Author Archives: Giancarlo Buonomo

Why does cirrhosis cause high SAAG ascites? Other than when there’s Thai food at noon conference, it’s the best part of the day on inpatient medicine. A patient comes in with ascites, they get a diagnostic paracentesis, you look at the fluid albumin and subtract it from that serum albumin that you pray you rememberedContinue reading “Episode 119 – While My Liver Gently Weeps”

Why does valproic acid cause elevated ammonia? Ah, serum ammonia. A lab that is often sent and often a head-scratcher. Sometimes an altered patient with cirrhosis and the most textbook asterixis will have a normal serum ammonia. And other times a patient has a sky-high ammonia and you have no idea why. Have you everContinue reading “Episode 116 – Ammonia Rising”

What’s with the black mold growing inside Chernobyl? In a recent Curious Clinicians episode about the tragedy of Chernobyl and the public-health effort to distribute iodine pills to the victims, we mentioned that the reactor that exploded (and even some of the wider fallout area) is now host to a curious organism: A black fungusContinue reading “Episode 114 – The Mold that Eats Radiation for Breakfast”

Why was iodine given to people exposed to radioactivity after Chernobyl? Chernobyl. Even those who don’t actually know where it is or what happened there use the word as a metaphor for catastrophe and irrevocable destruction. At 1:23 in the morning on April 26, 1986, in the northern Ukranian city of Pripyat, a nuclear powerContinue reading “Episode 112 – Wherefore Iodine?”

Why does rubbing salt in a wound hurt so much? As a metaphor, “rubbing salt in a wound” means to make an already-bad situation worse for someone, especially in an unnecessary or gratuitous way. One hears the phrase constantly, about everything from taxes to sports. Perhaps one reason it’s so common is that, even ifContinue reading “Episode 110 – Salt in the Wound”