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08/29/2011 - house staff representation and diuretic resistance

posted Sep 28, 2011, 5:30 PM by Chief Resident   [ updated Sep 28, 2011, 5:31 PM by Purnema Madahar ]
At the house staff feedback meeting with Phil Lief this afternoon, we talked about ways to engage in the improvement of the residency program and the functionality of the hospital:

1. Resident Council - a monthly meeting on Northwest that addresses practical matters in a multidisciplinary format. The nursing managers, the medical director and other support staff are present to hear about problems we encounter on the floors, from inadequate admin support to slow transportation to communication with the nurses. Firm 3 nominees are Rohit Das, David Dayan-Rosenman, Swana de Gijsel, Erin Goss, Magni Hamso and Arash Nafisis, but the meeting is open to all. Future dates are Tuesday 10/11, 11/8 and 12/6 at 4:00PM in the NW8 conference room.

2. Resident Forum - a monthly meeting with Jeff Weiss, the Medical Director, with residents and fellows from all departments. A good place to hear and speak about hospital-wide issues like meal cards, parking, IT support.... I will find out when the next meeting is.

3. COGME - the Council on Graduate Medical Education, the local body that reports to the ACGME on all residency accreditation issues. Held monthly over at Weiler, its focus is on the implementation and monitoring of all the residency programs sponsored by Albert Einstein. It offers an interesting perspective on graduate medical education. Each year, COGME is looking for residents to represent their department, so if youâ re interested, let me know.

During intern morning report, Phil Lief taught about diuretics and the mechanisms of diuretic resistance (persistence of edema despite adequate diuretic therapy). Some key points from the attached review:

1. Intrinsic renal disease or pre-renal azotemia, as seen in CHF, lead to the accumulation of endogenic organic anions. These compete with furosemide for the receptors that facilitate active secretion of furosemide to the tubular lumen, where furosemide is active.
2. The natriuretic effect of furosemide only lasts for about six hours and is followed by a phase of postdiuretic salt retention. Administration of lasix is therefore only effective if it is either dosed frequently enough to avoid salt retention or if the patient's salt intake is sufficiently restricted.
3. Chronic administration of furosemide likely results in hypertrophy and hyperplasia of the epithelium in the distal convoluted tubule, increasing sodium reabsorption.

For those of you who really want to get into the diuretics, I attached a more in-depth paper by Ellison.