RyanandaW

[RyanandaW @RyanandaW]

"You're the closest to heaven that I'll ever be"

[Dudes Posting Their W’s @DudespostingWs]

Legendary moment when the Goo Goo Dolls performed “Iris” Live In Buffalo in 2004.

It started raining and the show went on

[tempe.co @tempedotc0]

Momen ketika lu ngejek doi di chat
"nyenyenyenye" 😹🫵

[RyanandaW @RyanandaW]

@idextratime Bangkeee

[RyanandaW @RyanandaW]

@idextratime Paes sabar dikit tembus ini🤣

[TIRTA @tirta_cipeng]

Tenang, walau 1 dollar skrng udah 18.000

Itu artinya rupiah lagi dilemahin, biar ekspor josss, toh beli tempe goreng masih pake rupiah. Ga pake dolar.

Amanlah.
Itu buktinya ibox, resto mewah, event2 fashion tetep rame.

Ini ulah mata2 asing yg buat gaduh.
Jaya jaya jaya

[RyanandaW @RyanandaW]

@haadi_mul @provhusen Sit wasit

[RyanandaW @RyanandaW]

@txtdrstoryWA Alhamdulillah merdeka okegasss

[GOOD PEOPLE @Reza_R98]

@idextratime

[RyanandaW @RyanandaW]

Woyy pernah bajunya kecipratan pas pungsi empiema. Aromanya weeww🤧🤢

[Dr. Pankaj Royal @drpankajroyal]

Green colour pus aspirated from a patient of empyema thoracis.

Can you mention causative organism and treatment ?

#internalmedicine #MedX

[RyanandaW @RyanandaW]

@HabisNontonFilm Woyy🤣

[Indra P @indprat]

@HabisNontonFilm Draxbowo Destroyanto

[RyanandaW @RyanandaW]

@txtdarigenz97 Membandingkan kok sama2 hal buruk wkwk

[Ahmed Bennis MD 🫀 @drbennisahmed]

💊 Practical algorithm for diuretic resistance in acute HF from #HeartFailure26— this is the slide to save!
Start: Furosemide 120-160 mg
↓ Still congested?
Add Chlortalidone 12.5-50 mg/24h
↓ Still congested?
Tailor to the problem:
• Metabolic alkalosis → Acetazolamide 120-500 mg/24h
• Hyponatremia → Tolvaptan 15-50 mg/24h
• rLVEF + hypopotassemia → MRA 25-100 mg/24h
And running through the whole algorithm:
➕ Add iSGLT2 throughout
➕ Add sacubitril/valsartan if LVEF <49%
➕ Consider parenteral route if oral absorption is the issue
Clean. Practical. Evidence-based. 💯
(Adapted from de la Espriella R et al. Nefrologia 2021)
#CardioTwitter #HeartFailure #Cardiology #Diuretics #HFrEF

[RyanandaW @RyanandaW]

@idextratime @elchiringuitotv Otw emyu ni bos wkwkwk

[RyanandaW @RyanandaW]

@txtdarijasputih @KemenkesRI 3x umr wkwkw

[Dr. Chacón-Lozsán F .'. @franciscojlk]

💧 DKA resuscitation: Normal Saline vs Ringer’s Lactate, does it really matter?

For decades, 0.9% NaCl has been the default fluid in diabetic ketoacidosis.

But… is it still the best choice?

🧪 New randomized ICU data (2025-2026)

👉 88 patients with severe DKA
👉 Ringer’s Lactate (RL) vs Normal Saline (NS)
👉 Same insulin protocol

📊 Primary outcome: DKA resolution at 48h

➡️ No difference
• RL: 56.5%
• NS: 50%
(p = 0.66)

⚖️ So… clinically equivalent? Not exactly.

The physiology tells a different story 👇

🧠 What RL does better

Compared to NS:

✔️ Higher bicarbonate early
✔️ Better potassium levels
✔️ Lower chloride at 48h

➡️ Translation:

• Less hyperchloremic metabolic acidosis
• Lower risk of hypokalemia
• More physiologic acid-base recovery

⚠️ What NS still does

❗ Same DKA resolution speed
❗ Same ICU stay
❗ Same mortality

➡️ So endpoints look “equal”…
…but physiology is not.

🚨 Why this matters in real ICU practice

Hyperchloremia is not benign:

• Worsens metabolic acidosis
• Increases respiratory workload
• Promotes renal vasoconstriction
• Delays recovery

And hypokalemia?

• Arrhythmias
• Insulin resistance
• Delayed metabolic correction

🧬 Clinical interpretation

This is not about:

❌ “Which fluid resolves DKA faster?”

This is about:

➡️ Which fluid creates a better internal environment for recovery

🔥 Take-home message

👉 NS is acceptable
👉 RL is physiologically smarter

➡️ Especially in:

• Severe acidosis
• High chloride states
• Patients at risk of hypokalemia

📚 Trifi A. et al. (2025)
Medicina Intensiva
https://t.co/ulM20yqLRa

[RyanandaW @RyanandaW]

@apralzolam MI type 2

[RyanandaW @RyanandaW]

@tanyakanrl Cih wkwk

[Korek Gas @edeneric_grind]

@txtdrbekasi Udh beberapa kali case laka kereta api, yg paling kena impact adalah gerbong depan dan belakang yg isinya khusus wanita. Sptnya harus dievaluasi letak gerbong wanita ini jangan depan dan belakang

[RyanandaW @RyanandaW]

@BaseAnakFK Ez

[CardiovascularCorner @TrackYourHeart]

Biphasic T waves in V2–V3 in a pain-free patient describe which pattern?
A. Wellens pattern
B. Brugada pattern
C. S1Q3T3 pattern
D. De Winter pattern