tw weight , dieting , eating disorders
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can we all have a touch grass moment for a second. can we please remember that idols are real people. real people with problems they might not have the access to solutions for. many of them young, early 20’s, brains still unfinished.

“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.…

Thread:
I'm thinking about Tim Keller's influence.

There is the curious fact that Keller is well-regarded among the culture elite (or at least has not suffered the sort of vilification one might expect given his influence). How can we explain this?

Looking at Prodigal God and other writings, you see that his approach to urban ministry is deeply political in a way that appeals to Democrat-heavy cities. It involves two moves:

1) equalizing sins: elevating the sin of hypocrisy, "moralism," and "religion" (the sins of "conservatives") and equating these with the sins tolerated among liberal (e.g., homosexuality)
&
2) emphasizing "self-righteousness" as a sort of chief sin (the sin of "red states").

Keller effectively downplays the sins that liberals tolerate while elevating the sins of their political enemies, the red state conservatives.

But the greatest appeal to liberals is that critiquing the "self-righteous" vilifies political action, particularly the action of social conservatives (e.g., anti-gay marriage). And the equalization of sins eases concerns over changes in social policy (e.g., gay marriage).

Spoke with my neighbour. A type 2 diabetic on medications and realized even now there is so much ignorance on this subject. I have done extensive research on this subject (was forced 2 after being diagnosed)

Here sharing it with you all. retweet it, it may save someone's life.

My Neighbour said his hba1c is 7. Everything is fine, he just needs to bring it below 6.9 and he would be fine.
That is just baloney! anything more than 5.6 will result in all kind of complications (Kidney failure,retina failure (blindness) amputations& heart attack etc etc

When i told him the benifits of intermittent fasting and fasting, My neighbour Nitin said, I cannot fast as doctor said i need to eat 5 -6 times a day.

FACT: If you are NOT on any insulin enhancing drugs. you can fast as much as you want. (metformin is OK)

to which he said These drugs r permanent & progressive, you can never stop using them.
FACT: if you can change your diet, you can change your sugar and insulin levels and no longer need these drugs. (advise not aplicable to type 1 diabetics, they wud always need insulin injection

Diet, I am on diet precribed by WHO.
FACT: Fuck WHO, and don't eat carbohydrates. infact another name of diabetes is carb intolerance. You can never acheive 5.6 or lower while eating your rice and roti.

@MSF was allowed to enter #Mekelle on 16 Dec & here is their account 👇

"no basic supplies. The local hospital was running at 30 to 40 %, with very little medication"

This is why one of the reason why we demand unfetters #HumanitarianCorridor
#TigrayGenocide

#Adigrat "The situation was very tense & its hospital was in a terrible condition. Most of the health staff had left, there were hardly any medicines &there was no food, no water and no money"
#StopWarOnTigray
#TigrayGenocide
#HumanitarianCorridor
#EritreaOutOfTigray

After 1 month since @AbiyAhmedAli declared victory

"#Adwa & #Axum. There we found a similar situation: no electricity & no water. All the medicines had been stolen from #Adwa general hospital & the hospital furniture & equipment were broken"

#StopWarOnTigray
#TigrayGenocide

"Beyond the hospitals, around 80 or 90 per cent of the health centres that we visited between Mekele and Axum were not functional, either due to a lack of staff or because they had suffered robberies"

#StopWarOnTigray
#TigrayGenocide
#EritreaOutOfTigray
@UN @POTUS @StateDept

"1 woman had been in labour for 7 days without being able to give birth. Her life was saved because we were able to transport her to #Mekele"

It is really heartbreaking to imagine how many of our mothers & sister have lost their lives.

#StopWarOnTigray
#TigrayGenocide
@UN