clinical and Virological Outcomes of Nirmatrelvir-Ritonavir Treatment in Patients With Advanced Chronic Kidney Disease and Coronavirus Disease 2019 (COVID-19). Clin Infect Dis. 2023 Aug 2:ciad371. doi: 10.1093/cid/ciad371. Epub ahead of print.
DOACS Better than Warfarin in A-fib Even in CKD Patients
Spoon Feed
Analysis of multiple prior RCTs finds direct oral anticoagulants (DOAC) have improved safety and efficacy vs. warfarin in atrial fibrillation (AF) even as renal function decreases to as low as 25 mL/min.
Source
Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF. Circulation. 2023 Jun 6;147(23):1748-1757. doi: 10.1161/CIRCULATIONAHA.122.062752. Epub 2023 Apr 12.
Can Clinical or Lab Variables Predict Dehydration Severity in Children with DKA?
Spoon Feed
Most pediatric patients with diabetic ketoacidosis (DKA) have mild to moderate dehydration. Clinical and laboratory variables in isolation are not accurate predictors of rehydration needs.
Source
Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis. Ann Emerg Med. 2023 Apr 4;S0196-0644(23)00002-1. doi: 10.1016/j.annemergmed.2023.01.001. Online ahead of print.
Hyperkalemia in a Hemolyzed Pediatric BMP: Repeat or Do Not Repeat?
Spoon Feed
There is rarely any need to repeat potassium testing when the laboratory reports hyperkalemia on a hemolyzed sample in a child with a normal blood urea nitrogen (BUN) and creatinine (Cr).
Source
Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat? Pediatr Emerg Care. 2023 Jan 1;39(1):e1-e5. doi: 10.1097/PEC.0000000000002857. Epub 2022 Sep 29.
REFACED RCT – Is Fluid Restriction in Sepsis Feasible?
Spoon Feed
IV crystalloid fluid restriction in the first 24-hours for ED sepsis patients without associated shock significantly reduced volumes when compared to standard of care. A larger trial investigating patient-centered outcomes is likely imminent.
Source
Restrictive fluids versus standard care in adults with sepsis in the emergency department (REFACED): A multicenter, randomized feasibility trial. Acad Emerg Med. 2022 Oct;29(10):1172-1184. doi: 10.1111/acem.14546. Epub 2022 Aug 5.
Hypo-K+ Equals Hypo-Mg++…Right??
Spoon Feed
This retrospective single-center study found that hypokalemic patients who received magnesium within 4 hours of their potassium supplementation had no significant difference in time to serum potassium normalization.
Source
The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department. J Emerg Med. 2022 Oct 11:S0736-4679(22)00347-X. doi: 10.1016/j.jemermed.2022.06.007. Epub ahead of print.