Dr.Priyanshu Jaseja

Intern at LNH...

Learning and sharing Medicine

[Dr.Priyanshu Jaseja @PJaseja]

Here is the thread of the books I explored, along with standard books
#MedTwitter #MBBS
Some are fun to read, some give beautiful insight into a topic, and some might help with an exam or a quiz 🧵

[Dr.Priyanshu Jaseja @PJaseja]

Ref tweet
https://t.co/Or8kuL8LJ8

[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

[Dr.Priyanshu Jaseja @PJaseja]

Wow esmolol breaks down into methanol in the body... 🍺

[Aditya Gupta @DrAditya2935]

@PJaseja Mostly porphyrias are an exception to this enzyme rule.

[Dr.Priyanshu Jaseja @PJaseja]

A very cool article on caffeine-induced arrhythmia, new stuff to learn
#MedTwitter #Cardiotwitter

[Suchitha Kuntla @DocPeriop]

Esmolol bolus n infusion for rate control in caffeine induced myocardial irritability.
Theophylline and Caffeine induced arrythmias require you to think out of ACLS guidelines.

https://t.co/RMwzeoKwEa

(I'm finding it weirdly uncomfortable sharing substack links on X lol, that's some crossover)

[Dr.Priyanshu Jaseja @PJaseja]

@DocPeriop This is so fun to read!
Thanks for sharing

[Dr.Priyanshu Jaseja @PJaseja]

@Mayankraj23 yES

[Dr.Priyanshu Jaseja @PJaseja]

What all X-linked dominant conditions do you know of?
#MedTwitter

[Dr.Priyanshu Jaseja @PJaseja]

@witchdrkochi Exactly!

[Dr.Priyanshu Jaseja @PJaseja]

Immunologists are people who use the coolest words in the medical field...

[Arjun Raj @arjunrajlab]

Definitely more word salad. It's like Opus 4.8 was trained by an immunologist.

[Dr.Priyanshu Jaseja @PJaseja]

@DrShauryaGarg 😂😂 kunji type of MD psych...

[Dr.Priyanshu Jaseja @PJaseja]

SR in psychiatry shared this book with me -

Stahl's Essential Psychopharmacology Prescriber's Guide

This has answers from A to Z for all questions about psych drugs, well organised...

Dosing tips
Side effects
What to monitor
Art of Switching

A perfect reference to use!

[Dr.Priyanshu Jaseja @PJaseja]

@aaryankrtiwari Doing that only

[Dr.Priyanshu Jaseja @PJaseja]

@bronchomon

[Dr.Priyanshu Jaseja @PJaseja]

An exception to the enzyme defect being Autosomal recessive is Acute intermittent porphyria...
#MedTwittter

[Aditya Gupta @DrAditya2935]

A lot of people preparing for NEET PG have issues remembering which disease is autosomal recessive, what is dominant.

While ofcourse - at the end of the day it is a little bit of rote memorisation - there is a certain logic to it.

Remember- enzymes- pretty much of all them in our body are more than what’s required.
So, even a 50% enzyme activity suffices for majority.

Hence, unless enzymes are fully zero - disease won’t manifest.

So, any enzyme deficiency- will be AR - both genes have to be mutated/absent.

PKU
Galactosemia
Glycogen storage disorders
Congenital adrenal hyperplasia
Alpha 1 anti trypsin
Wilson

Even 1/2 Hb causes mild anemia - so even That/Sickle cell are AR.

Contrast this with neuromuscular damage in general.
Anything that causes damage to nerves and Muscle- even 50% damage would result in disease.
If you look at AD diseases - most are have some issues either with nerves or muscles or cytoskeleton.

Huntington
Myotonic dystrophy
Achondroplasia
Marfan
Hypertrophic cardiomyopathy.
Most neurocutaneous syndromes. (tuberous sclerosis/neurofibromatosis)

Ofcourse this is not hard and fast.
But serves to improve your memory and understanding.

X linked is genuinely just rote memorization. Those genes just happened to be on X chromosome.

[Dr.Priyanshu Jaseja @PJaseja]

@Blaze_t19_22 This came in 2nd year quiz of mine, I remember it from then on...

[Dr.Priyanshu Jaseja @PJaseja]

@skpaanda @Kurz_Gesagt @krishashok Will watch

[Dr.Priyanshu Jaseja @PJaseja]

1C means :1 part in 99 parts of water

Similarly, commonly used 30C in homeopathy means: 1 part in one million billion billion billion billion billion Billion parts of water

A pill containing one atom of the ingredient would need a diameter equal to the Earth–Sun distance🤣

[Dr.Priyanshu Jaseja @PJaseja]

@pragya_13_ You made it?

[Dr.Priyanshu Jaseja @PJaseja]

@Peroneal_ Step ahead

[Dr.Priyanshu Jaseja @PJaseja]

@Blaze_t19_22 Oh you remember them all!

[Dr.Priyanshu Jaseja @PJaseja]

@Peroneal_ Yeah, recently the new edition of Robbins has added Rett syndrome