@DerekSLarson

Private Practice Nephrologist | Chief of Nephrology, Missouri Baptist Hospital | Avoiding Nephrotoxins | @illinois_alma / @uchicago / @WUSTL alumnus

 St. Louis, MO
stlkidney.com
Joined February 2017
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  • Followers1.1K
416Media
Had a blast as a @NBCWeakestLink contestant but hoping for more #Nephrology questions next time
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An interesting case of wine-red/raspberry chromaturia and CRRT effluent coloration following hydroxocobalamin administration for refractory vasoplegia
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Derek Larson, MD, FASN retweeted
Tarek Alhamad@TransplantPulse17 Oct 2023
Communication and defining roles and duties are key points of transition of care. Wonderful discussion by @DerekSLarson #MTS2023
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When should patients be sent back to their general nephrologist to manage after a transplant? I’m giving a talk surrounding this and interested in your thoughts.
24%6 months
53%1 year
24%Never
0%Depends/Other (comment)
17 votes • Final results
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While practicing multiplication with my 9 y/o daughter, she asked if you can ever use multiplication and division together. Anyway, she now knows FeNa. Incidentally, her poor doll has a wicked case of ATN.
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Welp, just finalized my costume.
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Photo of included pin for reference. @Nephro_Sparks
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Gracie has been covering my call this weekend. #NephroCentric #GoldensOfTwitter
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A case of Metformin-induced lactic acidosis (MALA) including a brief thread covering risk factors, kinetics, and indications for hemodialysis 🧵 1/6
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Indications for extracorporeal removal (Calello, Crit Care Med. 2015) 🔹Severely elevated serum lactate (>20mmol/L) 🔹Severe metabolic acidosis (pH<7.0) 🔹Failure to improve with supportive care/bicarbonate therapy in 2-4 hours (by pH, lactate, clinical status)
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🚩Benefit of HD is the correction of metabolic acidosis more than the removal of Metformin 🚩CVVH/CVVHD can be considered if clinically unstable, although clearance is less than with conventional HD (per case reports) 🚩PRRT also has been described in retrospective reports fin
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Congo red positive amyloid deposit with apple-green birefringence in a kidney arteriole #RenalPath #MedTwitter
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A case of Valproic Acid toxicity (>1000mg/L after dilution) associated with acute hyperammonemia, encephalopathy, and respiratory depression VPA: ⬇️ MW (144 Da) ⬇️ Vd ⬆️ protein-binding saturation w/ toxicity = higher concentration of free drug available for HD clearance – at Chesterfield, MO
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Ever wonder how dialysis units make that fancy, high-quality water? It has always interested me as a nephrologist. Here's a 🧵with photos👇 1/12
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⭐️Deionization removes ionic contaminants when the RO fails or when additional purification is necessary ⭐️H+ exchanged for➡️Cations ⭐️OH- exchanged for➡️Anions ⭐️H+ and OH- combine to become water ⭐️Followed by an endotoxin filter since DI systems promote bacterial growth 11/12
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So: ✅ Dialysis patients are exposed to ~150L of dialysis solution each treatment ✅ Providing clean water for dialysis is critical for patient safety and positive patient outcomes ✅ The components of H20 treatment need to be monitored closely to ensure optimal performance Fin
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