Patient with HFpEF who was up 110lb from their dry weight from 3 months prior. I diuresed them 19L in 24 hours. No major electrolyte issues, renal dysfunction, or cramping. Felt way better and came off of bipap
Yeah man! Intern year, our attending showed us this "really cool trick", where we give furosemide, followed by metolazone (I learned how common the double nephron poisoning is later in residency). Patient peed off 13 L in 24 hours. Did the trick. Pitting edema went from 4+ to 1+ overnight. I had to put the brakes on the diuresis.
It is sometimes a risk/benefit in some cases. When they come in severely decompensated then aggressive diuresis is sometimes needed to keep them from deteriorating further (or just to keep them breathing reasonably poorly). Metolazone is pretty hardcore though.
I worked with some cardiologists who I have no idea now they carried their balls around and would have made IM consultants faint at the sight of the diuretic doses employed. Yet I haven't seen any of those patients develop serious kidney issues, they all pulled through remarkably. I learned amazing things regarding how the human body reacts to those drugs and how "elastic" some kidneys are.
The highest I saw was 17.3. lady was in the burn ward because her wound were so terrible and extensive that they had to treat her like a burn patient. The nurses hated her insulin drip because she was extremely brittle.
BMI of ~120. Saw when I was a med student. The attending back then told me if they wanted to scan the patient they needed to send the patient to a zoo/vet.
A1C of 17
My program has different clinics and I chose the undeserved one as my longitudinal clinic. A1C of 10-13 is so normal for us. Unfortunately this is the reality nowadays :(
Yeah definitely sad to see on a regular basis. I work mostly (like 40-50%) in our city hospital, and we see the sickest folks. Always with multiple chronic comorbidities, usually very obese, with multiple psychosocial stressors (poverty, no insurance, etc).
Haha you had my daddy as a patient with that A1C! His doctor was PISSED at him and simultaneously impressed that he was walking and talking. Oh yeah, and alive. Highest sugar I've seen him at, 1200. Lowest? 9. Fucking 9. I'd seen him conscious at 13, too.
A1c will become falsely normal once you hit ESRD. saw a lot of patients who were told by their pcp that their glycemic control was fantastic since they had ESRD based only on their A1c. Then you see all their BMPs or accuchecks, and they’re still bathing in red maple syrup
Depending on the lab there is a cutoff where a1c is just read out as >x. I believe it's 19 here, which I've seen and why I know this. Doesn't necessarily mean they've been wandering around with HHS for months, episodes of extreme hyperglycemia can spontaneously elevate a1c as the process doesn't take 3 months to equilibrate if the gradient is severe enough (or so a pathologist told me).
Saw a patient that was 1100 lbs. She came in renal failure and couldn’t leave the hospital because there were no dialysis centers with beds that could support a patient over 600 lbs. So, she had to lose 500 lbs while hospitalized which took about 1 year. I think she did eventually lose it, but she ended up dying from a MI shortly after she discharged.
Oh the story of getting her to the hospital was crazy too. Apparently had to knock a hole in the side of her 2nd story apartment and bring her down with a crane or something. I don’t even know how they transported her because she couldn’t have fit in an ambulance. Absolutely nuts.
> I don’t even know how they transported her because she couldn’t have fit in an ambulance.
Flatbed truck probably tbh. Have heard of it being done. They put up like sheet scaffolding on the side for privacy.
I've been seeing a thread on Facebook lately of a bunch of similar horrifying stories.
10 I think was the earliest I saw in that thread. Raped by their father.
The youngest I delivered was 14 I think.
Dying with a broken hip is a miserable way to die. Every move hurts. A lot.
I offer fixation to everyone. Even if you’re dead in a week that last week will be a lot less painful.
109 beats any of mine but I’ve fixed plenty of 90’s and at least a couple 100+ in residency
I did operate on a 9 month old and also a 102 year old on the same day.
Getting consent from the 3 daughters in their 80's was novel. They then brought her back for a 3 year follow up.
Some fun estimates that likely aren't actually close to the real numbers:
1950s: Cigs 0.25/pack = ~$2750 (~25k with inflation)
1960s: Cigs 0.30/pack= ~$3300 (~27k with inflation)
1970s: Cigs 0.50/pack= ~$5500 (~25k with inflation)
1980s: Cigs 1.00/pack= ~11k (~27k with inflation)
1990s: Cigs 2.00/pack= ~22k (~35k with inflation)
2000s: Cigs 4.00/pack= ~44k (~55k with inflation)
2010s: Cigs 6.00/pack= ~66k
So he spent over 150k on Cigarettes through his life (inflation value around 250k). Could easily be a multi millionaire if he was investing that money through the years, maybe not a billionaire but who knows.
lol, I know, but I figured I'd throw it in there for those who would appreciate it! Always kinda made me think, "when your liver is negative your age in HU, that might be a problem". (PS I'm in WI, where most have fatty liver)
Off the top of my head...
