- 44 minutes 57 seconds#214 Hyponatremia Management: A Core IM Classic
Throwback: Should you really fluid-restrict every patient with SIADH? When can IV fluids make hyponatremia better or worse? Are salt tabs actually doing enough? And what can urine studies tell you before you start treatment? Join us for a practical, physiology-driven approach to hyponatremia management, from fluids and solutes to loop diuretics and identifying the underlying cause.
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6:46 | Pearl 1: Key Principles
15:13 | Pearl 2: Fluids in hyponatremia
26: 03 | Pearl 3: Solutes in hyponatremia management
35:49 | Pearl 4: Lasix in hyponatremia management
40:05 | Pearl 5: Etiologies
Tags: CoreIM, Internal Medicine, Medical Education, SIADH, Fluid Restriction, Nephrology, Hospital Medicine, Urine Osmolality
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Why can lower-dose combinations be more effective and better tolerated than maximizing one medication? How to troubleshoot common challenges such as amlodipine edema, gout, electrolyte abnormalities, and the patient who says they cannot tolerate anything? Why ACT (ARBs, Calcium Channel Blockers, Thiazides) is the preferred first-line framework, and how to personalize medication choices based on comorbidities and side effects.
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03:00 | Diagnosing Hypertension
04:10 | When to Start Combination Therapy Instead of Monotherapy
07:00 | Choosing First-Line Therapy Using the ACT Framework
13:23 | Why ARBs Are Often Preferred Over ACE Inhibitors
16:02 | Choosing the Right ARB: Candesartan vs Losartan
18:39 | Comparing Potency & Duration Across First-Line Antihypertensives
20:54 | Amlodipine Edema: Why It Happens and How to Fix It
23:54 | Thiazides: Practical Tips, Electrolyte Problems & Class-Killer Side Effects
29:33 | Managing Patients Who 'Can't Tolerate' Blood Pressure Medications
Tags: Hypertension Management, High Blood Pressure, Primary Care, Internal Medicine, Core IM
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Learn from primary care docs what has been practiced and changed from the 2026 ACC/AHA Lipid Guidelines! Learn how the new CPR framework (Calculate, Personalize, Reclassify) and PREVENT risk calculator change statin decisions, why LDL targets are back, and when to use Lp(a), ApoB, and coronary artery calcium (CAC) testing. Discover updated risk-enhancing factors, expanded indications for non-statin therapies, and practical strategies to personalize lipid management for both primary and secondary
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01:17 | Highlight #1 & #2: CPR and PREVENT Score
03:14 | Highlight #3: Updated ASCVD Risk Categories Using the PREVENT Score
05:30 | Highlight #4: LDL Targets Are Back
07:20 | Highlight #5: High-Risk Conditions That Bypass the PREVENT Score
08:41 | Highlight #6: Lp(a) Screening for Everyone
11:51 | Highlight #7: When to Use ApoB Testing
13:16 | Highlight #8: Reproductive Risk Factors
15:29 | Highlight #9: Using CAC to Guide Statin Therapy
19:09 | Highlight #10: Non-Statin Therapies
Tags: CoreIM, Internal Medicine, Medical Education, Cholesterol, Statins, LDL, ASCVD, Preventive Cardiology, LpA, ApoB, CAC, ACC2026, Cardiology, PrimaryCare
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MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?
In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.
Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.
This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.
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01:57 | Understanding MASLD as a Systemic Disease
05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease
08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan)
16:15 | Lifestyle Treatment & Weight Loss Targets
19:00 | ESSENCE Trial: Semaglutide for MASH
21:58 | MAESTRO-NASH Trial: Resmetirom
27:27 | Future Treatments for MASH
30:51 | Key Takeaways for Clinicians
Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver Fibrosis
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What blood pressure should we target in patients on hemodialysis? Why volume control remains the foundation of treatment? How blood pressure targets differ from the general population. Learn practical pearls on medication timing around dialysis, drug dialyzability, antihypertensive selection, and strategies to prevent intradialytic complications while optimizing long-term outcomes.
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02: 19 | Pearl 1: Blood Pressure Targets
09: 40 | Pearl 2: Timing Medications and Dialyzability
15: 31 | Pearl 3 - Pharmacologic Management Nuances in Dialysis Patients
22: 57 | Putting It All Together: The Medication Hierarchy
Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, ESRD, End-Stage Kidney Disease, Hypertension, Kidney Health, Dry Weight, Volume Overload
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Why is fluid management the most important part of dialysis care? This episode explores the fundamentals of hemodialysis, why ESKD patients have unique physiology, and how volume overload, not just hypertension, drives many complications. Learn practical pearls on dry weight, sodium restriction, diuretics, and the strategies that can reduce hospitalizations and improve patient outcomes.
