The Curbsiders Internal Medicine Podcast #524 SHM Converge 2026–Recap
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May 4, 2026 
Kierstin Kennedy, MD, hospitalist focused on inpatient nutrition and TPN basics. Suchita Sata, MD, hepatology clinician with expertise in severe acute liver injury. Caroline Coleman, MD, hospitalist and medical illustrator sharing clinical pearls. They recap SHM Converge highlights: nutrition and TPN timing, severe liver injury workup, practice-changing society updates, concise clinical pearls and conference picks.
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Focus On End‑Organ Damage When Definitions Conflict
- Sepsis definitions vary (Sepsis-2 vs Sepsis-3) and institutional incentives drive which gets charted; focus clinically on infection causing end-organ damage.
- CMS uses Sepsis-2, but treating patients with end-organ dysfunction remains the practical 'true north'.
Early Carvedilol Lowers Ascites Risk In Portal Hypertension
- Carvedilol started early in cirrhosis with clinically significant portal hypertension reduces ascites recurrence and AKI incidence even before varices develop.
- CARVAS trial used carvedilol ~12.5 mg/day (divided) adjusted to BP and reduced two-year complications.
Oral And Extended‑Release Naltrexone Perform Similarly
- For alcohol use disorder, oral naltrexone and extended‑release injectable naltrexone show similar reductions in heavy drinking days.
- ADOPT trial supports choosing formulation based on patient preference and feasibility, not presumed superiority.