Hospital and Internal Medicine Podcast

More trials show low-salt diets and restrictive fluid strategies do not improve heart-failure outcomes, while another shows continuing metformin in many hospitalized patients reduces hypoglycemia, mortality, readmissions, and new insulin starts. The episode calls for evidence-based change in routine hospital care.  

This episode clarifies the difference between an elevated lactate level (hyperlactatemia) and true lactic acidosis, which requires evidence of metabolic acidosis (low pH or low bicarbonate). It discusses common causes of raised lactate, why mislabeling affects treatment location and mortality risk, and how EHRs and coding practices can perpetuate the confusion. Listeners will learn when to document lactic acidosis versus elevated lactate, the clinical implications for resuscitation and disposition, and the importance of precise medical terminology.

Fecalomas—rock‑hard impacted stool that cause obstruction, stercoral colitis, perforation, and even death—most often in immobile elderly patients or those on opioids. Standard treatments include aggressive bowel regimens, enemas, manual disimpaction, endoscopic fragmentation, and surgery. There are also case reports of using Coca‑Cola enemas to soften and reduce fecalomas when conventional measures failed. 

This episode examines the concerns about mouthwash and oral cancer. While ethanol can form the carcinogen acetaldehyde, how worried should we be? Strong antiseptic rinses can alter the oral microbiome and may reduce bacteria that help produce nitric oxide, with a small study showing a blunted post-exercise blood pressure drop; does that justify abandoning exercise or ignoring dental guidance?

Multiple studies in multiple journals are going against the norms and previous guidelines. The times they are a changing.

For acute treatment of Venous Thromboembolism the debate of which direct oral anticoagulant to use appears to now be settled.  

The double-blind, randomized phase III EMPEROR-Preserved trial showed a benefit of the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF). Now let us dig a bit more into those headlines.

An important recently published randomized control trial provides guidance on this controversy.

Spontaneous Bacterial Peritonitis - Unique Infections in Cirrhosis part 2

Unique Infectious Considerations in Cirrhosis - part 1

Can we trust a nuclear study to nail the diagnosis? Are motor abnormalities really the cause of symptoms? What is a POP procedure? 

Almost nobody feels comfortable managing DELAYED gastric emptying (gastroparesis) and very few medical providers even think about RAPID gastric emptying in their diabetic patients. Even if you send these patients to GI specialists, your blood sugar co-management of these patients can be heavily impacted by these issues. Is delayed gastric emptying always a bad thing? When your patient has upper GI symptoms, how often is it a gastric emptying abnormality? Time for some answers.

Does regular, low-dose, oral sustained-release morphine improve disease-specific health status or cause respiratory adverse effects in patients with moderate to very severe chronic breathlessness due to advanced chronic obstructive pulmonary disease? Digging in on the latest study.\r\n

My take on what went down at the Journal of the American Medical Association. I don\'t support the comment there isn\'t \"structural racism in health care\", but the backlash was an over-reaction. Can we have discussions about the controversial issues that affect healthcare (like gun violence or abortion) without cancel culture cancelling the people who want to have nuanced discussions? The backlash should have been productive dialogue in a field where every MD/DO/PA/NP by definition has an advanced degree. Nowadays the reaction is to go after the jobs of people that didn\'t even make the comment (even if they came out with statements opposing the comment).\r\n

Cows Milk - Healthy or Not?

Psilocybin Mushrooms - will they become an accepted medicine?

Everyday you are living through epigenetic changes. This lecture provides a basic understanding of how epigenetic changes influence infections, vaccinations, cancer, future generations, your muscles, and (of course) your tan.

Hyponatremia remains a challenging topic for many because they are trying to memorize algorithms and numbers. You can usually nail the etiology by history & physical and a brief chart review. 

Do really know what CRP is (other than saying it is an inflammatory marker)? Should we always shut down cytokines? If so, how? Why should we avoid giving a glucocorticoid to a COVID patient before they develop an elevated CRP or hypoxia? So many questions! A few answers are provided. 

If you use the term 'cytokine storm' and don't really know what you mean by it, you are far from unique. Let me help to try and clarify it for you just a bit.