Anthony Lau, PharmD BCPS

Finally. The Hyponatremia Intervention Trial is published The Hyponatremia Interventional Trial (HIT) has been published in NEJM Evidence. The results were unveiled at the Late-Breaking and High-Impact Clinical Trials session at ASN Kidney Week 2024 in Sa…

Finally the Hyponatremia Intervention Trial is published and it is a big disappointment

pbfluids.com/2026/03/fina...

New JAMA review attempts to equate pulmonary congestion with systemic congestion ("volume overload")

This is sloppy & often wrong

Pts w/ LV failure often have pulmonary congestion w/o systemic congestion

Pts w/ RV failure usually have systemic congestion w/ dry lungs

CVP isn't PCWP

#EMIMCC

This infographic highlights the critical role of Emergency Medicine Pharmacists in cardiac arrest, trauma resuscitation, and rapid sequence intubation. It demonstrates how pharmacists improve medication safety, optimize dosing and timing, and enhance adherence to evidence-based protocols during high-acuity emergencies. Overall, it showcases the impact of pharmacists in strengthening resuscitation teams and improving patient care when seconds matter most.

For #PharmacyAwarenessMonth, I’m highlighting the role of EM pharmacists in cardiac arrest, traumas & intubations…one of many ways #pharmacists make a difference each day! Optimize #meds, ↓errors, improve lifesaving care timing. Proud to stand with dedicated pharmacists☺️💪🔥 #pharmacy #Rxsky #EMsky

a man wearing glasses is praying with the words thank you behind him ALT: a man wearing glasses is praying with the words thank you behind him

Happy Pharm Awareness Month #PAM2026 to my incredible pharmacy colleagues in Canada & around the🌏! Proud to be a pharmacist alongside such dedicated colleagues. The work we do isn’t always easy but it matters...every💉💊, every💬, every🤒we help. Grateful to be in this with all of you 🙏 #pharmsky #RxSky

Initial Vancomycin Taper for the Prevention of Recurrent C difficile Infection This randomized clinical trial tested whether a 4-week pulse and taper vancomycin regimen was superior to a 2-week pulse regimen for preventing recurrence among patients with a first episode or first ...

🔥Just published 🔥
TAPER-V RCT
In this RCT of 256, a 4-week vancomycin pulse and taper regimen *had a probability of 74% to be superior to a standard 2-week pulse regimen in patients a first episode or first recurrence of CDI
Vanco for 10d is obsolete! #IDSky #EMIMCC
jamanetwork.com/journals/jam...

Insulin Bolus in DKA #criticalcare #emergencymedicine YouTube video by EMSwami

Insulin bolus typically not necessary in DKA but, consider if:

Delay in getting insulin drip from pharamacy.

Severe acidosis: reach therapeutic levels faster + fix the acidosis faster

Bolus dose: 0.1 U/kg

youtube.com/shorts/pYybS...
#EMIMCC

Fresh Blog: Mythbusting the use of beta-blockers for sinus tachycardia in thyroid storm

This is one of the most dangerous & pervasive myths currently in circulation about acute care

B-bl commonly precipitate shock or even arrest in these patients...(#1/2)

blog: emcrit.org/pulmcrit/tst... #EMIMCC

There are few absolute rules in medicine but «never treat sinus tachycardia, treat the cause» has extremely few exceptions.
#emimcc #cardiosky #medsky

a man with a beard is smiling and looking through a hole in a door . ALT: a man with a beard is smiling and looking through a hole in a door .

1/🧵what happens after stopping #glp1 agonists like #semaglutide (#Wegovy #Ozempic) or tirzepatide (#Mounjaro #Zepbound)?

Recent BMJ analysis looked at #weight regain & cardiometabolic changes after discontinuation. Let’s break it down 👇 #medsky #pharmsky #IMsky #Endosky #diet #lifestyle

Crystalloids in Hemorrhagic Shock #criticalcare #emergencymedicine #trauma YouTube video by EMSwami

Avoid crystalloid in hemorrhagic shock
-May incr BP but not O2 carrying
-Dilute Hgb + clotting factors
-Saline contributes to acidosis + cold fluids contribute to hypothermia which worsens clotting

Patients don’t bleed crystalloid so don’t give crystalloid

youtube.com/shorts/QltA6...
#EMIMCC

The new 2026 AHA/ASA stroke guidelines include this table 👇 for the management of thrombolytic-induced angioedema.

There is NO discussion or any additional text about this topic.

