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!🛁
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
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!🛁
Misunderstandings are so common (even with HCPs) that there is a campaign to change the name to "pituitary insipidus"
#NoTimeToDI
Pituitary adenomas themselves can cause lots of hormone dysfunction, but don't typically cause DI.
- renal disease
- electrolytes (⬇️ K, ⬆️ Ca – hence why hyperCa is dehydrating)
- drugs - can be seen with up to 15% of people taking LITHIUM 💊
They may have multiple other hormone deficiencies (e.g. cortisol, thyroid, sex hormones, growth hormone).
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!
– ⬆️ 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.
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
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..
- 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 👍
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
— Matthew Yglesias (@mattyglesias) January 30, 2021
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/
\u201cMilitary history\u201d is only in decline if you\u2014like the author & experts in this obnoxious piece\u2014see the subject as a narrowly defined, white dude-oriented, guns & bayonets approach. The field is 1000% better off w/today\u2019s diversity of topics & historians. https://t.co/dUf3OWyVpQ
— Jonathan S. Jones (@_jonathansjones) February 1, 2021
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/
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
If the Muslim world had not existed, there literally would be no technology/achievements today.
— Starks\u262a\ufe0f\U0001f1f9\U0001f1e9 (@MegaIntelIect) January 8, 2021
Science only developed because of Islam, Europe should be grateful to Islam for civilizing their barbaric cult.
Source: The Caliph's Splendor, Pg 204-05 https://t.co/HVypO52Tpc pic.twitter.com/00jYSbaDSs
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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It was Ved Vyas who edited the eighteen thousand shlokas of Bhagwat. This book destroys all your sins. It has twelve parts which are like kalpvraksh.
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.
It also discusses the evolution of universe.( https://t.co/2aK1AZSC79 )
Next is the portrayal of Vidur and his dialogue with Maitreyji. Then there is a mention of Creation of universe by Brahma and the preachings of Sankhya by Kapil Muni.
HOW LIFE EVOLVED IN THIS UNIVERSE AS PER OUR SCRIPTURES.
— Anshul Pandey (@Anshulspiritual) August 29, 2020
Well maximum of Living being are the Vansaj of Rishi Kashyap. I have tried to give stories from different-different Puran. So lets start.... pic.twitter.com/MrrTS4xORk
In the next section we find the portrayal of Sati, Dhruv, Pruthu, and the story of ancient King, Bahirshi.
In the next section we find the character of King Priyavrat and his sons, different types of loks in this universe, and description of Narak. ( https://t.co/gmDTkLktKS )
Thread on NARK(HELL) / \u0928\u0930\u094d\u0915
— Anshul Pandey (@Anshulspiritual) August 11, 2020
Well today i will take you to a journey where nobody wants to go i.e Nark. Hence beware of doing Adharma/Evil things. There are various mentions in Puranas about Nark, But my Thread is only as per Bhagwat puran(SS attached in below Thread)
1/8 pic.twitter.com/raHYWtB53Q
In the sixth part we find the portrayal of Ajaamil ( https://t.co/LdVSSNspa2 ), Daksh and the birth of Marudgans( https://t.co/tecNidVckj )
In the seventh section we find the story of Prahlad and the description of Varnashram dharma. This section is based on karma vaasna.
#THREAD
— Anshul Pandey (@Anshulspiritual) August 12, 2020
WHY PARENTS CHOOSE RELIGIOUS OR PARAMATMA'S NAMES FOR THEIR CHILDREN AND WHICH ARE THE EASIEST WAY TO WASH AWAY YOUR SINS.
Yesterday I had described the types of Naraka's and the Sin or Adharma for a person to be there.
1/8 pic.twitter.com/XjPB2hfnUC