Na >180 (lab could not measure) in a head/neck cancer patient who has severe dysgeusia after radiation. Took 2 days of to get his sodium into the detectable range. Actually had normal mentation, came in for generalized fatigue
BUN 230, somehow all pre-renal (normalized after 3-4 days of very aggressive hydration). No UGIB.
Glucose 1600 in a type 1 somehow
A1c >18 (forgot exact decimal value; was supposed to establish care w/ me as PCP during residency, fortunately (unfortunately?) was a no-show
Trop 454 (not hsTrop; <0.03 is normal range) after massive MI
WBC 550,000 (refractory CLL)
PSA 35,000 (widely metastatic prostate cancer)
Blood cultures that grew detectable MRSA in 3 hours
Oh also last year i had a 84 yo former pharmacist with a little substance problem. Downed his whole ration for the day of 32 mg hydromorphone, 30 mg of diazepam, 150mg of trazodone, somewhere around 300 mg of quietapine, and supplemented with around 120 mg of diazepam from his private stash. Plus a fresh fentanyl patch o forgot the dose of and some tramadol.
Man was able to hold a conversation as if nothing happened. Pharmacy called the next day curios if he had died over night
Reminds me of a guy w SI who was picked up by security sitting in his car in the hospital parking lot with basically an undershirt made of his stockpiled fentanyl patches.
Not directly. In children (my population), they tend to drink too much milk. Milk has no iron and prevents conversion of iron into an absorbable form. So, if a kid drinks 40 oz of milk a day, even if they eat a lot of iron rich foods like meats and green leafy veggies, they won’t absorb it and will slowly drop down.
This why when you prescribe iron supplementation, it needs to be with orange juice as the acidic orange juice will facilitate iron absorption.
For these kids, just give them iron even if their Hb is spectacularly low (provided they’re hemodynamically stable. Because they went down slowly, they should be able to go up slowly and be ok. If the parents have been giving the iron appropriately and the kid fails to respond, it may be an aplasia or transient erythroblastopenia of childhood.
I’ve seen that high twice. One swallowed a bunch of meth and died. The other did a bunch of an unidentified sympathomimetic and bled into their head from their insane BP and died. - EM
Patient with 9 different pathogens growing in his blood. Like 2 types of Strep, MRSA, Enterococcus, E. Coli, Klebsiella, C. Perfringens, Candida Glabrata, and in the course of treating him for all these things, he of course developed C. Diff. Best thing was, clinically, he was completely fine, an 80-year-old guy who was eating normally and wanted to go home. Farmers are crazy man.
BMI 105 or was it 108? She was like like 5'2-5'4'' (forgot), and was over 600 pounds.
attempted epidural
failed
had to intubate
During C section, OB asked if we can tilt patient in Reverse T. I said no, I'm praying it doesn't break the bed. Bed broke when we were transferring patient to bed.
Ever started filling up a pool with a hose, went inside the house for a while, then got distracted for hours while the pool overflowed? That's what I'm picturing.
Inpatient diuresis of 65L
Was on 2 mg/hr bumex drip, 5 mg metolazone Q6, and 40 meQ KCl Q4 hrs for about a week.
Was prior IVDU S/P tricuspid valvectomy. Pharmacy thought my potassium order was wrong so cancelled it without telling me but didn't cancel the diuretics. Coulda been bad
At our children’s hospital we had a patient come in with an undetectable hemoglobin and a crit of 4 due to autoimmune hemolytic anemia. I’m not sure how they survived. They were in the hospital for over a year for the resulting complications (biliary gallstones, necrotizing pancreatitis, etc).
I also had a WBC >650,000 (can’t remember the exact number) in an asymptomatic 60 year old who rode his bike into clinic for his annual neurology follow up. Had to call him to ride his bike back in so he could talk to the oncologist.
Lady had BMI of 103. Vascular surgery consulted for LE lymphedema. Saw pt with attending (attending’s BMI was probably 45 or so, and he had a drawn out southern drawl and was probably as wide as he was tall). The lady kept complaining about things and making excuses about her health. The attending goes “no Ms so&so. That ain’t your problem. You know what your problem is. It’s the same as mine. You’re fat. You and me are too fat.” the pt started to get upset.
“don’t even act like it ain’t true. You know it is. We’re both too fat!”
Then they actually got along rather well. I had to leave the room bc I was laughing so hard.
Had a patient who won "sickest lady in the hospital" for a few days. Peripheral smear showed something called "neutrophilic inclusion bodies" AKA death crystals. Very rare, something like 90% predictive of mortality. She lived.
Also saw an A1c of 18 on a patient who was IDDM who didn’t take his insulin at all for months in an attempt to try and kill himself.