I find this to be insufficient, not evidence-based, and potentially confusing... #1/2 #EMIMCC

Bicarb Pushes Utility #criticalcare #emergencymedicine YouTube video by EMSwami

Bicarb Pushes
-Na channel blockade on heart: TCA + diphenhydramine toxicity (narrows QRS + stabilizes patient)
-Salicylism: alkalinizes urine incr toxin excretion
-HypoNa w/ seizures or significant neurological dysfunction when hypertonic saline not available

youtube.com/shorts/gQrwA...
#EMIMCC

10/ TLDR: before stopping glp1 therapy, discuss long-term plans for weight maintenance, lifestyle support, patient expectations...

glp1 agonists are highly effective but stopping them often leads to predictable weight regain, similar to stopping meds for other chronic diseases

a man in a yellow jersey with the number 11 on it is playing basketball ALT: a man in a yellow jersey with the number 11 on it is playing basketball

9/ Why does rebound occur? 🤔

- appetite suppression ends
- metabolic adaptation persists
- behavioural supports may not be sufficient alone

8/ This doesn’t mean glp1 agonists don’t work...

it just reinforces that obesity is a chronic disease, not a short-term treatment problem...

7/ It wasn’t just weight...

cardiometabolic benefits (HbA1c, BP, lipids) also gradually reversed after discontinuation, often within ~1–1.5 years!

6/ Greater initial weight loss = greater rebound!

Patients who lost the most weight on glp1 receptor agonists also tended to regain weight more quickly after stopping...

5/ At this rate, many participants were projected to return to baseline weight within ~1.5–2 years after stopping therapy

4/ After stopping medication, weight regain was common...

On average, ~0.4 kg (0.9 lb) regained per month once treatment was discontinued

3/ While on treatment, participants lost an average of ~8.3 kg (18 lb) overall...

glp1 agents (semaglutide, tirzepatide) produced even greater weight loss

2/ BMJ study analyzed 37 randomized trials (9,300+ adults) across multiple weight-loss drugs, including glp1 receptor agonists

www.bmj.com/content/bmj/...

a man with a beard is smiling and looking through a hole in a door . ALT: a man with a beard is smiling and looking through a hole in a door .

1/🧵what happens after stopping #glp1 agonists like #semaglutide (#Wegovy #Ozempic) or tirzepatide (#Mounjaro #Zepbound)?

Recent BMJ analysis looked at #weight regain & cardiometabolic changes after discontinuation. Let’s break it down 👇 #medsky #pharmsky #IMsky #Endosky #diet #lifestyle

Had a great time running workshop on cardiogenic shock/critical care cardiology for early career cardiology trainees yesterday. A repeat question was wether I have a blood pressure limit for when I give diuretics. I don’t. If the patient is truly volume overloaded, the bp won’t ⬇️ from the diuretic

Bicarb Pushes + Acidosis #criticalcare #emergencymedicine YouTube video by EMSwami

No role for bicarb pushes in metabolic acidosis
-Bicarb only incr pH if incr ventilation
-Met acidosis w/ resp alkalosis are maximally ventilating + blowing off CO2
-Intubating unlikely to help
-Bicarb pushes will worsen acidosis if not increasing ventilation

youtube.com/shorts/uS2VN...
#EMIMCC

a close up of a woman 's face with her eyes closed and her mouth open . ALT: a close up of a woman 's face with her eyes closed and her mouth open .

antiseizure medications has a PK/PD profile similar to beta-lactam antibiotics:

-efficacy relates to the trough level
-toxicity relates to the peak level

so benefit/risk ratio is maximized with smaller, frequent dosing

hard to do outside the hospital re: adherence

but easy to do for inpatients

Empirical evidence is limited...this concern of hydralazine ↑ICP largely stems from a 2-patient case series, not robust or contemporary trials...based on what I could find.

www.ahajournals.org/doi/epdf/10....

journals.lww.com/ccmjournal/p...

a man in a suit is taking his blood pressure with a device that says tcm ALT: a man in a suit is taking his blood pressure with a device that says tcm

In ICH, should we be cautious w/ hydralazine for BP control?

Commonly used w/ labetalol...hydralazine is a direct cerebral vasodilator that can ↑cerebral blood volume and ICP, potentially ↓CPP in patients with impaired autoregulation or mass effect

Thoughts? #EMsky #EMIMCC #neurosky #pharmsky

↑ICP is a concern in ICH due to its association with early deterioration, poor outcomes, and need for prompt management. Curious what BP agents others are using for ICH...what’s your go-to? 🤔

a man in a suit is taking his blood pressure with a device that says tcm ALT: a man in a suit is taking his blood pressure with a device that says tcm

In ICH, should we be cautious w/ hydralazine for BP control?

Commonly used w/ labetalol...hydralazine is a direct cerebral vasodilator that can ↑cerebral blood volume and ICP, potentially ↓CPP in patients with impaired autoregulation or mass effect

Thoughts? #EMsky #EMIMCC #neurosky #pharmsky