Tuesday, 29 March 2016

I don't believe in...

This is a big match: "Personal experience vs. EBM". This is not against EBM, I am 100% in favour of an EBM approach, but I think personal experience should help us in our everyday practice.

So, here's a short list with a few things I don't believe in:

- I don't believe in D5W to correct hyperNa
Of course, it works, but I really find H2O is better and easier to use: no need to account for metabolic effects and possible changes in K levels. Effects on sodium levels are really more predictable. I'd like to see an head to head RCT.

- I don't believe in "Don't Use Furosemide in HyperCalcemia"
Most of these patients have high creatinine levels and, if there is not a very high Ca level (> 14 mg/dL),  you must be a very brave doctor to use pamidronate as a first line drug. Someone could say: "Creatinine is up because of hyperCa", that's true, but speaking clearly there are a number of circumstances in which you have no data about basal creatinine or precedent CKD history. If so, if you are not brave, you'll need to use large volume of saline in a patient whose heart function is a mystery. So, it would be prudent if you work in a busy ward to administer a little bit of furosemide. .

    .     Don't forget: this is a dumb comment!