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02:49 | Pearl 1: Foundations of Dialysis
09:21 | Pearl 2: Distinct Physiology
11:42 | Pearl 3: Why is fluid management so important?
19:43 | Pearl 4: Fluid Management Pro-tips
25:31 | Pearl 5: Diuretics in Patients with Residual Kidney Function
Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, Dialysis, End-stage kidney disease, Hypertension, Kidney Health, Dry Weight, Volume Overload
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Can AI manage post-op atrial fibrillation or does medicine still require human judgment? Using post-op AFib as a case study, we explore where algorithms help, where evidence falls short, and why clinical context still matters. When evidence is incomplete, and every patient is different, can AI truly practice medicine or only assist the clinicians who do? This episode explores the space between algorithms, uncertainty, and human judgment in modern medical care.
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02:51 | Broad workup for reversible causes and other etiologies of AFib that may occur post-op
05:10 | Considerations for management of post-op atrial fibrillation
13:00 | Stroke risk in atrial fibrillation
20:49 | Outpatient management of atrial fibrillation
25:54 | The role of AI in medical decision-making
Tags: CoreIM, Internal Medicine, Medical Education, Atrial Fibrillation, Cardiology, Open Evidence
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We start with a gripping story of seizures and use it as a jumping-off point to unpack practical pearls for in-flight emergencies. Along the way: what’s actually in the emergency medical kit, when planes divert, how ground medical support works, altitude physiology, legal protections, and how to stay calm when medicine suddenly happens at 35,000 feet. By the end, you may still sweat a little…but hopefully less than before.
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04:40 | Emergency Medical Kit (EMK) Standard Contents
08:50 | Role of Ground-Based Medical Support & Flight Diversion Decision-Making
19:35 | Interpreting Hypoxia at Altitude
22:06 | In-Flight Liability
23:35 | Common Chief Concerns & Useful Additional Medications
24:53 | How to Be Resourceful in an Austere Environment
Tags: CoreIM, Internal Medicine, Medical Education, In-flight Care, Medical Emergencies, Clinical Reasoning, Seizure Management, Hypoxia, Airway Management, Cardiac Emergency, Syncope, Respiratory Distress
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Can you distinguish benign eosinophilia from a sign of serious disease, and know exactly when to act at the bedside?
In this high-yield episode, test your clinical reasoning as we tackle:
- When eosinophilia becomes dangerous and why it matters
- How to distinguish if its from atopy vs. systemic disease
- Which medications to stop (and which to watch)
- How travel, diet, and exposure history shape your workup
- When to suspect malignancy before giving steroids
02:34 | Why Do We Care About Eosinophilia? (Pearl 1)
10:24 | Atopy and Eosinophilia (Pearl 2)
18:57 | Drugs and Eosinophilia (Pearl 3)
27:29 | ID and Eosinophilia (Pearl 4)
33:54 | Pearl 5: Eosinophilia, Steroids, and Neoplasms (Pearl 5)
Tags: CoreIM, Internal Medicine, Medical Education, Eosinophilia, Hypereosinophilia, Allergy Immunology, Hematology, Pulmonology, Parasitic Infections, Atopy
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Is coffee helping or harming our patients’ hearts?
In this Beyond Journal Club, we unpack the CRAVE trial and use it as a lens to answer a bigger question:
How should clinicians interpret nutrition research, especially when it feels inconsistent or hard to trust?
Listen for a concise, practical framework you can use the next time a patient asks about coffee, diet, or lifestyle.
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00:00 | Challenges of interpreting nutritional research.
02:22 | Best practices for evaluating studies in nutrition.
12:35 | Delve into the CRAVE trial as an example of critically appraising nutritional investigations.
26:41 | Applying this to clinical practice for your patients.
Tags: IMCore, Internal Medicine, Medical Education, Epidemiology, Diet and Lifestyle
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Why can these infections be tricky? How to diagnose osteomyelitis at the bedside? Do we always need IV vs oral antibiotics? And the best for last: Simple, practical wound care strategies for medical students, residents, and clinicians who want a clear, usable approach.
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02:15 | Pearl 1: Pathophysiology
08:20 | Pearl 2: Diagnosis
16:35 | Pearl 3: Treatment
20:35 | Pearl 4: Antibiotics
27:39 | Pearl 5: Wound Care
Tags: CoreIM, Internal Medicine, Medical Education, Diabetic Foot Infections, Osteomyelitis, Foot Ulcer, Wound Care
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