Background: Hospitalists routinely precept third year medical students on general internal medicine wards. One of the key patient care tasks for students is to interpret and initiate management for common electrolyte abnormalities. Formal training to achieve this is lacking for students transitioning from preclinical to clinical years. We designed and implemented a module on interpreting [...]

Background: Evidence-based guidelines/protocols for electrolyte replacement that safely encourage oral (PO) and/or intravenous (IV) dosing attain goal levels more successfully than standard care.1-17 PO is generally more comfortable and less dangerous than IV. Between 5/2017-11/2017, Jefferson dosed ~300,000 doses of potassium (K) and magnesium (Mg), with 30% and 19% of doses being PO, respectively. Guiding [...]

Background: Multiple educational modalities have been utilized to teach high value care to trainees, including lectures, facilitated group discussion, and behavioral nudges and prompts (1–3). However, little has been done to compare different educational strategies delivered via the same modality. The goal of this study was to explore whether different educational prompts encouraging thoughtful lab [...]

Background: Frequent blood draws are implicated in hospital-acquired anemia as well as rising costs. Critically ill patients undergo frequent venous and arterial blood sampling, both providing electrolyte concentrations. In this study, we sought to examine electrolyte values obtained by arterial blood gas testing (ABG) and central laboratory testing (VCL) and determine the extent of essentially [...]

Case Presentation: A 62 year-old woman with hypertension presented with one day of profound, generalized weakness. The patient awoke from sleep and felt nearly paralyzed from the neck down, unable to walk or hold a glass of water. Exam revealed 2+ strength in upper and lower extremities and left wrist drop but no cranial nerve [...]

Background: In the inpatient setting, serum potassium (K) and magnesium (Mg) are frequently replaced for patients with values within the reference range (generally K 3.5-5.0 mEq/L, Mg 1.3-2.2 mEq/L) to target an arbitrary goal of 4 mEq/L for K and 2 mEq/L for Mg.(1,2) For certain high-risk non-pregnant adults, K and Mg replacement to these [...]

Case Presentation: A 69-year-old female presented to the Emergency Department with progressive weakness, nausea, vomiting, diarrhea, abdominal pain, and confusion for several weeks following an eye surgery the month prior, with symptoms acutely worsening over the last week. On the day of admission, she was found disoriented and clinging to a doorway at home, unable [...]

Case Presentation: A 90-year-old man with chronic kidney disease and benign prostatic hyperplasia presented with a 4-month history of persistent mucous diarrhea, abdominal pain, and a few episodes of enterorrhagia. On exam, vital signs were normal except for hypotension. He was in mild acute distress but alert and oriented. He had dry mucous membranes and [...]

Case Presentation: A 36 year-old female with history of bulimia nervosa, bipolar disorder and borderline personality disorder presented to the emergency department after she woke up with painful spasm of bilateral hands. She had been vomiting multiple times daily for the past few days but denied any paresthesia, numbness, weakness, tingling, diarrhea, laxative or diuretic [...]

Case Presentation: A 34-year-old man with hypertension on chlorthalidone and recent COVID-19 infection treated with Paxlovid presented to the ED with three days of shortness of breath, dizziness, and diarrhea. On exam, he was alert, neurologically non-focal, and underweight by BMI. Initial lab work was significant for severe hyponatremia (< 100 mmol/L) and hypokalemia (2.3 [...]