John Njoroge

Student of/for life. Med student. #MedEd and #FOAMed enthusiast. Medical History novice.

[Keith Siau @drkeithsiau]

An easy NEJM image challenge today - endoscopic findings of the oesophagus in a patient with coffee ground vomiting. These were the findings on admission (top row) and one week later (bottom row). What’s the name of this syndrome?

[Joel M. Topf, MD FACP @kidney_boy]

ASN has released the program this year's #KidneyWk and I always thought they should lean into controversy, but this is going over the line.
A cage match?
Bare knuckle boxing?

[Brian Rifkin, MD @brian_rifkin]

The KDIGO AKI bundle #ERA26

[Javi del Cid @javidlcid]

Considering non-myopathic causes of elevated CK before initiating an extensive neuromuscular workup is essential for diagnostic efficiency, patient safety. Up to 1.3% of the general population exhibits asymptomatic or oligosymptomatic hyperCKemia, #eular2026 #london #autoimmune

[John Njoroge @4donjohn]

@Radion_Popalzai @schowardjd +1

[Dr Sudhir Kumar MD DM @hyderabaddoctor]

An HbA1c of 6.4% does not ALWAYS mean Prediabetes (as shown in this case)

A patient underwent routine testing.
🔹 HbA1c: 6.4%
🔹 Hemoglobin: 7.5 g/dL
🔹 MCV: 75 fL
🔹 MCH: 20 pg
At first glance, many would label this patient as having prediabetes. But that conclusion may be wrong.
1/n

[Suchitha Kuntla @DocPeriop]

Esmolol, a short acting cardio-selective Beta-1 adrenergic antagonist, is one the common drugs used for:

-rate control in SVTs
-hypertensive emergencies
-aortic dissection
-thyrotoxicosis
and in the Perioperative period as a hypotensive agent.

It is given as boluses/ continuous infusions, at well defined rates of 150-1000mcg/kg/min.

One needs to understand that Esmolol is hydrolysed by RBC and Plasma non-specific esterases, into acid metabolites (1/1500 times potent as esmolol) and METHANOL. Both the products are excreted by renal routes.

The methanol produced is barely closer to toxicity thresholds. But, on prolonged continuous infusions, accumulation of methanol can result in toxidrome of it's own.

It isn't very common occurrence and only anecdotes are all we have now, but, unexplained metabolic acidosis with High anion and Osmolal gaps in a patient on continuous infusion of ESMOLOL should probe you to think of its metabolite: METHANOL.

Sources:

1.https://t.co/gMuusvIcJ2

2.https://t.co/1oLxnvKkPo

[John Njoroge @4donjohn]

@cbgitter @EmpiricGame @thecurbsiders @COREIMpodcast @FreelyFiltered @CuriousClinPod Love these
Other 🔥ones: @CritCareTime @IDiots_pod @CPSolvers

[John Njoroge @4donjohn]

@drkeithsiau Barrett’s esophagus

[Josh Farkas MD 💊 @PulmCrit]

I'll start- the neutrophil/lymphocyte ratio (NLR) substantially outperforms the WBC for detection of infection

using WBC as an indicator of infection made sense 50 years ago. we have better instruments & its time to move on from the WBC

more on NLR here: https://t.co/unXP991e7p

[Nick Mark MD @nickmmark]

@PulmCrit A fun exercise to do with a CBC is to show people the counterintuitive fact that most of their 35 trillion cells are RBCs.

Normal RBC count = 5 million / uL
= 5 billion / mL
= 5 trillion / L
5 trillion RBCs/L * 5 liters = 25 trillion RBCs

25 / 35 = 71% of your cells are RBCs

[John Njoroge @4donjohn]

@AlhajiKe 🙏🏿

[Papa Heme @Papa_Heme]

How I perform informed consent in oncology!

1.Discuss diagnosis
2.Natural course of disease without treatment
3.Treatment options (pros/cons)
4.Explore patients opinions on above
5.Make treatment recommendation, explain why (integrating #4)
6.Toxicities
7.Ask patient to explain in own words
8.Document

[Tony Breu @tony_breu]

1/14
Why can't you use direct oral anticoagulants (DOACs) in patients with mechanical valves (MVs)?

DOACs have been one of the most important advances in my career. And yet, the presence of a MV is one of the few contraindications.

The reason highlights the unique nature of thrombus formation in those with a MV and provides insights into the evolution of human hemostasis.

[Nikolas Spyrou @NikolaSpyrouMD]

Intuitive interpretation of iron labs.
I wish I knew that in med school :-)

[Braydon Dymm, MD @BraydonDymm]

Eyelid myokymia: benign fasciculation of the orbicularis oculi, a clinical diagnosis

An isolated 10-minute episode does not require hospital admission for MRI Brain and Neurology consult.

Reassurance is the treatment of choice 👍

[Mo Imam @MoAImam]

Smith’s Fracture Classification

Type I: Extra-articular

Type II: Intra-articular, involving the dorsal joint surface

Type III: Intra-articular, entering the radiocarpal joint (volar Barton’s)

[Mo Imam @MoAImam]

Anatomy of a Boutonnière deformity. DIP, distal interphalangeal; PIP, proximal interphalangeal.

[Papa Heme @Papa_Heme]

Never forget B12 deficiency can cause a pseudo TMA that mimics TTP.
I just saw a case!

Rapidly progressive thrombocytopenia
Schistos
Elevated LDH

Hints it’s B12 deficiency include leukopenia and and hyperseg PMNs

Fortunately it’s an easy fix and fire up the B12