Carolina

Consultant in Paediatric Palliative Medicine

[Jeremy Corbyn @jeremycorbyn]

When elderly people, lawyers, vicars and doctors are being arrested for sitting peacefully, something has gone very very wrong.

[Ibon Perez @IbonPerezTV]

Impresionante cómo @informativost5 usa la realidad aumentada para narrar, paso a paso, lo que ocurrirá desde el inicio del cónclave hasta el icónico ‘habemus papam’. Incluso se escucha el eco de los pasos en la Capilla Sixtina. Una maravilla audiovisual

[RTVE Noticias @rtvenoticias]

#TDResumen2024 | Aitana Sánchez Gijón recuerda a las víctimas de violencia de género de 2024: “Más de 40 nombres propios que ya nadie pronunciará en 2025. Más de 40 mujeres asesinadas. Más de 40 vidas truncadas”.

https://t.co/LHxV7XZTjG

[Antonio Iofrío @AntonioIofrio]

Como cada 1 de enero, Concierto de Año Nuevo, saltos de esquí… y el Calendario de Vacunaciones e inmunizaciones de la @aepediatria @CAV_AEP
Hilo con las novedades para 2025 🧵

[literland @literlandweb1]

Último deseo y último consejo del año: “(…) Lo bueno es aquello que sin grandes destellos lo llena todo.”
"Nada", Carmen Laforet

[Nigel Gooding @PortmanBlueBoy]

Start the New Year with a new challenge and join our amazing paediatric pharmacy team in Cambridge @CUH_Pharmacy This role will provide multiple opportunities for you to develop at an advanced practice level
https://t.co/jFSAnBq02e

[Carolina @13Ororo]

Can’t wait to organize another course with @PaNGEaCambridge

[Juan Diego Botto @JuanDiegoBotto]

Feliz día de la constitución, uno de mis libros de ficción favoritos.

[Lessie 🪐 @YouAreMyBezoar]

how the email finds me

[Inés Martín Rodrigo @imartinrodrigo]

"No more shame".

#25N

[The King's Fund @TheKingsFund]

Compassionate leadership helps to create psychologically safe working environments. Previous studies on doctors, nurses & midwives have shown that the wellbeing of health & care staff is affected by 8 key factors, organised into 3 core needs 👇 Read more: https://t.co/FUb45jbTRt

[Ainhoa Paredes @AinhoaParedesUK]

🇬🇧 La película @SoyNevenka ha llegado a #Londres. El público ha tenido la suerte de poder escuchar a Icíar Bollaín y a Nevenka Fernández. Sala llena por segundo día consecutivo y muchos aplausos 👏🏻👏🏻👏🏻 #IamNevenka #cinema 🎞️ #London #LFF #SoyNevenka @BFI #LFF2024 🎦

[Salvados @salvadostv]

Esto seguro que a muchas os suena:
“Cuando las mujeres nos quejamos de problemas médicos no catalogados, se nos trata de locas”.

#SalvadosEssure

[Consulado General de España en Londres @CGEspLondres]

🗓✈️ A partir del 02 de abril 2025, los ciudadanos españoles necesitarán una #autorización de viaje electrónica ETA (Electronic Travel Authorisation), para #viajar a Reino Unido🇬🇧

Toda la ℹ️ en detalle: https://t.co/TN0ODPSC5U

[Dr Ben Bowers @Ben_Bowers__]

Please could you help our research into peoples needs regarding systems for using injectable end-of-life symptom control medications at home 🏡 More info & short 5 min survey⬇️

Pls RT. Keen to have members of the public views

https://t.co/DInfjBZzZP

@PELi_Cam @MarieCurieEOLC

[Prof. Christina Pagel - @chrischirp.bsky.social @chrischirp]

Prof @Kevin_Fong giving the most devastating and moving testimony to the Covid Inquiry of visiting hospital intensive care units at the height of the second wave in late Dec 2020.

The unimaginable scale of death, the trauma, the loss of hope.
Please watch this 2min clip.

[Dr Kevin Fong @Kevin_Fong]

Thank you to the many thousands of people across the whole of the NHS & social care who helped deliver the care during the pandemic. Has been a strange and difficult day. But felt it was important to give witness to some small part of the enormity of the challenge we all faced.

[NPEGNorwich @NPEG12]

NPEG is proud to announce out next webinar. Thur 5th Sept: Cow's Milk Allergy. No registration required. https://t.co/x0mmeO8hMZ @DrNickTwit @nnuhjlch @NNUH @eastpaeds @alex_brightwell

[SrivatsaNagachandan @Srivatsa34]

🧠 Understanding Lactate: A Critical Biomarker in Clinical Practice 🧠

Overview:
Lactate, a product of anaerobic glycolysis, serves as a crucial indicator of either Type A (oxygen delivery issues) or Type B (altered metabolism) causes. It’s predominantly cleared by the liver, and its accumulation leads to lactic acidosis.

Lactate Levels:

•Normal Range: 0.6-1.8 mmol/L
•Hyperlactatemia: 2-5 mmol/L
•Severe Lactic Acidosis: > 5 mmol/L
•Critical Threshold: Lactate > 8 mmol/L indicates high mortality risk.

Physiology:
Lactate is produced at approximately 20 mmols/kg/day, entering circulation and undergoing hepatic and renal metabolism (Cori cycle). All tissues can produce lactate under anaerobic conditions, with significant contributions from skin, red cells, brain, muscle, and gut.

Lactate Metabolism:

•Primarily metabolized in the liver (60%) and kidney (30%).
•The heart can also utilize lactate for ATP production.
•Converted into glucose (50%) or CO2 and water (50%) without net acid accumulation.

Pathophysiology:
Lactic acidosis may arise from excessive tissue lactate production or impaired hepatic clearance, often seen in conditions like sepsis and ARDS. It is crucial to differentiate between Type A (inadequate oxygen delivery) and Type B (metabolic issues).

Type A Causes:

•Anaerobic muscular activity (e.g., sprinting, convulsions)
•Tissue hypoperfusion (e.g., shock, cardiac arrest)
•Reduced oxygen delivery/utilization (e.g., hypoxaemia, CO poisoning)

Type B Causes:

•B1: Underlying diseases like leukemia, thiamine deficiency, or hepatic failure.
•B2: Drugs and toxins including beta-agonists, methanol, or biguanides.
•B3: Inborn errors of metabolism.

Diagnosis:
Measuring plasma lactate levels is key, followed by identifying and treating the underlying cause. D-lactate, produced by intestinal bacteria, is a noteworthy isomer not detected by standard assays.

Management:

•Address the root cause and restore adequate oxygen delivery.
•Use bicarbonate cautiously, as studies show minimal benefit in correcting lactic acidosis.
•Dialysis/haemofiltration can be a useful marker of disease progression, though not a primary treatment.

Evidence:

•Elevated lactate levels correlate with higher mortality.
•Lactate clearance is a strong prognostic marker, non-inferior to ScVO2 monitoring in guiding therapy.

Practical Tips for Sample Collection:

•Venous samples are typically equivalent to arterial ones in clinical settings.
•No need to remove the tourniquet unless venous access is prolonged.
•Store samples properly to ensure accuracy, and repeat measurements if elevated after 4 hours or sooner with a change in condition.

Understanding and managing lactate is vital for improving patient outcomes, especially in critical care settings. Let’s continue to deepen our knowledge and refine our practices to better serve our patients.

#CriticalCare #IntensiveCare #Lactate #MedicalScience #PatientCare #Sepsis #Acidosis

courtesy: https://t.co/nkQdcdTwgM