iiinova — where your digital self keeps evolving

6/ Thanks to all for this great learning! By: @shreyatrivedimd.bsky.social Dr. Alice Kennedy Dr. Ross Prager Graphic: Dr. Alice Kennedy Audio: Xi Park

5/ When is Doppler most useful clinically? 💧 Differentiating AKI 💧 Guiding decongestion 💧 Phenotyping septic shock - Ex: more fluids vs. vasopressors 💧 Investigating delirium

4/ VExUS score combines assessment of: 💧 IVC - Short axis 💧 Doppler of hepatic vein - Look for retrograde flow 💧 Doppler of portal vein - Measure pulsatility 💧 Doppler of intrarenal veins - Look for discontinuation flow **validated in post cardiac surgery patients

3/ High risk for congestion injuries: 💧 Sepsis 💧 Heart Failure 💧 AKI 💧 Post cardiac surgery

2/ Volume overload 🚫🟰 venous congestion 💧 Volume overload: evidence of excess extracellular volume 💧 Venous congestion: high back pressure leading to reversal of blood flor from RA into end organs, which can cause injury

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1/ 🚨 NEW episode on venous congestion & the VExUS score 💧 Venous congestion is a century-old concept, but modern tools now allow clinicians to detect, quantify, and monitor it ‼️ 🖥️: www.coreimpodcast.com/2025/11/19/v...

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5/ Thanks to all for diving into this debate on diabetes drugs! Authors: @shreyatrivedimd.bsky.social, Dr. Tracy Rabin, Dr. Kenneth Fifer and Dr. Cary Blum Graphic: Amy Mu Audio: Kathreene Gala

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4/ SGLTis are best for: 🍬 Patients with HFrEF/HFpEF or CKD 🍬 ASCVD or high CV risk 🍬 Patients prioritizing oral route 🍬 Patients w/ “a little bit of everything” 🍬 A1C lowering is not priority

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3/ GLP1RAs are best for: 🍬 Patients with obesity 🍬 Established ASCVD 🍬 Needing dual benefit: glucose + weight control 🍬 Proteinuric diabetic kidney disease already on ACE/ARB & SGLT2i

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2/ Metformin is best for: 🍬 Overweight patients with no ASCVD or HF 🍬 Budget-conscious patients 🍬 Initial therapy in most patients

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CORE IM @coreimpodcast.bsky.social · 29/10/2025

1/ 🚨 NEW episode on first line meds for Type 2 DM ‼️ Let’s dive in and discuss whether tried and true metformin vs. newer options, like SGLT2i or GLP1RA, are better for YOUR patient 🌊 🖥️: www.coreimpodcast.com/2025/11/05/d...

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2/ Thanks, Dr. Stephen Cooper!

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CORE IM @coreimpodcast.bsky.social · 29/10/2025

1/ 🚨 NEW video on Lp(a) ‼️ Let’s review what it is, who should be screened, and what we can do about it if it’s elevated 🎥: www.youtube.com/watch?v=lKkf... Behind the scenes: www.youtube.com/watch?v=Xh9L... 🖥️: www.coreimpodcast.com/2025/04/02/l...

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CORE IM @coreimpodcast.bsky.social · 28/10/2025

TRUE ‼️ Use this handy chart to remember conversions and glucocorticoid/mineralocorticoid activity of steroids! www.coreimpodcast.com/2023/06/28/s...

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CORE IM @coreimpodcast.bsky.social · 28/10/2025

#TriviaTuesday True or false: 1mg dexamethasone is approximately equal to 20mg hydrocortisone

NEJM.org @nejm.org · 23/10/2025

Reposted by CORE IM

Do the benefits of bisphosphonates outweigh the risk of side effects? Dr. Ole-Petter R. Hamnvik explains. Learn more about bisphosphonates and fracture prevention in the latest episode of Beyond Journal Club, a podcast from @coreimpodcast.bsky.social and NEJM Group: nej.md/4q7hOK3  #MedSky

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Noah markewitz @noahmarkewitz11.bsky.social · 22/10/2025

Had so much to say about HRS we had to split it into two episodes! Check out part 2 on HRS treatment, Transplant, and a topic near and dear to my heart, palliative care.

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7/ Thanks to all! Authors: @shreyatrivedimd.bsky.social @noahmarkewitz11.bsky.social Dr. Yaling Tang Experts: Dr. Juan Carlos Q. Velez, Dr. Nikhilesh Mazumder, Dr. Marina Serper Graphic: Dr. Dexter Nwachukwu Peer Reviewers: Dr. Justin Belcher and @ebtapper.bsky.social Audio: Kathreene Gala

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6/ Palliative care? 🫘 The❓is whether to do chronic dialysis knowing it won’t ⬇️ the liver disease 🫘 W/ dialysis: expected lifespan is a few months 🫘 W/out dialysis: expected lifespan is days-weeks 🫘 BP may too ⬇️ for dialysis 💡 Early palliative care involvement is best

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5/ Transplant? 🫘 Dialysis can act as a bridge to transplant 🫘 Liver transplant is based off MELD 3.0 🫘 To be considered for simultaneous Liver Kidney transplant must be on dialysis for 6+ weeks, or have a GFR < 60 for at least 90 days prior to dialysis start

