Welcome to The Pearl Log — where post-shift wisdom surfaces, one shiny clinical take at a time. Some pearls are fresh, some are rough, all are found under pressure.
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Potpourri: Recurrent Hypoglycemia, Valproic Acid Overdose, Vertigo, and Autism
A mixed bag of medicine and myth from this week’s shifts:
recurrent hypoglycemia (think meds, organ failure, and missed meals), valproic acid toxicity (with carnitine on your side), and a reminder to assess for the timing and triggers of vertigo. Oh—and Tylenol doesn’t cause autism. Read the studies, follow the money, and keep your critical lens sharper than your 10-blade.
Dialysis after contrast in patients with ESRD?
Ordering contrast on a dialysis patient? Go ahead.
Modern low-osmolality agents likely aren’t directly nephrotoxic, and studies show no loss of residual function in dialysis patients who still make urine. The ACR backs this up—no need for an extra dialysis session or delay in imaging. Get the scan, make the diagnosis.
Lactate, Lactate, Lactate…
Lactate has two personalities, and not all of them mean “shock.”
Type A stems from true hypoperfusion and anaerobic metabolism, while Type B comes from impaired lactate clearance or altered cellular processing—think thiamine deficiency, ethanol, metformin, malignancy, or liver disease. And when it spikes after a seizure? It’s only meaningful if caught fast—within about 90 minutes—before it clears and the trail goes cold.