The Curbsiders Internal Medicine Podcast #106: Hotcakes: Cardiac risk, diabetes, pulmonary embolism, opioid use disorder, neck ties and nose picking?
Jul 30, 2018
Robert Centor, seasoned internist and Chair of Medicine known for practical clinical teaching. Rapid-fire discussion covers updated ASCVD risk estimates and statin implications. Debates CT pulmonary angiography’s ability to rule out PE and outpatient management of low-risk PE. Reviews metformin safety at lower eGFR, SGLT2 renal effects, MOUD after overdose, expanded diabetes screening, and quirky links like nose-picking and neckties.
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Discharge Low Risk PE Using Hestia And DOACs
- Use Hestia criteria to identify low-risk PE patients who may be safely discharged on oral rivaroxaban with close follow-up.
- An academic emergency medicine trial sent Hestia-negative PE patients home on rivaroxaban with no deaths at 90 days.
Metformin Appears Safe Above eGFR 30
- Observational data support metformin safety down to eGFR 30–60, without increased hospitalizations for acidosis in stage 3A/3B CKD.
- Robert Centor highlights propensity-matched administrative data and FDA guidance now allowing metformin use above eGFR 30.
Watch Volume Status When Starting Metformin In Lower GFR
- Monitor patients with eGFR <45 closely for volume contraction and AKI before and after starting metformin.
- Centor warns kidneys with lower GFRs concentrate urine poorly, raising risk of volume-related AKI.