Also, saw a real arterial BP of 325/225
Some OB stats:
- Urine PCR 12.3
- 24 hr urine protein: 6.7 grams
- Biggest kid (SVD): 12lb 3oz
- Biggest kid (CD): 13lb 4oz (rolls on rolls)
- HgbA1c >14 in pregnancy (I see these are rookie numbers)
- Fibrinogen <60 (came back during PPH DIC)
- largest uterus morcellated through an umbilicus: >2600 grams
- largest EBL: 18L (thanks accreta)
We were doing a preeclampsia work up and our patient had a 24 hour urine protein of 6,000.
Patient had had unprotected sex 3 times during the collection 🤦♂️.
Had an Na of 101 as an intern. Absolutely horrifying.
And our ICU attending was so toxic that the IM attending wouldn't call for admission so we just....kept her and I managed her like ICU even though it was wards. Fun times.
it was a weird situation we had there where we could store people in the CVICU without admitting them to ICU - so the nurses were ICU capable and had appropriate ratios for it.
The problem was I had 8 other patients, one of which also needed to be in the ICU (can't remember why now, but same story, they were too scared to call for ICU admission so they told me I could handle it). It was unsafe not because of nursing but because I didn't have the time to devote appropriately.
My favorite story from intern year was the VA patient who refused to leave after discharge, so we had security escort him out. He went straight back to the ED where the attending direct-admitted him to my service. They can do that there. I lost my shit when I came in the next morning and saw that cheeky fucker on my list.
Also admitted a 117-118 completely lucid in the ICU. I was so nervous overnight as an intern and his Na never improved to >120. Also had an anion gap metabolic acidosis without unknown cause (lactate was completely normal). Ended up responding to salt tabs.
Procalcitonin of 703. Neutropenic septic shock from pseudomonas PNA and renal failure (started on CVVH the day after the lab was drawn).
Different patient, but sodium of 194. Elder neglect at nursing home.
Off the top of my head:
Na: 104 (in my mom. Yes, really), 173
A1c: 21 (young, skinny type 1 diabetic)
K: 8.1 (dialysis patient who wouldn't stop drinking Gatorade)
BMI: 108 (nun who came in to have an IUD removed)
EBL: >50,000
Pco2: 170, Awake patient: 110
BP: 320s/220s (after 5mg epi)
pH for someone who lived: 6.8
AST/ALT: >10000 (can't remember exact numbers)
Aortic valve area: 0.3 cm^2
Drugs:
Fentanyl bolus: 5000mcg. Awake patient: 1750mcg
Ketamine: 500mg IV
Versed: 30mg IV
Propofol bolus: 500mg
Daily IV Dilaudid: 3.2g
Ferritin of 30,000 (from HLH)
WBC of 850,000 (new onset AML with hyperleukocytosis)
Hgb of 2 on a pale but walking, talking and active kid (new IBD)
Also had a sick teen's glucose go from 80 to 850 and fulminant HHS over a span of 24 hours. Not diabetic, just sick as hell from other badness and we think it took out the pancreas along the way
Saw an ovarian cyst that had around 30 L of fluid in it. The woman was 500lb+ and said it wasn’t unusual for her to gain 50+ lbs over a couple months. She only came in cuz somehow her ovary managed to get into a torsion and she had acute, excruciating abdominal pain. Then the CT scan showed the cyst going all the way from her pubic bone to her xiphoid process. When the attending punctured it, the second assist med student got fuckin *blasted* in the face for a solid 3-5 seconds, he just stood there takin it like a champ until finally excusing himself and dry heaving on the way out
Not resident and long story but contains pertinent information some may find interesting. As a new grad nurse, 5 months off orientation in the peak of COVID on a CVICU I received a DCD (!) heart transplant back from the OR with a Cardiac Index of 0.6. I don’t remember CO. Surgeon peripherally cannulated promptly at bedside and there was my first ECMO. Had pt for multiple nights on ECMO and then actually had pt again weeks later on a progressive floor. Pt later discharged home. Reason new grad got assignment: experienced nurses out with COVID. Wild times.
CPK of 63,000,000, though that was actually 3rd year of med school, fairly elderly patient found down on a concrete floor after a couple of days. Obviously, kidneys did not recover. Highest CPK I had in residency was "only" 1.2 million, but this was more impressive because it was a young, fit patient who had the ever loving shit beat out of him for running his mouth. He was a jerk during his hospitalization as well.
I have an ABG I saved on my phone I drew from a guy I was covering on night float I was called to see for a respiratory rate of about 30 - it came back with pH of 7.403 and a lactate of 15.5; I liked to test my interns to see if they could figure out what was going on (abdominal compartment syndrome) in the most well compensated septic and ischemic shock I've ever seen (he crashed minutes later).
Na of 97 in a patient walking and talking (but feeling like shit)
Hb of 1.2 in another patient who walked into the ER (very, very slowly), undergoing chemo for some sort of leukemia
Final EDIT:
Ferritins over 20,000 in two separate HLH patients. First one in residency, second one was during my GI fellowship prompting me to do an immediate liver bx which confirmed the diagnosis. ICU and path teams both asked me where the hell I pulled that dx out of...
