You what now

Are they disrupting my menstrual cycle because my body does that just fine I do not DO NOT need a startup for that

A week ago I voluntarily admitted myself to the hospital to get help bc I am losing weight as a result of increased food intolerances, secondary to my very severe #MECFS. A psychiatrist here decided that im mentally ill, 1/

purely on the basis that the medical workup was unable to explain my food intolerance. My psych eval only found mild anxiety and depression. 2/

They have put me on a 72hr psych hold while they work to get the county courts to commit me to a psych ward. This is a nightmare. They have taken away most of my belongings, put me in a new uniform, and are keeping me under 24/7 video surveillance. 3/

In the middle of the night last night when I sat up to use the urinal loud alarms sounded, as though I was trying to escape. I can’t even walk and hadn’t even left my bed. 4/

If they succeed in having me fully committed I will lose ability to communicate with the outside world except for an occasional phone call. I will lose all agency, and will very likely have treatments forced upon me. 5/

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…

breaking my social media fast, which may or may not exist anymore, to share something i found really really helpful from today's therapy sesh. i figured out why i (we?) have so much trouble celebrating our wins

so ive been in therapy for 100 years. still anxious, but im pretty sure i was born that way so i'll stay that way. still depressed too, which i thought id be cured of by now. aa few sessions ago we talked about what i think a return to health 'should' look like

initially i figured itd look like being the person i was before i got depressed. energetic, not needing pep talks to do shit like go outside, cooking everyday, working out at least 30 mins at least 3 days a week, calling my mom everyday, etc.

that session i realized that im a completely different person than i was before i got depressed. also the world has changed a lot & things are just done differently now. not allowing for those things had me reaching for shit that was impossible.

so i make some concessions but say that i *still* want to be able to do some things that i dont want to do. like i cant just sit on the couch and never move in the name of accepting who i am, which is A Bitch Who Don't Like To Move. i still want to be able to eve if i dont want