Hospital and Internal Medicine Podcast

Episodet

• Elevated Lactate vs Lactic Acidosis: Words That Change Care And Outcomes 16.06.2026 9min

  This episode clarifies the difference between an elevated lactate level (hyperlactatemia) and true lactic acidosis, which requires evidence of metabolic acidosis (low pH or low bicarbonate). It discusses common causes of raised lactate, why mislabeling affects treatment location and mortality risk, and how EHRs and coding practices can perpetuate the confusion. Listeners will learn when to document lactic acidosis versus elevated lactate, the clinical implications for resuscitation and disposition, and the importance of precise medical terminology. If you find elevated ascorbic acid (Vitamin C) in the blood, you don't diagnose the patient as having an ascorbic acidosis. Likewise, just because lactic acid is elevated in the blood does not mean it is an acidosis (though sometimes it can be - learn the difference).
• When Stool Turns to Stone: Manually Disimpact Again or Buy Coca Cola? Fecalomas, Risks, and Treatments 25.05.2026 10min

  Fecalomas—rock‑hard impacted stool that cause obstruction, stercoral colitis, perforation, and even death—most often in immobile elderly patients or those on opioids. Standard treatments include aggressive bowel regimens, enemas, manual disimpaction, endoscopic fragmentation, and surgery. There are also case reports of using Coca‑Cola enemas to soften and reduce fecalomas when conventional measures failed. 
• Does Mouthwash Cause Oral Cancer? Does Mouthwash Eliminate The Benefits of Exercise? 14.05.2026 18min

  This episode examines the concerns about mouthwash and oral cancer. While ethanol can form the carcinogen acetaldehyde, how worried should we be? Strong antiseptic rinses can alter the oral microbiome and may reduce bacteria that help produce nitric oxide, with a small study showing a blunted post-exercise blood pressure drop; does that justify abandoning exercise or ignoring dental guidance?
• Recent Hyponatremia Correction Rate Data Is Becoming Harder to Ignore 20.04.2026 10min

  Multiple studies in multiple journals are going against the norms and previous guidelines. The times they are a changing.
• In the COBRRA Trial Apixaban Kicked The Asssssth of Rivaroxaban 12.04.2026 6min

  For acute treatment of Venous Thromboembolism the debate of which direct oral anticoagulant to use appears to now be settled.  
• Heart Failure with Preserved Ejection Fraction (Diastolic CHF) and SGLT-2 Inhibitor Therapy 27.01.2022 11min

  The double-blind, randomized phase III EMPEROR-Preserved trial showed a benefit of the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF). Now let us dig a bit more into those headlines.  
• Should You Postpone Interventions for INFECTED Necrotizing Pancreatitis? 18.10.2021 10min

  An important recently published randomized control trial provides guidance on this controversy.
• Spontaneous Bacterial Peritonitis - Unique Infections in Cirrhosis part 2 27.06.2021 18min
• Unique Infectious Considerations in Cirrhosis - part 1 15.06.2021 7min
• Diabetic Gastric Emptying Abnormalities (and sometimes normal) - Part 1 09.05.2021 10min

  Almost nobody feels comfortable managing DELAYED gastric emptying (gastroparesis) and very few medical providers even think about RAPID gastric emptying in their diabetic patients. Even if you send these patients to GI specialists, your blood sugar co-management of these patients can be heavily impacted by these issues. Is delayed gastric emptying always a bad thing? When your patient has upper GI symptoms, how often is it a gastric emptying abnormality? Time for some answers.
• Gastric Emptying Abnormalities - Part 2 08.05.2021 9min

  Can we trust a nuclear study to nail the diagnosis? Are motor abnormalities really the cause of symptoms? What is a POP procedure? 
• Morphine for later stage COPD patients not on hospice 09.04.2021 8min

  Does regular, low-dose, oral sustained-release morphine improve disease-specific health status or cause respiratory adverse effects in patients with moderate to very severe chronic breathlessness due to advanced chronic obstructive pulmonary disease? Digging in on the latest study.
• The JAMA controversy and loss of conversation in medicine 05.04.2021 19min

  My take on what went down at the Journal of the American Medical Association. I disagree with the comment there isn't "structural racism in health care", but was the backlash against the Editor who didn't say it (and actually opposed the comment) an over-reaction? Can we have discussions about the controversial issues that affect healthcare (like gun violence or abortion) without cancel culture cancelling the people who want to have nuanced discussions? I fear we lost the ability to have dialogue in a field where every MD/DO/PA/NP by definition has an advanced degree - and therefore we should be able to dispute misinformed statements to bring about change without the outrage going so far as to fire a person who actually objected to the hurtful statement. 
• Cows Milk - Healthy or Not? 06.03.2021 11min
• Psilocybin Mushrooms - will they become an accepted medicine? 19.02.2021 28min
• Understand Basic Epigenetic Changes in Medicine and Everyday Life 04.02.2021 12min

  This lecture provides a basic understanding of how epigenetic changes influence infections/sepsis, vaccinations, cancer, future generations, your muscles, and (of course) those sweet tan-lines you are rocking. Every day you are living through epigenetic changes that have huge implications on your health and who you are.
• Hyponatremia etiology by history and physical 23.12.2020 29min

  Hyponatremia remains a challenging topic for many because they are trying to memorize algorithms and numbers. You can usually nail the etiology by history & physical and a brief chart review. 
• Cytokine Storm - part 1 01.12.2020 5min

  If you use the term 'cytokine storm' and don't really know what you mean by it, you are far from unique. Let me help to try and clarify it for you just a bit.
• Cytokine Storm - part 2 01.12.2020 12min

  Do you know what CRP is (other than saying it is an inflammatory marker)? Should we always shut down cytokines? If so, how? Why should we avoid giving a glucocorticoid to a COVID patient before they develop an elevated CRP or hypoxia? So many questions! A few answers are provided. 
• The Most Important Person That Lived For Our Health and Wellbeing 27.11.2020 31min

  Hint: That person died in 2017