I'm not pro-murdering babies.
I'm pro-Becky who found out at her 20 week anatomy scan that the infant she had been so excited to bring into this world had developed without life sustaining organs.

“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.…

On December 29 we were dillucidating here if the drops meant "surprise, relatively neutral expression" or "a negative expression, horror" (Remember: https://t.co/J2gjQjAENw ). Well, December 22 drops seem to clarify it. First, the December 29 drop that generated the confusion 1/*

didn't appear in today drops, while several old ones have been posted again. I would say that all December 22 drops regarding facial expression mean and clarify "surprise". 2/*

More 3/*

And more. So, they didn't point to a negative event, just to one that generates surprise. 4/*

All these drops were completed with a Christmas gift one, confirming the surprise neutral meaning and adding a related positive one connected to the surprise. 5/*

Me: Made a thread about how people don't understand hyperacusis and give advice that obviously I've already tried.

This person only a few tweets into the thread:

I only tweeted this because, like it or not, this is the general population's reaction to me talking about hyperacusis.

Similar replies happened when there was the whole "not clapping" article regarding Cambridge.

They're so quick to label disabilities as not real disabilities.

It's important to remember this when people may ask why we've never talked about this before, or why it's not talked about a lot.

Most people don't talk about their hyperacusis because if they do, people respond like this. So most of the time, honestly it's easier to say nothing

Yes I am petty enough to add screenshots of this toxicity to this thread:

Asking for accessibility is "pathetic." /s : )

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