Winners chosen at the SHM Clinical Vignettes competition

 

ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.

The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.

By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.

“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”

The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.

Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.

The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.

 

She presented with nonbilious, nonbloody emesis. On physical exam, she was found to be tachycardic, with diffuse tenderness of the abdomen. She was positive for ketones and had an elevated acetone level and elevated osmolar gap, the difference between the measured and calculated solutes in the serum.

Clinicians identified that low carbohydrate intake, high fat intake, and a high metabolic state, such as that brought on by breastfeeding, can contribute to ketoacidosis. She was treated with IV glucose-containing fluids, bicarbonate, fomepizole, and thiamine.

The case shows that patients should be warned about ketoacidosis risk when they start an ultra-low carbohydrate diet, especially if they are breastfeeding or lactating, Dr. Hudson said.

“Usually they’re safe, but they may not be if you’re in a high metabolic state,” he told judges.

 

“We take care of so many patients on a daily basis and we rarely get to tell their stories,” he said. “To be able to tell the story of the patients and give the learning points that we took away to others, I think is very rewarding.”

The winner of the trainee award, Maxwell Bressman, MD, a resident at Montefiore Medical Center in New York, presented the case of a 62-year-old woman with hypertension who had profound generalized weakness and an inability to walk.

“She actually came to the hospital because she couldn’t lift a cup of tea,” Dr. Bressman told judges.

Clinicians traced her problem to that very tea – a licorice-containing brew – after an ECG indicated hypokalemia. A breakdown product of licorice, glycyrrhizic acid, can prevent the breakdown of cortisol into cortisone, causing increased absorption of sodium in exchange for potassium, he explained.

“I really like interesting cases – it’s something I’ve thought about throughout medical school,” Dr. Bressman said. “It’s been incredibly fun. We have great cases at Montefiore. ... It’s taught me to think very broadly and with an expansive differential.”

 

ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.

The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.

By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.

“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”

The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.

Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.

The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.

 

She presented with nonbilious, nonbloody emesis. On physical exam, she was found to be tachycardic, with diffuse tenderness of the abdomen. She was positive for ketones and had an elevated acetone level and elevated osmolar gap, the difference between the measured and calculated solutes in the serum.

Clinicians identified that low carbohydrate intake, high fat intake, and a high metabolic state, such as that brought on by breastfeeding, can contribute to ketoacidosis. She was treated with IV glucose-containing fluids, bicarbonate, fomepizole, and thiamine.

The case shows that patients should be warned about ketoacidosis risk when they start an ultra-low carbohydrate diet, especially if they are breastfeeding or lactating, Dr. Hudson said.

“Usually they’re safe, but they may not be if you’re in a high metabolic state,” he told judges.

 

“We take care of so many patients on a daily basis and we rarely get to tell their stories,” he said. “To be able to tell the story of the patients and give the learning points that we took away to others, I think is very rewarding.”

The winner of the trainee award, Maxwell Bressman, MD, a resident at Montefiore Medical Center in New York, presented the case of a 62-year-old woman with hypertension who had profound generalized weakness and an inability to walk.

“She actually came to the hospital because she couldn’t lift a cup of tea,” Dr. Bressman told judges.

Clinicians traced her problem to that very tea – a licorice-containing brew – after an ECG indicated hypokalemia. A breakdown product of licorice, glycyrrhizic acid, can prevent the breakdown of cortisol into cortisone, causing increased absorption of sodium in exchange for potassium, he explained.

“I really like interesting cases – it’s something I’ve thought about throughout medical school,” Dr. Bressman said. “It’s been incredibly fun. We have great cases at Montefiore. ... It’s taught me to think very broadly and with an expansive differential.”

 

ORLANDO – Researchers presenting a case of starving ketoacidosis in a woman who was on a “Paleo” diet while breastfeeding won the Clinical Vignettes competition held Monday at HM18. The announcement capped a flurry of presenting and judging of posters on single cases that were captivating in both the stories they told and the lessons they taught.

The trainee award winner in the competition were presenters of a case of licorice-induced hypokalemia that, clinicians learned, was brought about by the drinking of an obscure kind of tea. The two others that made it into the final round of judging were on cases of syphilitic hepatitis and cardiac amyloidosis.

By chance, both of the winners highlighted dietary triggers, said Stephanie Sherman, MD, chair of the annual meeting’s clinical vignettes committee.

“The common themes in both of these were the importance of dietary history when interviewing patients,” Dr. Sherman said. “And then both had a beautiful review of the physiology that’s normal and how it gets broken in these situations.”

The Clinical Vignettes portion of the RIV competition, which also includes research and innovations categories, was separate this year because of space constraints, Dr. Sherman said.

Judges said they looked not only at how interesting and applicable each case was, but also the quality of the oral presentation and the poster’s visual appeal and clarity.

The ketoacidosis case, presented by Timothy Judson, MD, a resident at University of California, San Francisco, involved a 40-year-old woman who was previously healthy and had given birth 9 weeks earlier. Since the birth, the woman had been on a Paleo diet, a low-carbohydrate, ketogenic diet. She also was breastfeeding her newborn and continuing to breastfeed her 2-year-old son.

 

She presented with nonbilious, nonbloody emesis. On physical exam, she was found to be tachycardic, with diffuse tenderness of the abdomen. She was positive for ketones and had an elevated acetone level and elevated osmolar gap, the difference between the measured and calculated solutes in the serum.

Clinicians identified that low carbohydrate intake, high fat intake, and a high metabolic state, such as that brought on by breastfeeding, can contribute to ketoacidosis. She was treated with IV glucose-containing fluids, bicarbonate, fomepizole, and thiamine.

The case shows that patients should be warned about ketoacidosis risk when they start an ultra-low carbohydrate diet, especially if they are breastfeeding or lactating, Dr. Hudson said.

“Usually they’re safe, but they may not be if you’re in a high metabolic state,” he told judges.

 

“We take care of so many patients on a daily basis and we rarely get to tell their stories,” he said. “To be able to tell the story of the patients and give the learning points that we took away to others, I think is very rewarding.”

The winner of the trainee award, Maxwell Bressman, MD, a resident at Montefiore Medical Center in New York, presented the case of a 62-year-old woman with hypertension who had profound generalized weakness and an inability to walk.

“She actually came to the hospital because she couldn’t lift a cup of tea,” Dr. Bressman told judges.

Clinicians traced her problem to that very tea – a licorice-containing brew – after an ECG indicated hypokalemia. A breakdown product of licorice, glycyrrhizic acid, can prevent the breakdown of cortisol into cortisone, causing increased absorption of sodium in exchange for potassium, he explained.

“I really like interesting cases – it’s something I’ve thought about throughout medical school,” Dr. Bressman said. “It’s been incredibly fun. We have great cases at Montefiore. ... It’s taught me to think very broadly and with an expansive differential.”