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IV contrast doses used for CT scans appear to fall below the toxic threshold for nephrotoxicity, with no convincing evidence they cause acute kidney injury (AKI) in most patients.
Source
The dose of iodinated contrast required for a CT scan is below the toxicological threshold of concern for nephrotoxicity: a toxicological perspective. JEM Rep. 2026 Jun;5(2). doi: 10.1016/j.jemrpt.2026.100220.
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In this retrospective cohort study, a single 50 mL dose of 8.4% sodium bicarbonate (HTB) was more likely than 100 mL of 3% hypertonic saline (HTS) to achieve a ≥4 mEq/L increase in serum sodium in patients with severe hyponatremia.
Source
Comparison of 8.4% Sodium Bicarbonate vs. 3% Sodium Chloride in Severe Hyponatremia: A Retrospective Cohort Study. Acad Emerg Med. 2026 Apr;33(4):e70283. doi: 10.1111/acem.70283. PMID: 41937305
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Check out the latest installment in JAMA’s Rational Clinical Exam series, which covers intra-vascular volume overload.
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Does This Patient Have Volume Overload?: The Rational Clinical Examination. JAMA. 2026 Feb 23. doi: 10.1001/jama.2026.0446. Epub ahead of print. PMID: 41729549
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When comparing IV insulin lispro versus IV insulin regular for hyperkalemia in the ED, lispro was associated with a significant decrease in potassium but an increase in hypoglycemic events.
Source
Comparison of Single-Dose Intravenous Insulin Regular vs. Insulin Lispro for Hyperkalemia Treatment in the Emergency Department: The SIR-LISPRO Trial. Am J Emerg Med. 2025 Dec 26;101:92-98. doi: 10.1016/j.ajem.2025.12.031. Epub ahead of print. PMID: 41477935; PMCID: PMC12810486.
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Drop the delta-delta and learn a simpler approach to acid-base calculations! Once you learn the basics, check your math with the JournalFeed Acid-Base Calculator.
Source
Quantitative Acid-Base: A Simplified Approach for the Emergency Physician. J Emerg Med. 2025 Oct;77:50-60. doi: 10.1016/j.jemermed.2025.07.021. Epub 2025 Jul 15. PMID: 40850064.
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In this retrospective study of ED-diagnosed UTIs, Cephalexin dosed twice daily was just as effective as four times daily, with no significant difference in treatment failure – suggesting BID dosing may be a practical, adherence-friendly option in some patients.
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Cephalexin twice daily versus four times daily for the treatment of urinary tract infections diagnosed in the emergency department. Am J Emerg Med. 2025 Jul;93:80-85. doi: 10.1016/j.ajem.2025.03.058. Epub 2025 Mar 24. PMID: 40184663
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Irregularities in potassium (both hyper- and hypo-) increased the likelihood of in-hospital cardiac arrest (IHCA), but only hyperkalemia was associated with worse post-resuscitation outcomes.
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Potassium Levels and In-Hospital Cardiac Arrest: A Matched Case-Control Study. Crit Care Med. 2025 Jul 1;53(7):e1426-e1436. doi: 10.1097/CCM.0000000000006713. Epub 2025 May 19. PMID: 40387484
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In patients with CKD and gout, acute flares should avoid NSAIDs and consider either dose-adjusted colchicine, oral steroids, or intra-articular steroids; for urate lowering, start low and go slow with allopurinol.
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Gout Management in Patients With CKD. Am J Kidney Dis. 2025 Jul 1:S0272-6386(25)00924-2. doi: 10.1053/j.ajkd.2025.04.020. Epub ahead of print. PMID: 40609855
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This meta-analysis suggests that patients with hypernatremia may have a mortality and length of stay benefit with a faster correction goal than current guidelines.
Source
Systematic review and meta-analysis of the treatment of hypernatremia in adult hospitalized patients: impact on mortality, morbidity, and treatment-related side effects. J Crit Care. 2025 Jun;87:155012. doi: 10.1016/j.jcrc.2024.155012. Epub 2025 Jan 6. PMID: 39765195
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For resistant hypertension, amiloride was noninferior to spironolactone in lowering blood pressure at 3-month follow-up.
Source
Spironolactone vs Amiloride for Resistant Hypertension: A Randomized Clinical Trial. JAMA. 2025 May 14:e255129. doi: 10.1001/jama.2025.5129. Epub ahead of print. PMID: 40366680