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What factors do you have to consider while treating a cancer pt with a malignant pleural effusion and concurrent infection? 🤔
1/
🚨Cancer pts are at risk for MPE➡️consequence of metastatic involvement of the primary tumor in the pleura💨
What factors do you have to consider while treating a cancer pt with a malignant pleural effusion and concurrent infection? 🤔
1/
🚨Cancer pts are at risk for MPE➡️consequence of metastatic involvement of the primary tumor in the pleura💨
💡Lung, breast, and lymphoma are the most common causes💡
Query of the pleural fluid with the use of the Lights criteria will help to determine the etiology (transudative or exudative)
Exudative=malignant OR infection
One of the criteria is a serum protein ratio >0.5
Query of the pleural fluid with the use of the Lights criteria will help to determine the etiology (transudative or exudative)
Exudative=malignant OR infection
One of the criteria is a serum protein ratio >0.5
Since both MPE & infectious effusions🦠contain↗️↗️protein
🛑Avoid highly protein bound abx (Ex: daptomycin, ceftriaxone, ertapenem)➡️can get sequestered in the pleural fluid& have↘️systemic distribution & ↘️the ability to treat a bacteremia if present 😳🤯
🛑Avoid highly protein bound abx (Ex: daptomycin, ceftriaxone, ertapenem)➡️can get sequestered in the pleural fluid& have↘️systemic distribution & ↘️the ability to treat a bacteremia if present 😳🤯
Why do some pts with renal cell carcinoma present w/ polycythemia🩸vs others w/anemia🤔?
1/ Erythropoietin (EPO)➡️glycoprotein that induces differentiation of erythrocytes in the bone marrow to promote RBC production➡️produced in the KIDNEY
1/ Erythropoietin (EPO)➡️glycoprotein that induces differentiation of erythrocytes in the bone marrow to promote RBC production➡️produced in the KIDNEY
In RCC➡️EPO is produced ectopically by RCC tumor cells causing abnormalities in RBC production
🧐In fact‼️ ectopic EPO occurs in 66% of RCC pts!
Despite high concentrations of EPO➡️Anemia (⬇️RBC) is common due to poor nutrition🍎, hematuria🩸 or ineffective erythropoiesis🛑
🧐In fact‼️ ectopic EPO occurs in 66% of RCC pts!
Despite high concentrations of EPO➡️Anemia (⬇️RBC) is common due to poor nutrition🍎, hematuria🩸 or ineffective erythropoiesis🛑
Polycythemia➡️less common in 1-5% of pts, most common in clear cell RCC is due to paraneoplastic production of EPO results in excess RBC and reduction in inhibitory proteins that haunt RBC production!
pubmed.ncbi.nlm.nih.gov/2297568/
#oncopharm
#twitterx #OTILT #renalcellcarinoma #rcc
pubmed.ncbi.nlm.nih.gov/2297568/
#oncopharm
#twitterx #OTILT #renalcellcarinoma #rcc
Awesome MICU rounds w/ @MikeMcCurdyMD
Been learning tons about AT2!
Ever consider AT2 in cirrhosis?
#OTILT Angiotensinogen▶️produced in liver ▶️main AT2 precursor
In liver failure,⏬SVR ▶️⏫regulation of RAAS & aldosterone ▶️ascites💦&hepatorenal syndrome🤯
Been learning tons about AT2!
Ever consider AT2 in cirrhosis?
#OTILT Angiotensinogen▶️produced in liver ▶️main AT2 precursor
In liver failure,⏬SVR ▶️⏫regulation of RAAS & aldosterone ▶️ascites💦&hepatorenal syndrome🤯
AT2 acts directly on peripheral vasculature and can restore perfusion thereby ⏬RAAS
🛑Patients w/ liver failure▶️excluded from
ATHOS-3 🛑
However check out this awesome case (below) that shares data on its use in liver disease (Shameless plug @MikeMcCurdyMD Great work!)
🛑Patients w/ liver failure▶️excluded from
ATHOS-3 🛑
However check out this awesome case (below) that shares data on its use in liver disease (Shameless plug @MikeMcCurdyMD Great work!)
journals.sagepub.com/doi/full/10.11…
How are you using AT2 in your practice? @DRxDray @Prof_J_NYC @AFlanneryPharmD @GilbertPharmD @iEMPharmD @MprizzleER @PulmCrit @EMHighAK @gmjones09 @MelanieLaine2 @BissellBrittany @PharmacyCCEd @EMCCC2 @ccarterpharmd @EMToxRx
How are you using AT2 in your practice? @DRxDray @Prof_J_NYC @AFlanneryPharmD @GilbertPharmD @iEMPharmD @MprizzleER @PulmCrit @EMHighAK @gmjones09 @MelanieLaine2 @BissellBrittany @PharmacyCCEd @EMCCC2 @ccarterpharmd @EMToxRx
