Naveen Balakrishnan, MD (he/him)

UTSW Neph Class of '26| He/Him/His| Nephrology and Critical Care Fellow| Loves chess, cricket, videogames, social justice reform, anti-racism. Views my own.

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

@EMNerd_ Note that traditional criteria to start RRT is pH < 7.1 despite failing medical management which I consider an additional flaw in BICAR-ICU2

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

@EMNerd_ I completely agree with your end evaluation, and I think I can add a bit.

BICAR-ICU2 used pts with pH < 7.2 and used a pH < 7.2 as 1 of 3 criteria fulfilling dialysis initiation.

SODA-BIC enrolled pts with pH < 7.3. This probably suggests they’re not completely comparable.

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

@AnilMakam Additionally we should ask if pH is associated with improved CV, etc, then why is mortality unchanged? There are noted harms of bicarbonate amp or gtt clinically that are not captured in trials (low ionized calcium -> worse CV; paradoxical intracellular acidosis; fluid load)

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

@AnilMakam My take on this is a bit different. My take is pH really a good marker for initiation of dialysis in the acute setting? Perhaps these trials expose a flaw in RRT evaluation.

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

@LosiggioRosario @CritCareReviews @JAMA_current @NEJM @SRAnesthesiaICU @giovannilandoni @CStoppe @chodgsonANZICRC @bronwenconnolly @f_g_zampieri @DogICUma Interesting regarding high dose vitamin C - High dose vitamin C is known to cause calcium oxalate nephropathy in patients with normal renal function. Taking into account the vasoplegia and volume loss of burns patients, would seem logically high risk.

[UTSW Nephrology @UTSWNephrology]

Journal Club spotlight 🌟

Great discussion led by our first-year fellow Dr. Yaseen Jumani on the LIBERATE-D trial, exploring strategies to reduce dialysis burden and rethink how we approach care for patients with acute kidney injury needing dialysis.

[NephroPOCUS @NephroP]

#POCUS in #Nephrology and #CriticalCare
🔗https://t.co/vIC2E4KBYS

[Matthew Sparks, MD @Nephro_Sparks]

Really troubled by this question in a popular surgical critical care study book…

Surgical Critical Care and Emergency Surgery

Topic is early v late dialysis and so much on this topic is know and just disappointing to this question…. The keyed answer was….

@jaykoyner

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

Day 2 of #ASNKidney and #Kidneywk going strong. So many folks around me involved in pushing the needle!

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

Let the Beans begin #ASNKidney #KidneyWeek

[UTSW Nephrology @UTSWNephrology]

🩺Shedding light on what makes us stand out.

Think you know UTSW Nephrology? Think again. Explore the Top 10 things you didn’t know about our fellowship.

We’re bringing you a countdown — sharing a different fact every day! 🚀

Starting with
🔟Training Ground for Future Leaders

[UTSW Nephrology @UTSWNephrology]

🧠💥 Think you can crack the case? Join us for The Seldin Challenge!
This special Renal Grand Rounds features a complex case presentation by Dr. Kelley Harris and real-time discussion with guest Dr. Eleanor Lederer. Don't miss it!
📅 Oct. 30 | 🕛 Noon | 📍K5.600 or Zoom

[Critical Care Reviews @CritCareReviews]

Where does the fluid go?

➡️ Excess crystalloid pools in skin, gut and lungs
➡️ Rapid ~1.3–1.5 L opens a slow-exchange third space that traps fluid

CCR Journal Watch
https://t.co/Sp06oA6IDG

[Turning the Tide @Turningthe_Tide]

1/
💡 IV fluid is the most over-prescribed drug in hospitals.
Why? Because when faced with certain problems, our reflex is always “give fluids”.
Let’s unpack the cognitive biases behind this — and why they harm patients.

[Ashley Miller @icmteaching]

🧵 What is Critical Closing Pressure — and why does it matter for perfusion?

A thread to clear up one of the most misused and misunderstood ideas in circulatory physiology.
👇

[UTSW Nephrology @UTSWNephrology]

Always fun times at Graduation day!

[NephroPOCUS @NephroP]

Tricuspid regurgitation, right ventricular function, and renal congestion: a #cardiorenal 🔺
#POCUS #VExUS #Nephpearls
🔗 Front. Cardiovasc. Med. 2023
Doi: 10.3389/fcvm.2023.1255503

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

Additionally, 3g salt tabs TID is equivalent to 150 mEq of Cl. This is equal to a little less than 1/3 L of 3% NS - I would be curious of the efficacy of this.

We often rec salt tabs with diuresis in HF with hyponatremia - often met with resistance.

[Naveen Balakrishnan, MD (he/him) @NBalakrishnanMD]

Awesome physiology! I wonder if it’s more accurate to state it’s a low effective arterial blood volume state with decreased filtration of chloride than a chloride deficient state as patients with heart failure are usually total body salt up.

[Ross Prager @ross_prager]

The only diuretic that has demonstrated to reduce mortality is... 3% saline?

A 🧵

TLDR: it's not about sodium (for once).

[Ross Prager @ross_prager]

The only diuretic that has demonstrated to reduce mortality is... 3% saline?

A 🧵

TLDR: it's not about sodium (for once).