The Curbsiders Internal Medicine Podcast

#104: Renal tubular acidosis with Kidney Boy, Joel Topf MD

16 snips
Jul 16, 2018
In this episode, Joel Topf, Chief of Nephrology at Kashlak Memorial Hospital and known as @Kidney_Boy, breaks down renal tubular acidosis (RTA) with humor and insight. He discusses the three types of non-gap metabolic acidosis and dives into common causes and treatment challenges. The conversation highlights the kidney's role in acid-base balance and the implications of choice in IV fluids. Joel also shares valuable insights from clinical cases, making a complex topic accessible and engaging for both professionals and enthusiasts in nephrology.
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ANECDOTE

A Resident's Regrettable Failure

  • Joel Topf recounts a challenging experience as a resident involving a patient with chest pain.
  • His tactical focus overshadowed strategic thinking, delaying critical consultation and leading to the patient's death.
ANECDOTE

Overlooked Salmonellosis

  • Paul Williams shares a case where he dismissed a patient's seemingly trivial complaint of frequent bowel movements.
  • The patient's creatinine subsequently rose to 11 due to undiagnosed salmonellosis, highlighting the importance of not overlooking patient concerns.
ADVICE

NAGMA: Three Main Categories

  • Consider three main categories for non-anion gap metabolic acidosis (NAGMA): GI loss, chloride intoxication, and renal tubular acidosis (RTA).
  • Prioritize investigating GI issues, the most frequent cause of NAGMA, before considering less common causes like RTA.
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