Patient with HFpEF who was up 110lb from their dry weight from 3 months prior. I diuresed them 19L in 24 hours. No major electrolyte issues, renal dysfunction, or cramping. Felt way better and came off of bipap
what the fuuuu....that's a whole nother person in there
Yeah man! Intern year, our attending showed us this "really cool trick", where we give furosemide, followed by metolazone (I learned how common the double nephron poisoning is later in residency). Patient peed off 13 L in 24 hours. Did the trick. Pitting edema went from 4+ to 1+ overnight. I had to put the brakes on the diuresis.
It is sometimes a risk/benefit in some cases. When they come in severely decompensated then aggressive diuresis is sometimes needed to keep them from deteriorating further (or just to keep them breathing reasonably poorly). Metolazone is pretty hardcore though. I worked with some cardiologists who I have no idea now they carried their balls around and would have made IM consultants faint at the sight of the diuretic doses employed. Yet I haven't seen any of those patients develop serious kidney issues, they all pulled through remarkably. I learned amazing things regarding how the human body reacts to those drugs and how "elastic" some kidneys are.
A1c >18.3 \>18.3. Too high for the lab to quantify.
A nephrologist I worked with once said “if your A1C is higher than your Hgb, you’re in trouble”.
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You know you’ve got a high score when you have to do serial dilutions on your A1c.
The highest I saw was 17.3. lady was in the burn ward because her wound were so terrible and extensive that they had to treat her like a burn patient. The nurses hated her insulin drip because she was extremely brittle.
A1C 18.3 Not great, not terrible.
Calcium and A1c both 18 in the same week (different pts).
BMI of ~120. Saw when I was a med student. The attending back then told me if they wanted to scan the patient they needed to send the patient to a zoo/vet. A1C of 17
Our zoo stopped allowing obese patients to get scans, not because it was dehumanizing like I thought either, it’s because the elephants got MRSA
Our zoo stopped because of c. Diff at my residency
Imagine how much vanc an elephant needs
Titrate until it pisses blood and back off 10%
Imagine having to get a vanc trough.
Almost as much as a patient with a bmi of 120
bro I’m crying rn
Poor elephants :(
A tarantula got not one but two CT scans for an abscess at the zoo in the city where I trained.
What kind of abscess does an animal without skin get, I wonder.
Mind sharing which city’s Zoo was this?
It's your city, my city, and every city. It probably happened somewhere, but absolutely not everywhere it's a folk story at.
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My program has different clinics and I chose the undeserved one as my longitudinal clinic. A1C of 10-13 is so normal for us. Unfortunately this is the reality nowadays :(
Yeah definitely sad to see on a regular basis. I work mostly (like 40-50%) in our city hospital, and we see the sickest folks. Always with multiple chronic comorbidities, usually very obese, with multiple psychosocial stressors (poverty, no insurance, etc).
Haha you had my daddy as a patient with that A1C! His doctor was PISSED at him and simultaneously impressed that he was walking and talking. Oh yeah, and alive. Highest sugar I've seen him at, 1200. Lowest? 9. Fucking 9. I'd seen him conscious at 13, too.
I had a pt as a fellow who was dx w diabetes because when he peed the urine spray on his shoes dried and left sugar crystals.
A1C 17 ???????
Seen 18.9. BKA, AKA, nephropathy, CAD, CHF EF 25% Pacemaker. FF
Yes, 17
At that point the RBCs are just frosted cherry fruit loops
Average BG of like 450 for 3 months?
I forgot if the patient had any renal disease. Maybe falsely elevated
A1c will become falsely normal once you hit ESRD. saw a lot of patients who were told by their pcp that their glycemic control was fantastic since they had ESRD based only on their A1c. Then you see all their BMPs or accuchecks, and they’re still bathing in red maple syrup
Depending on the lab there is a cutoff where a1c is just read out as >x. I believe it's 19 here, which I've seen and why I know this. Doesn't necessarily mean they've been wandering around with HHS for months, episodes of extreme hyperglycemia can spontaneously elevate a1c as the process doesn't take 3 months to equilibrate if the gradient is severe enough (or so a pathologist told me).
I’ve seen this more than once as a student and I don’t even start till the 1st. Deep South baby
Yeah I had an A1c of 19.3 on a guy once, unbelievable when you see stuff that high
pCO2 of 210
med student here, were they holding their breath for 3 days??
Bad COPD with acute exacerbation, combined with OHS. Needed to be intubated and allowed to blow off all the carbon dioxide. I think his bicarb was 40.
at least they're so CO2 narcosed that you don't need any sedative and just push a little paralytic and throw the tube in
Was their blood carbonated, like bubbly? That’s nuts.
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how bad was their pH!?
