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“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 Importance of correct indication of colonoscopic surveillance studies (English 🇺🇸🇬🇧)
@KM_Pawlak @KMonkemuller @drkeithsiau @JacquelineChuMD @PerelmansPearls @stevenbollipo @SWexner @DrBloodandGuts @ebtapper @DCharabaty @RashidLui @AdvaniRashmiMD @AtoosaRabiee @DrMohdZein

@GI_Guy @RodriguezParra_ @DrHarryThomas @TennysonMD @AustinChiangMD @KralJan @thomaskroner @alinkmd #GITwitter

1/ The implementation of screening and surveillance programs can reduce the incidence and mortality of

2 / But for these to be effective and to guarantee protection against CCR, they must meet a series of conditions. One of them is the correct indication for endoscopic studies for both screening and surveillance.

3 / According to a recent meta-analysis, the minority of patients who undergo colonoscopies have a correct indication, with less than 50% adherence to the surveillance intervals proposed by scientific

@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