Core IM | Internal Medicine Podcast

#194: Severe Hypertriglyceridemia: 5 Pearls Segment

Wed, 03 Dec 2025

How quickly can triglycerides rise? At what threshold are patients at risk of pancreatitis or cardiovascular adverse outcomes? What do you have to rule out? How do you counsel on lifestyle changes? Which medications do you start with why and when?

🔹 Transcript and Shownotes

(03:19) | Lipoprotein Lipase and Why Triglycerides Fluctuate Fast

(05:27) | Triglycerides as a Cardiovascular Risk Marker

(09:28) | Acute Management For Pancreatitis induced by Triglycerides

(14:34) | Lifestyle Counseling

(17:31) | Medications That Lower Triglycerides

(25:29) | How to Choose the Right Triglyceride Therapy

(27:56) | Genetic Causes and When to Suspect Familial Disorders

Tags: CoreIM, Internal Medicine, Lipidology, lipid, Cardiology, Metabolic Health, Triglycerides, Evidence-Based Medicine, Clinical Reasoning, Hospital Medicine, Medical Education, primary care

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#193 Venous Congestion & VEXUS Interview with Dr. Ross Prager

Wed, 19 Nov 2025

Why is venous congestion not the same as volume overload? How can looking at IVC as well as doppler on the hepatic vein, portal vein, and/or intrarenal vein help? Can venous congestion explain someone's delirium? Or be at play in septic shock? What are the limitations of the VEXUS score?

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🔹Transcript and Shownotes

(00:00) | Volume overload vs. Venous Congestion

(05:49) | Venous Congestion and AKI, mortality, possible delirium

(10:10) | Measuring Venous Congestion and the Role of VEXUS

(15:05) | Common Mistakes and Best Practices of VEXUS score

(23:13) | Assessing Fluid Tolerance and Risks with Venous Doppler in Acute Care

(25:29) | Fluid vs. Vasopressor Strategy Guided by Venous Assessment

Tags: CoreIM, Internal Medicine, Critical Care, Nephrology, Cardiology, Fluid Management, POCUS, Ultrasound, Doppler, Hospital Medicine, Clinical Reasoning, Medical Education

#192 Debate on First-Line Medications for Diabetes

Wed, 05 Nov 2025

SGLT-2i vs. GLP-1? vs Metformin? How do you balance the cost and coverage of first-line options like metformin, SGLT-2, and GLP-1s? How do you choose between SGLT-2 and GLP-1s for comorbidities like CAD or CKD? And how do you weigh their side effects and practical use?

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🔹 Transcript and Show Notes

Timestamps:

(01:43) | Case 1: Managing Uncontrolled Diabetes in a 47-Year-Old Male

(07:15) | Understanding Cost and Insurance Barriers in Diabetes Care

(09:26) | Case 2: Addressing Weight Gain and Financial Stress in a 52-Year-Old Male

(14:16) | Case 3: Managing Coronary Artery Disease and CKD in a 66-Year-Old Male

(19:41) | Case 4: Severe Obesity and Pain Management in a 59-Year-Old Female

(24:19) | Case 5: High A1C and Vascular Comorbidities in a 67-Year-Old Female

(35:34) | Weighing Side Effects and Practical Use of GLP-1 and SGLT2 Inhibitors

Tags: CoreIM, Primary Care, Endocrinology, Diabetes Mellitus, Type 2 Diabetes, Type 1 Diabetes, Metformin, GLP-1, SGLT2, Insulin, CGM, A1C, DKA, Medical Education, Clinical Reasoning, Hospital Medicine

#191 Hepatorenal Syndrome Part 2 on Management: 5 Pearls Segment

Wed, 22 Oct 2025

What really works when treating HRS? Vasoconstrictors like terlipressin vs. norepinephrine vs. midodrine: how do we decide which to use? Do you give albumin? When do you give Lasix or another diuretic? When is the better choice transplant, dialysis, or even palliative care?

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🔹 Transcript & Show Notes

Timestamps:

(00:12) | Introduction and Overview of Hepatorenal Treatment

(03:38) | Vasoconstrictors Focus: Terlipressin, Norepinephrine, and Midodrine

(12:32) | Finding the Right Dose of Albumin and Knowing When to Stop

(15:06) | Volume Management: Balancing MAP, Diuretics, and Creatinine

(21:42) | Understanding the High Mortality of HRS-AKI

(32:30) | Transplant, Dialysis, or Palliation Care

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Hepatorenal Syndrome, HRS-AKI, Cirrhosis, Nephrology, Liver Disease

#190: Hepatorenal Syndrome Part 1: 5 Pearls Segment

Wed, 15 Oct 2025

HRS-AKI vs. other causes of AKI in cirrhosis: What do serum or urine sodium clues, albumin challenges, and shifting diagnostic criteria actually reveal about getting the diagnosis right?

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🔹 Transcript & Show Notes

Timestamps:

(00:57) | Understanding the Pathophysiology of HRS

(03:42) | How Portal Hypertension Traps the Kidneys

(10:32) | Sorting the Differential of AKI in Cirrhosis Beyond HRS

(18:28) | Hyponatremia and Urine Sodium in Advanced Cirrhosis

(24:04) | Official Diagnosis and Evolving Criteria of HRS

(29:30) | Albumin: When It Helps and When to Hold Back

(34:00) | Recap and Future Directions

Tags: CoreIM, Internal Medicine, Primary Care, Medical Education, IMCore, Physician Assistant, Nurse Practitioner, Medical Student, Nephrology, renal, hepatology, Portal Hypertension, Liver Disease