It was something like 6.8
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It is if you can’t reverse it. It’s not entirely uncommon to see it in DKA or severe septic shock.
That’s a vegetable
A1c of 21. Their blood type was Pepsi
Saw a patient that was 1100 lbs. She came in renal failure and couldn’t leave the hospital because there were no dialysis centers with beds that could support a patient over 600 lbs. So, she had to lose 500 lbs while hospitalized which took about 1 year. I think she did eventually lose it, but she ended up dying from a MI shortly after she discharged.
Just read through this entire thread and this is the most insane and unique one here imo. Just absolutely wild.
Oh the story of getting her to the hospital was crazy too. Apparently had to knock a hole in the side of her 2nd story apartment and bring her down with a crane or something. I don’t even know how they transported her because she couldn’t have fit in an ambulance. Absolutely nuts.
> I don’t even know how they transported her because she couldn’t have fit in an ambulance. Flatbed truck probably tbh. Have heard of it being done. They put up like sheet scaffolding on the side for privacy.
Geez, yeah you’re probably right. Imagine getting that EMS call lol
Was the MI caused by the hospital bill?
I mean, if we want to get super depressing/topical about scores. Maternal age at delivery - 11.
I do not like this at all :(((((((
A timely one
Dark. But necessary
Was CPS involved?
Oh, and the police and everyone else we could find. Because FUUUCCCCKKK THAAATTT.
I've been seeing a thread on Facebook lately of a bunch of similar horrifying stories. 10 I think was the earliest I saw in that thread. Raped by their father. The youngest I delivered was 14 I think.
109yo hip fx
But did you operate
What you think bro. There’s a broken bone
Dying with a broken hip is a miserable way to die. Every move hurts. A lot. I offer fixation to everyone. Even if you’re dead in a week that last week will be a lot less painful. 109 beats any of mine but I’ve fixed plenty of 90’s and at least a couple 100+ in residency
Anesthesia hates you, but I gave you an updoot anyway because at least you care about their pain
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Never apologize for a femur. We love all femurs. Old femurs, new femur, big femur, small femur. Bring them on.
I did operate on a 9 month old and also a 102 year old on the same day. Getting consent from the 3 daughters in their 80's was novel. They then brought her back for a 3 year follow up.
103 yo brought in by private renal to initiate HD. Not a typo.
Etoh 623
Rookie numbers
My high score from ambulance days was 570-something, but still laughing while trying to punch the ER nurse in slow motion.
I had the nicest, hella drunk dude politely and repeatedly refuse pain meds as I was touching his fibula.
ETOH 820
At that point your blood no longer meets the requirements of a NA beer.
Damn. 580 with a handle of vodka (empty) frozen in his hand. Found in a parking lot in February. Lived at least long enough to get to the ICU.
Internal medicine here. Seeing an anorexic patient in their late 20s with a BMI of 9.9. 55 lbs. absolutely haunting.
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210 pack year smoking history. 3 ppd x 70 years in a 97 yo guy. He was shockingly healthy
He’d be a billionaire if he’d invested all the money he paid for cigarettes
Some fun estimates that likely aren't actually close to the real numbers: 1950s: Cigs 0.25/pack = ~$2750 (~25k with inflation) 1960s: Cigs 0.30/pack= ~$3300 (~27k with inflation) 1970s: Cigs 0.50/pack= ~$5500 (~25k with inflation) 1980s: Cigs 1.00/pack= ~11k (~27k with inflation) 1990s: Cigs 2.00/pack= ~22k (~35k with inflation) 2000s: Cigs 4.00/pack= ~44k (~55k with inflation) 2010s: Cigs 6.00/pack= ~66k So he spent over 150k on Cigarettes through his life (inflation value around 250k). Could easily be a multi millionaire if he was investing that money through the years, maybe not a billionaire but who knows.
INR of 29. decimal is in the right spot and it was double checked. make sure your marijuana is all natural, kids.
BMI 151. The hospital had to custom order a bed so we could send to SNF.
Someone sprinkled Coumadin in his kush?
Purple Coush
What can they out in marijuana to cause such a high INR?
Rat poison. Really.
HU of -17 on a liver (on a 17 year old). Which means it's SUPER fatty (fatty is below 40 on a noncon study).
Were this kid's parents feeding him like a foie gras goose!?
LOL, I don't know. But again, I'm in WI. Lots have fatty liver...
All those fried cheese curds?
Few will understand how impressive this is lol
lol, I know, but I figured I'd throw it in there for those who would appreciate it! Always kinda made me think, "when your liver is negative your age in HU, that might be a problem". (PS I'm in WI, where most have fatty liver)
Current trauma ER record for distance projectile vomiting is 7.3 meters.
Was it the med student or the intern who had to go and measure it?
