Acid-Base Diagnosis & Clinical Approach with Dr. Bill Bortcosh--Part 1
Oct 28, 2024
auto_awesome
Dr. Bill Bortcosh, a pediatric critical care expert and associate medical director of safety, shares insights into acid-base diagnosis in this engaging discussion. He emphasizes the importance of understanding acid-base status for acute care, illustrates this with a compelling case study, and explains the role of anion gap in diagnosis. Bortcosh also explores the emotional challenges in critical care and discusses his transition to pharmaceutical safety, shedding light on drug safety assessments and the complexities faced by healthcare providers.
Dr. Bill Bortcosh emphasizes the critical evaluation of acid-base status in pediatric critical care to improve patient management and outcomes.
The podcast highlights the importance of understanding anion gap metabolic acidosis by using mnemonics like 'MUDPILES' to identify underlying causes effectively.
Deep dives
Career Transition and Physician Wellness
Dr. Bill Borkosch discusses his transition from a clinical intensivist role to an associate medical director of safety at a pharmaceutical company. This decision was driven by the need for a better work-life balance, allowing him to pursue academic interests like education and clinical research while still practicing clinically part-time. He emphasizes how managing clinical responsibilities alongside passions can lead to burnout, highlighting the importance of optimizing systems that empower physicians to maintain a healthy balance between patient care and personal well-being. His journey reflects the necessity for healthcare professionals to self-reflect on their career choices and wellness.
Understanding Metabolic Acidosis
The podcast delves into metabolic acidosis, particularly focusing on anion gap metabolic acidosis and its significance in pediatric critical care. This condition can manifest from various underlying disorders, necessitating a detailed differential diagnosis that includes both anion gap types and non-anion gap types. Each type of metabolic acidosis informs clinicians about the probable causes and therapeutic approaches, making the understanding of these conditions crucial to effective patient management. A structured framework for recognizing and addressing these acid-base disorders enhances clinicians' ability to make informed decisions in critical settings.
Anion Gap Metabolic Acidosis and Its Causes
The discussion emphasizes the importance of recognizing the elevated anion gap as a signal of underlying pathology, hinting at the presence of unmeasured acids in the bloodstream. Key causes include conditions represented by the mnemonic 'MUDPILES,' which refers to methanol, uremia, DKA, paracetamol, iron, lactate, ethanol, and salicylates. Each condition has specific etiologies and mechanisms, for example, methanol leads to formic acidosis, while lactic acidosis might indicate circulatory failure. Understanding these mechanisms allows clinicians to discern the appropriate diagnoses and interventions for patients exhibiting signs of metabolic acidosis.
Clinical Application of Acid-Base Knowledge
The episode highlights a case study to demonstrate the practical application of acid-base physiology in a clinical setting. By analyzing laboratory values, the hosts illustrate the importance of looking closely at anoint gap results and the necessity for physicians to maintain a high index of suspicion for potential complications. The conversation touches on integrating test results, physical examinations, and clinical judgment to formulate differential diagnoses effectively. Moreover, they urge that understanding the underlying pathologies and their presentations leads to better patient outcomes in critical care situations.
Dr. Bill Bortcosh received his Doctorate of Medicine from Albany Medical School, NY. He completed his pediatric residency at the University of Massachusetts Medical School followed by pediatric critical care fellowship at Massachusetts General Hospital. Learning Objectives:
By the end of this podcast series, listeners should be able to discuss:
Why critical evaluation of a patient’s acid-base status can be useful and practical in the acute care setting
The basic pathophysiology of each acid-base disturbance
The definition of an anion gap and how to use it as a screening tool
The use of Winter’s formula to identify a respiratory acidosis or alkalosis
The utility of the delta-delta to identify additional metabolic acidosis or alkalosis
How to support PedsCrit: Please complete our Listener Feedback Survey Please rate and review on Spotify and Apple Podcasts! Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.
Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.comfor detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.
Get the Snipd podcast app
Unlock the knowledge in podcasts with the podcast player of the future.
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode
Save any moment
Hear something you like? Tap your headphones to save it with AI-generated key takeaways
Share & Export
Send highlights to Twitter, WhatsApp or export them to Notion, Readwise & more
AI-powered podcast player
Listen to all your favourite podcasts with AI-powered features
Discover highlights
Listen to the best highlights from the podcasts you love and dive into the full episode