Hospital and Internal Medicine Podcast

Latest Episodes:

Science vs. Hospital Habit: Why We Ignore the Data on Salt, Fluids, and Metformin Sep 12, 2026

Show notes

More trials show low-salt diets and restrictive fluid strategies do not improve heart-failure outcomes, while another shows continuing metformin in many hospitalized patients reduces hypoglycemia, mortality, readmissions, and new insulin starts. The episode calls for evidence-based change in routine hospital care.

Elevated Lactate vs Lactic Acidosis: Words That Change Care And Outcomes Jun 16, 2026

Show notes

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 May 25, 2026

Show notes

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? May 14, 2026

Show notes

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 Apr 20, 2026

Show notes

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 Apr 12, 2026

Show notes

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 Jan 27, 2022

Show notes

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? Oct 18, 2021

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An important recently published randomized control trial provides guidance on this controversy.

Spontaneous Bacterial Peritonitis - Unique Infections in Cirrhosis part 2 Jun 27, 2021

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Unique Infectious Considerations in Cirrhosis - part 1 Jun 15, 2021

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