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
💊 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
💧 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
@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