Every medical student learns the differential diagnosis for an anion gap metabolic acidosis. The list is particularly crucial for emergency physicians, who often see this finding in sick, undifferentiated patients. Many people use the mnemonics “MUDPILES CAT” or “GOLDMARK” to help remember this list. An alternative mnemonic, “KULT IMPACT”, provides a practical and organized way of remembering the differential. “KULT” denotes the most common organic causes: Ketones: diabetic ketoacidosis (DKA), alcoholic ketoacidosis, starvation …
DOACs versus Warfarin: What is their impact on mortality?
A 68-year-old woman presents with palpitations, feeling generally unwell for three days. She denies any chest pain, shortness of breath, or lightheadedness. Past medical history includes hypertension, dyslipidemia, and osteoarthritis with no history of dysrhythmia. Her heart rate is 125 and her remaining vital signs are normal. Her pulse is irregular and her physical exam is otherwise unremarkable. ECG shows atrial fibrillation. You slow her heart rate using diltiazem. Your workup reveals no …