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4/ Diuretics: 💡 “No BP no PP” 🫘 Before managing volume, first raise the MAP ‼️ 🫘 Diuretics may raise Cr mildly, but acceptable if patient is improving clinically

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3/ Albumin: 🫘 Only given to bring patients to euvolemia 💡 A main side effect of CONFIRM was respiratory compromise by giving repeated doses of albumin

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2/ Vasoconstrictors: 1️⃣ Terlipressin - CONFIRM trial - Contraindications: Cr > 5, MELD > 35, ACLF grade 3, volume overload, or active ischemia 2️⃣ Norepinephrine 3️⃣ Midodrine, octreotide - Usually only given if contraindications to terlipressin

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Zaven Sargsyan @sargsyanz.bsky.social · 17/10/2025

1/ 🚨 NEW #5Pearls: Hepatorenal Syndrome Part ✌️ Let’s dive into treatment 🌊! 1️⃣ Vasoconstrictors 2️⃣ Albumin 3️⃣ Diuretics Goal: raise MAP by 10-15 ‼️ 🖥️: www.coreimpodcast.com/2025/10/22/h...

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Amazing episode, thanks @juancarlosqvelez.bsky.social @coreimpodcast.bsky.social and crew! Something I've always struggled with below. Appreciate any insights!

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Juan Carlos Q Vélez, MD @juancarlosqvelez.bsky.social · 16/10/2025

Check out the new episode of the @coreimpodcast.bsky.social podcast about hepatorenal syndrome (HRS) #HRS #Nephrology

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Will Preston @willpreston.bsky.social · 15/10/2025

5 pearls is such a great series because even when it’s covering a topic I think I know well, there’s always something important I learn — many such moments in this excellent episode.

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Zaven Sargsyan @sargsyanz.bsky.social · 15/10/2025

Yeeeees can’t wait to listen

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Noah markewitz @noahmarkewitz11.bsky.social · 15/10/2025

It has been a dream to be able to be a part of my favorite podcast. Check out this very fun episode on one of the most interesting diseases, Hepatorenal Syndrome!

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5/ Avoid albumin if: 🫘 Pt is clinically volume overloaded Give albumin* if: 🫘 Pt is clinically volume down or you’re unsure of volume status *1g/kg up to 100g/day

4/ How to diagnose HRS: 🫘 Absence of strong evidence of another diagnosis 🫘 No need for albumin challenge 🤔 🫘 Use clues from H&P ‼️

3/ Both serum and urine sodium can be helpful in diagnosing HRS ‼️ 🫘 Serum sodium ⬇️ because ⬆️ RAAS & ⬆️ ADH 🫘 FeNa < 0.5%* *even if patient is on a diuretic

2/ Use clues from history and physical for your differential ‼️ Pre-renal: 🫘 Increased BMs 🫘 Recent diuretic dose ⬆️ HRS: 🫘 More frequent paras 🫘 SBP ATN: 🫘 Shock 🫘 Muddy brown casts

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CORE IM @coreimpodcast.bsky.social · 14/10/2025

1/ 🚨 NEW #5Pearls: Hepatorenal Syndrome (HRS) part 1️⃣ AKI + portal HTN 🟰hepatorenal syndrome 🖥️: www.coreimpodcast.com/2025/10/15/h...

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Answer: YES Review the REVISE trial w/ @NEJMGroup below ⤵️ www.coreimpodcast.com/2024/12/11/s...

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CORE IM @coreimpodcast.bsky.social · 14/10/2025

#TriviaTuesday Does stress ulcer prophylaxis with a PPI reduce clinically-important bleeding compared to no prophylaxis in mechanically ventilated patients in a contemporary ICU setting?

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8/ Thanks to all for breaking (pun-intended) this down! By: Dr. Sarah Gorey, Dr. Clem Lee Dr. Greg Katz and @shreyatrivedimd.bsky.social Experts: Dr. Annie Garment and Dr. Ole-Petter R. Hamnvik Graphic: Dr. Jimin Hwang Audio: Kathreene Gala RN

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7/ 🦴 Guidelines have not yet changed to recommend that we treat all postmenopausal women with one dose of IV zoledronate 🦴 There is huge potential for both cost savings and reduction of important fractures

6/ 🦴 Control was placebo 🦴 Results ➡️LOWER fracture risk in BOTH arms receiving zoledronate (vs control) 🦴 NNT: 21 to prevent 1 vertebral fracture 🦴 NO osteonecrosis of jaw or atypical femoral fractures ‼️

5/ Can infrequent zoledronate (IV bisphosphonate) be used as primary prevention for osteoporosis in women? 🦴 RCT 🦴 1054 women aged 50-60 from New Zealand 🦴 Intervention: zoledronate: 2 doses, one at baseline and one at 5 yr OR 1 dose at baseline, followed by placebo at 5 yrs

4/ Some v rare side effects of bisphosphonates: 🦴 Osteonecrosis of the jaw 🦴 Atypical femoral fractures 🤔

3/ Meds for osteoporosis: 🦴 Bisphosphosphonates - FIT & HORIZON trials 🦴 Denosumab (Prolia) - FREEDOM trial 🦴 Romosozumab (Evenity) - FRAME & ARCH trial 🦴 Teriparatide (PTH analogue)

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2/ Osteoporosis: 🦴 ⬇️ bone density ➡️ fractures 🦴 Dx w/ DEXA and/or fragility fracture