From the Director
Hope you all had a great week. I've been working on my resilience here in Florida with Dave, the kids and in-laws. Thanks to Randy and the chiefs for holding down the fort, and to five great SARS for outstanding talks -
Johanna Chan, Paul Park, Tara Spector, Vaishali Patel and Ryan Schulties.
Congratulations to SAR
Adia Ross on her selection as a national
Baldridge Scholar. First resident physician selected to this prestigious presidential quality council!
And, a special congratulations to Tian and Andy Zhang on the birth of
Vivian Zhang!!!! Pictures soon!
This weeks pubmed from the program goes to JAR
John Stanifer for his upcoming case report in the American Journal of Medicine - A Case of Sjogren's Syndrome Associated Transverse Myelitis"
Looking forward to seeing you all on Monday!
Happy Easter and Passover to those who are celebrating
Aimee
What Did I Read This Week (by David Butterly, MD )
[box] Managing Hyperkalemia Caused by Inhibitors of the Renin–Angiotensin–Aldosterone System; Biff F. Palmer, M.D. (
Palmer.NEJM) [/box]
I pulled the article I reviewed this week for my Gen Med 1 team due to a patient we admitted to our service. This is a lady
Mariam Naveed, Tiffany Randolph, Jason Watts, John Greene and I had the pleasure of caring for. She is an 82 y.o. transferred from a local nursing home with confusion, weakness, and myoclonus. She had a long history of HTN and had been maintained on ARB therapy with Valsartan with well controlled HTN. She also had mild CKD with baseline creatinine of 1.6 and normal serum potassium. She developed a diarrheal illness a few days prior to admission. This was followed by the onset of confusion, decreased PO intake and progressive weakness. On admission she had a potassium of 8.0 along with a creatinine of 2.8. Clinically she was felt to be volume depleted. We medically managed her hyperkalemia, stopped the ARB, and gave isotonic saline. She gradually improved, did not require dialysis, and by DC had a creatinine of 1.3 and a K of 3.7. Both the confusion and the myoclonus resolved with correction of the renal failure and hyperkalemia
This article entitled
Managing Hyperkalemia Caused by Inhibitors of the Renin-Angiotensin-Aldosterone System appeared in the NEJM in 2004 and is a nice review of the physiology seen in our patient. The article is a well written review of an important clinical problem and the author, Biff Palmer, is on faculty at UTSW and publishes extensively in this area. ACE-Inhibitors and ARBs are widely used and account for between 10 and 40% of patients hospitalized for hyperkalemia. Hyperkalemia is not common in patients without other risk factors and was not seen frequently in controlled trials. For the most part, the low incidence of hyperkalemia seen in these trials can be attributed to enrollment of patients at low risk. Unfortunately, CKD is not infrequent in patients with CAD and CHF, so I expect that we will be seeing more of this complication with increasing utilization in higher risk patient groups.
Potassium excretion is dependent on 2 major factors: 1) distal delivery of Na along with 2) Aldosterone activity. The physiology of the renin-angiotensin system along with the many drugs we use interfering with it are shown in Figure 1 on pg 588. Our patient is an excellent example of the problems that can occur when distal Na delivery is altered (diarrheal illness leading to volume depletion) in the presence of the ARB. Fortunately she was expertly managed by the ER physicians along with the on call IM resident and the entire medical team. She recovered well without any long-term consequences.
Have a great Holiday weekend
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From the Chief Residents
Grand Rounds
4/13 - Roy Pleasants, Current tobacco issues and strategies
4/20 - Victor Tapson, Pulmonary Critical Care
4/27 - Stan Branch, Gastroenterology
Noon Conference
| Day |
Date |
Topic |
Lecturer |
Time |
Vendor |
| Monday |
4/9 |
SAR TALK |
Michael Durheim |
12:00 |
Bullock's BBQ |
| Tuesday |
4/10 |
Business of Medicine |
|
12:00 |
Saladelia |
| Wednesday |
4/11 |
ACGME survey discussion |
Aimee Zaas |
12:00 |
Chick-fil-A |
| Thursday |
4/12 |
SAR TALK |
Daniel Ong/Steve Sumner |
12:00 |
Meelos |
DOC On Call Policies
Attaching the recently posted on call policies for reference.
OnCall DOC 20121
Stead Society Activities
April 22 - STEAD TREAD 5 K
Info available at
Stead Tread 5 K
April 26, Ronald McDonald House (preparing / serving dinner)
Contact Steve Crowley or Michael Shafique to sign up.
steven.d.crowley@dm.duke.edu michael.shafique@duke.edu
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From the Residency Office
Opportunity - DFA National Leadership Conference
The Doctors for America Leadership Conference will be held in DC this year on April 22-24. There is a particular interest in reaching out to residents if you are available to attend. For more information please use the following link:
https://www.facebook.com/#!/DoctorsforAmerica
Dates to Add to Your Calendars
April 10 - Hematology Oncology Fellowship Discussion (1:00 p.m. – 2:00 p.m. 405 Seeley G. Mudd Building Conference Room)
April 22 - Stead Tread 5 K, hosted by Stead B
April 25 - Cardiology Symposium, Searle Lecture Hall 8:00am to 5:00pm.
April 26 - Ronald McDonald House dinner, hosted by Stead E
April 27 - DoM Annual Resident Photo Shoot, after Grand Rounds (rain date - May 18)
April 27 Nephrology Fellowship Discussion (contact Dr. Steve Smith (
stephen.smith@duke.edu))
May 1 - Annual Duke Residents vs Faculty Basketball Game (6:00 @ Cameron Indoor Stadium) NEW
May 4 - Humanism in Medicine
May 19 - Annual Resident Picnic (Dr Burton's Farm)
June 2 - Annual SAR Dinner
(invitations only)
June 13 –Resident Research Event, 5-7pm
Useful links
