So this weekend you heard from our friends @BukuRenal that mismanagement of IV fluids can cause harm.

A group we’d like to highlight who can come to serious harm from ⬆️/⬇️ fluids is patients with

💦DIABETES INSIPIDUS 💦

See below 👇

#medtwitter #FOAMed

Diabetes insipidus (DI) is the inability to hold onto water due to lack of /resistance to ADH.

Remember ADH is released as serum osmolality ⬆️ to ⬆️ renal water reabsorption, but in patients with DI this doesn’t occur and so they pass large vol watery urine - can be >10L/day!🛁
Note diabetes insipidus has nothing to do with glucose/sugar like diabetes mellitus! ⛔️❌⛔️

Misunderstandings are so common (even with HCPs) that there is a campaign to change the name to "pituitary insipidus"

#NoTimeToDI
Cranial DI (ADH not released) is usually due to pituitary/hypothalamic surgery, infiltration (inflammation/malignancy - rare) or head trauma. Can also be genetic.

Pituitary adenomas themselves can cause lots of hormone dysfunction, but don't typically cause DI.
Nephrogenic DI (ADH resistance) can be caused by
- renal disease
- electrolytes (⬇️ K, ⬆️ Ca – hence why hyperCa is dehydrating)
- drugs - can be seen with up to 15% of people taking LITHIUM 💊
Outwith the neurosurgical ward, you are most likely to come across patients with a prior established diagnosis of DI.

They may have multiple other hormone deficiencies (e.g. cortisol, thyroid, sex hormones, growth hormone).
When well, people with DI can usually manage their fluid balance (and sodium) by drinking in response to thirst.

Adding synthetic ADH (desmopressin) – nasal spray or tablet – also helps by ⬇️ UO and so ⬇️polyuria/nocturia when given at🌛 - can be very important for QOL!
🏥In hospital this balance can go wrong:⚠️

– ⬆️ fluid losses (e.g. fever, vomiting)
- ⬇️access to meds and/or fluids (esp if confused, drowsy, NBM etc)

= profound dehydration and ⬆️⬆️ Na despite “reassuring” UO

Sadly this has led to several deaths.
So what can you do?

1.RECOGNISE DI – from PMHx, drug hx, medic alert, electronic record alert and SHARE INFO WITH TEAM 📢

-> rare condition often = ⬇️ awareness

2.Give usual desmo - 🔔CRITICAL MED🔔

3.Alert endo team 📞

4.Monitor – Na AT LEAST DAILY, fluid in/out
⬆️Na (i.e. dehydration) is concerning:

1.Consider ⬆️ level care and d/w specialist asap

2.Give desmo – can be given IV/IM (get help w conversion!) if usual routes not available 💉

3.Aim to bring down Na SLOWLY with fluids (<10mmol/24h)

5.👀 Na e.g. 4hrly, fluid in/out..
⬇️Na can also occur:

- those taking Desmopressin will struggle to excrete excesses if given too much fluid
- d/w specialist - may require Desmopressin dose change or delay to allow for controlled diuresis

Allow pt to take fluid orally (v IV) if possible so can self-regulate 👍
How confident are you in caring for people with DI?

Did you know the Society for Endocrinology has published advice about DI for non-specialists?

You can find that here 👇

https://t.co/kHjDRH7G4G

More from Health

I think @SamAdlerBell in his quest to be the contrarian on Fauci gets several things wrong here. 1/


First, the failure last year actually was driven by the White House, the #Trump inner circle. Watch what's happening now, the US' scientific and public health infrastructure is creaking back to life. 2/

I think Sam underestimates the decimation of many of our health agencies over the past four years and the establishment of ideological control over them during the pandemic. 3/

I also am puzzled why Tony gets the blame for not speaking up, etc. Robert Redfield, Brett Giroir, Deb Birx, Jerome Adams, Alex Azar all could have done the same. 4/

Several of these people Bob Redfield, Brett Giroir, Alex Azar were led by craven ambition, Jerome Adams by cowardice, but I do think Deb Birx and Tony tried as institutionalists, insiders to make a difference. 5/
Now you know I love to sh-t in Harvard. But I also like accuracy. So I decided to go look at Harvard’s catalog to see its lack of military history that this article describes (they only teach history of pets it claims) and what I found shocked me! Shocked me! A thread: 1/


First off, Harvard students literally have multiple sections of military history that they can take listed. (It appears these ones are taught at MIT, so they might have to walk down the street for these) but... 2/


Say they want to stay on campus...they can only take numerous classes on war and diplomacy...3/


They have an entire class on Yalta. That’s right. An entire class on Yalta. 4/


But wait! There is more! They can take the British Empire, The Fall of the Roman Empire for those wanting traditional topics... 5/
Thread on how atheism leads to mental retardation (backed with medical citations🧵💉)

To start with, atheism is an unnatural self-contradicting doctrine.

Medical terminology proves that human beings are naturally pre-disposed to believe in God. Oxford scientists assert that people are "born believers".

https://t.co/kE0Fi588yn
https://t.co/OqyXcGIMJn


It should be known that atheism could never produce an intelligently-functioning society and neither ever will.

Contrastingly, Islam produced several intellectuals & polymaths, was on the forefront of scientific development, boasting 100% literacy


It is also scientifically proven that atheism led to lesser scientific curiosity and scientific frauds, which is also why atheists incline to pseudo-science.

Whereas, religion in general and Islam in particular boosted education.

https://t.co/19Onc84u3g


Atheists are also likely to affected by pervasive mental and developmental disorders like high-functioning autism.

Cognitive Scientists and renowned Neurologists found that more atheism is leads to greater autism.

https://t.co/zRjEyFoX3P

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प्रथम भाव -
इस भाव से हम व्यक्ति की रोगप्रतिरोधक क्षमता, सिर, मष्तिस्क का विचार करते हैं।


द्वितीय भाव-
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चतुर्थ भाव- छाती व इसके आंतरिक अंग, जातक की मानसिक स्थिति/प्रकृति, स्तन आदि की गणना की जाती है


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In the first skandh, the importance of Vedvyas


and characters of Pandavas are described by the dialogues between Suutji and Shaunakji. Then there is the story of Parikshit.
Next there is a Brahm Narad dialogue describing the avtaar of Bhagwan. Then the characteristics of Puraan are mentioned.

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https://t.co/2aK1AZSC79 )

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In the sixth part we find the portrayal of Ajaamil ( https://t.co/LdVSSNspa2 ), Daksh and the birth of Marudgans( https://t.co/tecNidVckj )

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