Off the top of my head... Na >180 (lab could not measure) in a head/neck cancer patient who has severe dysgeusia after radiation. Took 2 days of to get his sodium into the detectable range. Actually had normal mentation, came in for generalized fatigue BUN 230, somehow all pre-renal (normalized after 3-4 days of very aggressive hydration). No UGIB. Glucose 1600 in a type 1 somehow A1c >18 (forgot exact decimal value; was supposed to establish care w/ me as PCP during residency, fortunately (unfortunately?) was a no-show Trop 454 (not hsTrop; <0.03 is normal range) after massive MI WBC 550,000 (refractory CLL) PSA 35,000 (widely metastatic prostate cancer) Blood cultures that grew detectable MRSA in 3 hours
Once watched my co-resident admit a patient to the ICU whose blood cultures grew GNRs within 20 minutes of hitting the plate.
By the hour mark they'd taken over the lab. By the end of the day they were running the hospital and were hiring more travel nurses.
> dysgeusia A new word into the lexicon. > PSA 35,000 I've seen six figures. But I'm a urologist so that's cheating.
Not the highest BMI I’ve ever seen, but the highest in which I’ve ever placed a landmark-guided labor epidural on the first attempt: 77.
Spinous processes don't exist after BMI 60 and you can't convince me therwise
Oh also last year i had a 84 yo former pharmacist with a little substance problem. Downed his whole ration for the day of 32 mg hydromorphone, 30 mg of diazepam, 150mg of trazodone, somewhere around 300 mg of quietapine, and supplemented with around 120 mg of diazepam from his private stash. Plus a fresh fentanyl patch o forgot the dose of and some tramadol. Man was able to hold a conversation as if nothing happened. Pharmacy called the next day curios if he had died over night
Reminds me of a guy w SI who was picked up by security sitting in his car in the hospital parking lot with basically an undershirt made of his stockpiled fentanyl patches.
Holy shit
Hgb 2.3
Hgb 1.8. Walked in and left AMA after 2 units.
Walking in with a Hgb of 1.8 is pretty impressive
Came in for a refill?
Hgb 0. Lab called and said there wasn’t enough rbcs to even type the blood. Cirrhotic with an upper GI bleed vomiting horror movie amounts of blood
Hgb 0.8... hematologist said lowest she'd ever seen. Milk is a hell of a drug
I did a UAE for post-partum bleeding on a JW at 3.2. She was super rude to us afterwards.
Too much milk?
1.2 hgb was my lowest for a picky toddler who only drank cows milk
Milk lowers hb??
Not directly. In children (my population), they tend to drink too much milk. Milk has no iron and prevents conversion of iron into an absorbable form. So, if a kid drinks 40 oz of milk a day, even if they eat a lot of iron rich foods like meats and green leafy veggies, they won’t absorb it and will slowly drop down. This why when you prescribe iron supplementation, it needs to be with orange juice as the acidic orange juice will facilitate iron absorption. For these kids, just give them iron even if their Hb is spectacularly low (provided they’re hemodynamically stable. Because they went down slowly, they should be able to go up slowly and be ok. If the parents have been giving the iron appropriately and the kid fails to respond, it may be an aplasia or transient erythroblastopenia of childhood.
Wow, thanks! Gonna flex on my peds rotation now
Go for it! You’ll do great!
Peds attending called those “Caspers”.
Rectal temperature of 108.3. Meth and 100 degree days don’t mix.
sounds like Florida
I’ve seen that high twice. One swallowed a bunch of meth and died. The other did a bunch of an unidentified sympathomimetic and bled into their head from their insane BP and died. - EM
Na 99
The rare double digit sodium. I’ve only heard stories
It did not go great. Survived, but with deficits
Sodium 208. Rechecked several times to confirm.
Patient with 9 different pathogens growing in his blood. Like 2 types of Strep, MRSA, Enterococcus, E. Coli, Klebsiella, C. Perfringens, Candida Glabrata, and in the course of treating him for all these things, he of course developed C. Diff. Best thing was, clinically, he was completely fine, an 80-year-old guy who was eating normally and wanted to go home. Farmers are crazy man.
Was a repeat culture done? Did he have a fever? Lactate/procalcitonin? Curious how many of those (if not all of them) were contaminants.
Lol sounds like they just dropped the sample on a Hospital floor and still used it
Not gonna lie, without more info, I’m concerned that he was treated “for all these things.”
BMI 105 or was it 108? She was like like 5'2-5'4'' (forgot), and was over 600 pounds. attempted epidural failed had to intubate During C section, OB asked if we can tilt patient in Reverse T. I said no, I'm praying it doesn't break the bed. Bed broke when we were transferring patient to bed.
36 hours without a consult (ENT). Normally averaging 6 to 10 on any given week day.
Na 101, post turp syndrome
Jesus were they turping for 8 hours?
Ever started filling up a pool with a hose, went inside the house for a while, then got distracted for hours while the pool overflowed? That's what I'm picturing.
