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PaperclipPerfector  8mo ago (text post)   3779 thread views

Small-Scale Question Sunday for February 25, 2024

Do you have a dumb question that you're kind of embarrassed to ask in the main thread? Is there something you're just not sure about?

This is your opportunity to ask questions. No question too simple or too silly.

Culture war topics are accepted, and proposals for a better intro post are appreciated.

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You have summoned a crankier doctor than the one I think you are looking for but I'm sure he will chime in at some point.

Some thoughts:

-It's generally standard of care to recommend that patients on psychiatric medication (or just cross through that and make it just meds in general) abstain from alcohol use. This is for a variety of reasons, chronic and acute alcohol use both have impacts on certain kinds of drug metabolism. Some medications have specific interactions with alcohol (ex: Benzos). Alcohol and Marijuana appear to have a problematic effect on underlying conditions (no shit booze is a downer). This also applies to non-psych things. We are going to suggest you stop drinking.

-Just because it's standard of care doesn't mean it's mandatory, but again if we are speaking in official capacity we are going to tell you not to do it.

-SSRIs are (with some exceptions) pretty fucking safe. Older antidepressants have some issues. We have mostly switched for a reason.

-Alcohol is a poison with a very variable effect on the human body. Sick? Tired? Just worked out? Empty or full stomach? Haven't drank in a while? Random luck of the draw nonsense? You'll have a bad time. Easy to blame on the social boogieman if you do two doubles on an empty stomach.

-Personal anecdote: I've run into a "date rape" drug level alcohol response in settings where I know nobodies shit is tampered with, so I'm certain this class of thing exists, including one time where it was me and my own bottle of rum (and I later connected the dots that I recently had diarrhea and that may have been responsible for my bad time...).

-People are variable (duh) and have variable responses to things AND also variable awareness. There are a lot of people in this world who struggle to realize they are drunk until they are absolutely obliterated. You can easily see how those types (or other adjacent groups) might feel they were drugged if they got really drunk secondary to some other non-sketchy circumstance.

-Mixing uppers and downers is a huge problem and a lot of young people don't take the combination of stimulants (including all that Starbucks) and alcohol seriously. That combo can cause severe reactions and more people abuse those things now.

You have summoned a crankier doctor than the one I think you are looking for but I'm sure he will chime in at some point.

My general sunny disposition has been severely tarnished of late. The schadenfreude from seeing the nurses being chewed out after a patient lodged a formal complaint when they woke him up for his sleeping pills has yet to outweigh the far more numerous times I've been woken up to prescribe them to someone enjoying a far more restful night than I have.*

Personal anecdote: I've run into a "date rape" drug level alcohol response in settings where I know nobodies shit is tampered with, so I'm certain this class of thing exists, including one time where it was me and my own bottle of rum (and I later connected the dots that I recently had diarrhea and that may have been responsible for my bad time...).

I can handle an ungodly amount of liquor (a terrible thing for my bank balance if I were to indulge it), but I remember accepting a single shot of local moonshine at a girl's birthday party and then poof, total anterograde amnesia, with me waking up next morning with a pounding hangover in my knickers.

In her bed.

I'm told that I was uh, talked into crossdressing, and someone has a video of it, which I must figure out a way to delete. Then again, if I ever become cancel-worthy for my many online crimespeeches, it offers a convenient retreat into Protected Characteristic territory. I'm just grateful I didn't go blind, the fucking thing smelled like hand sanitizer and tasted like coconut.

*Urine output on an intensive care unit: case-control study :

Objective To compare urine output between junior doctors in an intensive care unit and the patients for whom they are responsible.

Design Case-control study.

Setting General intensive care unit in a tertiary referral hospital.

Participants 18 junior doctors responsible for clerking patients on weekday day shifts in the unit from 23 March to 23 April 2009 volunteered as “cases.” Controls were the patients in the unit clerked by those doctors. Exclusion criteria (for both groups) were pregnancy, baseline estimated glomerular filtration rate <15 ml/min/1.73 m2, and renal replacement therapy.

Main outcome measures Oliguria (defined as mean urine output <0.5 ml/kg/hour over six or more hours of measurement) and urine output (in ml/kg/hour) as a continuous variable.

Results Doctors were classed as oliguric and “at risk” of acute kidney injury on 19 (22%) of 87 shifts in which urine output was measured, and oliguric to the point of being “in injury” on one (1%) further shift. Data were available for 208 of 209 controls matched to cases in the data collection period; 13 of these were excluded because the control was receiving renal replacement therapy. Doctors were more likely to be oliguric than their patients (odds ratio 1.99, 95% confidence interval 1.08 to 3.68, P=0.03). For each additional 1 ml/kg/hour mean urine output, the odds ratio for being a case rather than a control was 0.27 (0.12 to 0.58, P=0.001). Mortality among doctors was astonishingly low, at 0% (0% to 18%).

Conclusions Managing our own fluid balance is more difficult than managing it in our patients. We should drink more water. Modifications to the criteria for acute kidney injury could be needed for the assessment of junior doctors in an intensive care unit.

(This is why I avoid ICU work like the plague, and if you think medical oncology discharges are bad..)

That is an amazing confidence interval.

At least you can be sure that you won't have more doctors at the end of the study!

It's both a numbers game in terms of having your own personal random bad experience and in terms of meeting people who have zero insight into and understanding of their drinking, but if you expand that to a whole population you are going to catch some weirdness.

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