The Curbsiders Internal Medicine Podcast #424 Hotcakes: Transfusion in Acute MI, COVID-19 Rebound after Paxlovid, Every-other-day Iron Revisited, Oral Phenylephrine Doesn’t Work, and Stop Correcting Serum Calcium
Jan 29, 2024
In this podcast, the hosts cover a range of intriguing topics including transfusion thresholds in acute MI, COVID-19 rebound after treatment with nirmatrelvir, the prevalence of iron deficiency, the ineffectiveness of oral phenylephrine, and the liberal vs restrictive transfusion strategy in MI. They also discuss challenges in transfusion decision making, highlight the unreliability of corrected calcium levels, and explore iron supplementation for anemia. A humorous introduction and calcium puns add entertainment to the episode.
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How To Measure Ionized Calcium Correctly
- If you need accurate calcium, order ionized calcium and process the sample promptly.
- Keep the sample on ice and run within ~30 minutes if not processed immediately.
Paxlovid Linked To Higher Virologic Rebound Rates
- Observational cohort data show Paxlovid (nirmatrelvir/ritonavir) is associated with higher virologic rebound: ~20% vs 2% in untreated.
- Rebound often asymptomatic and not linked to severe outcomes in that cohort.
Frequent Sampling Reveals More Rebounds
- Frequent testing found rebounds that prior studies missed, meaning rebound may be under-recognized.
- Rebound extended viral shedding past usual isolation periods, raising public-health concerns.