In this episode of IM Basics, Dr. Eric Acker and Dr. Tark break down the essentials of recognizing and managing hyperkalemia, a potentially life-threatening electrolyte disturbance. They discuss common presentations—ranging from dialysis patients to those with tumor lysis syndrome—and highlight key decision points in diagnosis and management.

Topics Covered:

• Common presentations of hyperkalemia and when to suspect it even without classic symptoms.
• ECG findings in hyperkalemia: from peaked T waves to sine waves.
• When to act and how aggressively, based on potassium levels and clinical stability.
• The three pillars of treatment:
  • Cardiac membrane stabilization with calcium gluconate.
  • Potassium shift therapies (e.g., insulin with dextrose, high-dose albuterol).
  • Potassium elimination (e.g., dialysis, Lokelma®, loop diuretics, or rarely, Kayexalate®).
• A practical discussion on the timing of interventions—why and when to delay shifting before dialysis.
• Tips on avoiding overtreatment, interpreting lab errors like pseudohyperkalemia, and reassessing post-intervention.

Clinical Pearls:

• Use calcium gluconate to stabilize membranes, not to lower potassium directly.
• Watch for hyperkalemia in AKI, rhabdomyolysis, tumor lysis syndrome, and missed dialysis.
• Lokelma® has high sodium content—consider alternatives like patiromer in volume-sensitive patients.
• Always reassess potassium after treatment to guide further interventions.

References & Citations:

• Sterns RH. "Hyperkalemia." N Engl J Med. 2022;386(15):1426–1435. DOI: 10.1056/NEJMra2110952.
• Montford JR, Linas S. "How dangerous is hyperkalemia?" J Am Soc Nephrol. 2017;28(11):3155–3165. DOI: 10.1681/ASN.2016121344.
• Kayexalate safety concerns: Patel K, et al. "Sodium polystyrene sulfonate-induced colonic necrosis." Am J Med Sci.2012;343(2):155–157.

In this educational episode of IM Basic, Drs. Eric Acker and Tark break down the complex topic of septic shock for PGY1 residents and medical students. They explore the pathophysiology, clinical presentation, and diagnostic challenges of septic shock, emphasizing the importance of recognizing atypical signs like hypothermia and bradycardia. The discussion covers essential labs (lactate, procalcitonin), imaging strategies, and the role of scoring systems like SOFA and qSOFA.

Key treatment principles are unpacked, including individualized fluid resuscitation, the timing and selection of vasopressors like norepinephrine (Levophed), and nuanced antibiotic stewardship tailored to suspected pathogens and resistance patterns. The hosts also highlight the importance of source control and the dangers of mimics like DKA and thyroid storm. This is a must-listen for those looking to build a solid clinical foundation in managing septic shock.

Citations & References:

• PulmCrit - Septic Shock
• Surviving Sepsis Campaign Guidelines (2021)
• Sepsis-3 Definitions [Singer et al., JAMA. 2016]
• VANISH Trial (Gordon et al., JAMA. 2016)
• CAT Trial [Annane et al., Crit Care Med. 2007]

Some may start off an internal medicine podcast on how to manage diabetes or hypertension, maybe even a discussion on sodium. We will get to all those topics in our podcast, but right off the bat, we wanted to start on a topic that is life or death: Shock. Recognizing a shock patient is sometimes easy and sometimes very difficult, as it can appear to be something else.

We're going to do a series on shock and its different types. We want the intern and medical student to know right off the bat about the sickest patients and know how to start intervening and saving their lives.

In this foundational episode of IM Basics, Dr. Eric Acker is joined by Dr. Tark and Dr. Bass to provide a high-yield overview of shock for PGY1 residents and medical students. They break down the clinical signs and early indicators of shock, including mental status changes, blood pressure trends, and heart rate abnormalities.

The team discusses the value of history-taking, bedside tools like point-of-care ultrasound (POCUS), and essential labs (CBC, BMP, lactate, Procalcitonin) in differentiating between types of shock. They review the four major shock categories—hypovolemic, cardiogenic, distributive, and obstructive—and stress the importance of early intervention, not just diagnostic pondering.

With practical guidance on workup strategies, resuscitation, and when to escalate to ICU support, this episode equips learners to recognize and manage shock before it's too late.

References for this episode:

• Uptodate - Evaluation of and initial approach to the adult patient with undifferentiated hypotension and shock.
• IBCC - PULMCrit - "Shock & vasoactive medications"