In this episode, I’ll discuss the rare case when a very hypotonic solution may be indicated. Subscribe on iTunes, Android, or Stitcher A commentary published in AJHP argues for abandoning the use of extremely hypo-osmolar intravenous solutions to treat hypernatremia. The authors consider extremely hypotonic solutions to be 0.225% sodium chloride (also called one-quarter normal […]

In this episode, I’ll discuss oral vs IV phosphate replacement for critically ill patients with mild to moderate hypophosphatemia. Subscribe on iTunes, Android, or Stitcher IV phosphate is frequently used to replace low serum phosphate levels in critically ill patients. However this often requires the administration of significant amounts of IV fluid, which can complicate […]

In this episode, I’ll discuss the impact of ceftriaxone on the development of pneumonia and noninfectious outcomes after out-of-hospital cardiac arrest. Subscribe on iTunes, Android, or Stitcher While previous studies have shown that ceftriaxone can prevent pneumonia after out-of-hospital cardiac arrest (OHCA), the effects on other outcomes, such as mortality and the development of resistance, […]

In this episode, I’ll discuss endobronchial instillation of epinephrine, cold saline, and saline to prevent bleeding in patients undergoing endobronchial biopsy. Subscribe on iTunes, Android, or Stitcher Severe bleeding as a result of an endobronchial biopsy has the potential for serious and even fatal patient outcomes. Providers routinely administer medications through the channel of the […]

In this episode, I’ll discuss how to judge whether a journal is reputable. Subscribe on iTunes, Android, or Stitcher There are dozens of well-established journals that when we read an article in them, the thought never comes to mind “Is this journal reputable?” But there are also journals with little or even no peer review, […]

In this episode, I’ll discuss oral beta-lactams for complicated UTIs. Subscribe on iTunes, Android, or Stitcher Most oral beta-lactams (especially cephalosporins)have usually been avoided when treating complicated UTIs out of concern for reduced effectiveness. However, in light of increasing resistance and toxicity issues with fluoroquinolones and trimethoprim/sulfamethoxazole (TMP/SMX), researchers are re-examining oral beta-lactams to see […]

In this episode, I’ll discuss a novel metric for antibiotic stewardship. Subscribe on iTunes, Android, or Stitcher Days of Therapy (DOT) is probably the most common metric to track antimicrobial stewardship efforts related to antibiotic consumption. DOT is not a perfect metric as it is calculated by calendar day regardless of the number of doses […]

In this episode, I’ll discuss the effects of therapeutic plasma exchange on enoxaparin half-life. Subscribe on iTunes, Android, or Stitcher Therapeutic Plasma Exchange (TPE) or plasmapharaesis is a procedure that takes the patient’s blood and passes it through an apheresis machine, where the filtered plasma is removed and discarded with reinfusion of red blood cells […]

In this episode, I’ll discuss what predicts critical care pharmacist intervention – patient acuity or medication regimen complexity? Subscribe on iTunes, Android, or Stitcher It makes intuitive sense that both scenarios of high patient acuity and high medication regimen complexity would be legitimate ways of identifying ICU patients who are more likely to need pharmacist […]

In this episode, I’ll discuss the 2026 AHA Stroke Guideline changes to how contraindications to thrombolytics are presented. Subscribe on iTunes, Android, or Stitcher The data to support contraindications to thrombolytic therapy for acute ischemic stroke is limited to case reports and common sense concerning what patient characteristics might increase the risk of intracerebral hemorrhage […]

In this episode, I’ll discuss which antibiotic should be given first in sepsis – the beta-lactam or the vancomycin? Subscribe on iTunes, Android, or Stitcher Quickly administering appropriate empiric antibiotic therapy is essential in the treatment of severe infections. If multiple antibiotics are required for empiric therapy to treat a severe infection (such as for […]

In this episode, I’ll discuss whether patients taking beta-blockers require increased doses of epinephrine for anaphylaxis. Subscribe on iTunes, Android, or Stitcher Animal data suggests that patients taking beta-blockers have more severe anaphylaxis, possibly by decreasing the threshold for mast cell activation. Because beta-blockers interfere with the same receptors epinephrine needs to activate to effectively […]