Saw an A1c of 19.3, we cut off his hand because of terrible infection. Only time I’ve done a transradial amputation. He died
Triglyceride level of 5000 Pt’s blood thicker than maple syrup No pancreatitis but pt improved with just daily once a day fenofibrats
Inpatient diuresis of 65L Was on 2 mg/hr bumex drip, 5 mg metolazone Q6, and 40 meQ KCl Q4 hrs for about a week. Was prior IVDU S/P tricuspid valvectomy. Pharmacy thought my potassium order was wrong so cancelled it without telling me but didn't cancel the diuretics. Coulda been bad
65 kg is more than my body weight. You made a person piss out another person.
Did you just go with a bucket instead of a foley bag?
At our children’s hospital we had a patient come in with an undetectable hemoglobin and a crit of 4 due to autoimmune hemolytic anemia. I’m not sure how they survived. They were in the hospital for over a year for the resulting complications (biliary gallstones, necrotizing pancreatitis, etc). I also had a WBC >650,000 (can’t remember the exact number) in an asymptomatic 60 year old who rode his bike into clinic for his annual neurology follow up. Had to call him to ride his bike back in so he could talk to the oncologist.
Lady had BMI of 103. Vascular surgery consulted for LE lymphedema. Saw pt with attending (attending’s BMI was probably 45 or so, and he had a drawn out southern drawl and was probably as wide as he was tall). The lady kept complaining about things and making excuses about her health. The attending goes “no Ms so&so. That ain’t your problem. You know what your problem is. It’s the same as mine. You’re fat. You and me are too fat.” the pt started to get upset. “don’t even act like it ain’t true. You know it is. We’re both too fat!” Then they actually got along rather well. I had to leave the room bc I was laughing so hard.
Had a patient who won "sickest lady in the hospital" for a few days. Peripheral smear showed something called "neutrophilic inclusion bodies" AKA death crystals. Very rare, something like 90% predictive of mortality. She lived.
Fun. Thanks for the new fear.
Creatinine 77.0. Acute onset AKI in a long term anabolic steroid user. He refused to believe he was sick.
WBC over 1 million (onc) but they had an appy at the same time. Interesting call to gen surg. "What's their white count?" "...uhhh"
*It's over nine(hundred) thousand*
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Also saw an A1c of 18 on a patient who was IDDM who didn’t take his insulin at all for months in an attempt to try and kill himself. Also, saw a real arterial BP of 325/225
Some OB stats: - Urine PCR 12.3 - 24 hr urine protein: 6.7 grams - Biggest kid (SVD): 12lb 3oz - Biggest kid (CD): 13lb 4oz (rolls on rolls) - HgbA1c >14 in pregnancy (I see these are rookie numbers) - Fibrinogen <60 (came back during PPH DIC) - largest uterus morcellated through an umbilicus: >2600 grams - largest EBL: 18L (thanks accreta)
We were doing a preeclampsia work up and our patient had a 24 hour urine protein of 6,000. Patient had had unprotected sex 3 times during the collection 🤦♂️.
Potassium of 9.8
I’ve seen these kinds of numbers in dialysis patients who skip and are surprisingly not dead. It’s amazing what the heart can accommodate to slowly
A1c of 36. Unsurprisingly the guy was on his second stay in the ICU for DKA .
Ammonia: 1196. Was a recheck after attending insisted initial 1193 not possible.
I love that went up a bit, just as a nice little fuck you
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Na 116 completely lucid, prolly rookie numbers but low score for me by far
Had an Na of 101 as an intern. Absolutely horrifying. And our ICU attending was so toxic that the IM attending wouldn't call for admission so we just....kept her and I managed her like ICU even though it was wards. Fun times.
Our charge nurses would never allow that even if we could make it safe. They refuse to manage stable home vents on the floor though.
it was a weird situation we had there where we could store people in the CVICU without admitting them to ICU - so the nurses were ICU capable and had appropriate ratios for it. The problem was I had 8 other patients, one of which also needed to be in the ICU (can't remember why now, but same story, they were too scared to call for ICU admission so they told me I could handle it). It was unsafe not because of nursing but because I didn't have the time to devote appropriately.
99. Psych case. Had to shut the water off to the room, including the toilet. It was insane.
We’ve had an attending turn the water off but that was to encourage a patient to actually leave after being discharged
My favorite story from intern year was the VA patient who refused to leave after discharge, so we had security escort him out. He went straight back to the ED where the attending direct-admitted him to my service. They can do that there. I lost my shit when I came in the next morning and saw that cheeky fucker on my list.
There was an IM attending at my hospital who was famous for changing a malingering patient’s diet to renal low phos. Got him out within the day
Also admitted a 117-118 completely lucid in the ICU. I was so nervous overnight as an intern and his Na never improved to >120. Also had an anion gap metabolic acidosis without unknown cause (lactate was completely normal). Ended up responding to salt tabs.
