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08/03/2011 - Dengue, hyponatremia and Crohn's flare

posted Sep 20, 2011, 5:36 AM by Chief Resident   [ updated Sep 20, 2011, 5:38 AM by Purnema Madahar ]
Hitting the mid-week mark in stride.
Some quick feedback on timeliness: pretty good for IMR, we only started a few minutes late. For Chief of Service, not quite as good. Please make an effort to come on time. It's perfectly acceptable to remind your attending that noon conference starts at 12:30 and that attending rounds should really end at 11:30. Due to the setup and the line for food, noon conference gets quite chaotic if people trickle in late.
I apologize to the folks who got a 6am admission that ended up on Klau, out of reach for house staff. We're working on fixing the logistic snafu.
A big Thank You for the first IMR to Sam Weisblatt and Dr. Shaines. I attached the Sodium paper from the 1998 Lancet series 'Electrolyte Quintet'. Let's see if we can find cases for the other 4 electrolytes.
I hope that you all enjoyed the CoS on Dengue. A Thank You to Christian for bringing us this case from his previous rotation in the MICU. I attached two Lancet Seminars on the Dengue syndromes and hemorrhagic flaviviruses including some excellent discussion of the pathogenesis.
Lastly, the following question came up during intake:
Q: Should we treat a Crohn's flare with abx?
A: According to a recent meta-analysis (attached), there is benefit to abx in Crohn's to induce remission and prevent flares. Benefit might be limited if only the small bowel is affected. In our pt, it seemed that she only had inflammation in her small bowel, so I would think that abx are still questionable.