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Chess e4 vienna system

on December 19, 2025

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Vancomycin Dosing

hi this is Elissa critical care pharmacy resident and my clinical pearl today we'll cover vancomycin monitoring and the transition from traful new monitoring to monitoring of the AUC or area under the curve briefly vancomycin Vancomycin is a glycol pop type antibiotic and it's been FDA approved now for more than five decades banco Meissen is used mainly for broad-spectrum gram-positive coverage especially of more resistant microorganisms such as methicillin-resistant Staph aureus the main side effect I want to pull out is nephrotoxicity and this generally occurs when vancomycin is used at higher doses so when we target a trough of 15 to 20 when vancomycin is used for a long period of time or when a patient is also receiving other nephrotoxic medications such as pepper cilenti's of Actium we're all familiar with vancomycin trough only monitoring as this is really what we've done in recent years targeted trough anywhere from 10 to 20 but typically 15 to 20 when we...

PHEWAS

PHEWAS today we're talking about genome-wide Association so first we're gonna start with why multi phenotype associations what is motivation and then we're going to look at different ways of dealing with multiple phenotypes on one hand dealing with G was and epigenomics across many phenotypes looking at if genomics or feliz and then looking at meta phenotype inference image and imputation from the clinic correct so first of all why multi phenotype analysis so basically what are they trying to do on one hand you know associations Association testing has been typically between you know genetic variants and a single trait every single example we looked at so far it was basically looking at a single variable and how it varies across hundreds of thousands of individuals but that one single variable as opposed to an increasing trend to have really truly much richer in note a big data so instead of measuring a single variable across individuals what you can do is actually measur...

hyponatremia

hyponatremia Maximum rates of change Acute hyponatremia no more than 4-6 mEq in 4-6 hours and daily no more than 8 Chronic hyponatremia no more than 10-12 mEq Hypernatremia no more than 10-12 hyponatremia weight * correction / time = flow rate 90 * 4 / 24 = 15 mEq 513 mEq in 1L, 159 of regular in 1L ns 3% 313 rate 3 * 90, 90 kilograms change by 3 90 * 3 = 270 / 513 * 1000mL that's mililiters run over 24 hours. over hours 543 mililiters = 22mL / hr hypotonic to ctrl edema use smaller change rate 4-6 go up by 3 take their weight multiply by 3, how much divide by 24 70 * 6 = 420 / 24 = 17.5 run at 17.5 70 * 6 3/31 Ahmad desat listen for wheezing, nebs, steroids, suction them, spo2, abg, cxray if chest xray clear - pulmonary embolism sodium treatment goals - 4-6 mEq Calculate 120 over 24 hours what his goal 124-126 how much fluid the best way to approach to approach hyponatremia, they've already given a liter bolus of NS Immediately repeat a BMP, go off of that number, that 1 li...

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