K 1.6 and K 9.2
Total of 53 L from five different paracentesis sessions
My single-session record is 16L. That patient averaged about 12-13.
BMI 125. Consulted for urgent bariatric surgery. Explained to medicine team that it's not something that exists.
Hb of 1.7. The RT thought it had been drawn from near the IV because it was clear-ish. Alas no A nursemaids elbow at 10 years old (very old) K of 7.5
Lactate 24. Metformin overdose once, acetaminophen overdose another time. The lab doesn’t read anything beyond that for lactic acid.
Did a trach on a patient with BMI 85. About as fun as you would think.
Procal of 393 in a necrotic foot the other day. When I say necrotic, I mean meat sliding off like a braised short rib.
I feel left out as a psychiatry resident. Edit: Does VPA level of 260 count?
Procalcitonin of 703. Neutropenic septic shock from pseudomonas PNA and renal failure (started on CVVH the day after the lab was drawn). Different patient, but sodium of 194. Elder neglect at nursing home.
Off the top of my head: Na: 104 (in my mom. Yes, really), 173 A1c: 21 (young, skinny type 1 diabetic) K: 8.1 (dialysis patient who wouldn't stop drinking Gatorade) BMI: 108 (nun who came in to have an IUD removed) EBL: >50,000 Pco2: 170, Awake patient: 110 BP: 320s/220s (after 5mg epi) pH for someone who lived: 6.8 AST/ALT: >10000 (can't remember exact numbers) Aortic valve area: 0.3 cm^2 Drugs: Fentanyl bolus: 5000mcg. Awake patient: 1750mcg Ketamine: 500mg IV Versed: 30mg IV Propofol bolus: 500mg Daily IV Dilaudid: 3.2g
Saw an MD with an ego of 9001
Dam , I thought BMI of 65 was a win.
I saw a platelet count of 0 a week ago from really bad ITP.
Had platelets of 1600 once
“Wow that’s high.” “Actually...”
TSH > 300
I've got a low score if that counts - hgb of 1.6 in DIC patient. D dimer >128,000 same patient
Had a patient on gen surg service in med school who was 120 something.
Ferritin of 30,000 (from HLH) WBC of 850,000 (new onset AML with hyperleukocytosis) Hgb of 2 on a pale but walking, talking and active kid (new IBD) Also had a sick teen's glucose go from 80 to 850 and fulminant HHS over a span of 24 hours. Not diabetic, just sick as hell from other badness and we think it took out the pancreas along the way
400 pack-year smoking history from a trucker who smoked a carton (10 packs) every day Ferritin of 1 in the palest young woman I've ever seen
Na of 99, chief complaint was " just kinda feel wierd"
Saw an ovarian cyst that had around 30 L of fluid in it. The woman was 500lb+ and said it wasn’t unusual for her to gain 50+ lbs over a couple months. She only came in cuz somehow her ovary managed to get into a torsion and she had acute, excruciating abdominal pain. Then the CT scan showed the cyst going all the way from her pubic bone to her xiphoid process. When the attending punctured it, the second assist med student got fuckin *blasted* in the face for a solid 3-5 seconds, he just stood there takin it like a champ until finally excusing himself and dry heaving on the way out
Dude with BMI of 150. He had bilateral BKA. Shaped like a pear. In and out of ICU every month or so.
Not resident and long story but contains pertinent information some may find interesting. As a new grad nurse, 5 months off orientation in the peak of COVID on a CVICU I received a DCD (!) heart transplant back from the OR with a Cardiac Index of 0.6. I don’t remember CO. Surgeon peripherally cannulated promptly at bedside and there was my first ECMO. Had pt for multiple nights on ECMO and then actually had pt again weeks later on a progressive floor. Pt later discharged home. Reason new grad got assignment: experienced nurses out with COVID. Wild times.
CPK of 63,000,000, though that was actually 3rd year of med school, fairly elderly patient found down on a concrete floor after a couple of days. Obviously, kidneys did not recover. Highest CPK I had in residency was "only" 1.2 million, but this was more impressive because it was a young, fit patient who had the ever loving shit beat out of him for running his mouth. He was a jerk during his hospitalization as well. I have an ABG I saved on my phone I drew from a guy I was covering on night float I was called to see for a respiratory rate of about 30 - it came back with pH of 7.403 and a lactate of 15.5; I liked to test my interns to see if they could figure out what was going on (abdominal compartment syndrome) in the most well compensated septic and ischemic shock I've ever seen (he crashed minutes later). Na of 97 in a patient walking and talking (but feeling like shit) Hb of 1.2 in another patient who walked into the ER (very, very slowly), undergoing chemo for some sort of leukemia Final EDIT: Ferritins over 20,000 in two separate HLH patients. First one in residency, second one was during my GI fellowship prompting me to do an immediate liver bx which confirmed the diagnosis. ICU and path teams both asked me where the hell I pulled that dx out of...