This podcast is for educational and informational purposes only and does not constitute formal

medical advice, clinical guidance, or institutional policy.

The views expressed are those of the hosts and guests and may not reflect those of any

official policies or affiliated organizations.

Always verify information, console appropriate resources, and apply your own clinical

judgment before caring for patients.

Welcome to Gray Matters, where we unpack how medical management is rarely black or white.

And go on deep dives along the way.

I'm Dr. Nick Villano.

And I'm Dr. Shraer, it's been a while.

I'm looking forward to jumping back into the fog of uncertainty with you.

The fog of uncertainty.

Sounds really dreadful, but I do think it's easier to cut through fog with some help and some

friends.

So I had this patient on the inpatient awards recently.

He's 72.

He has a history of hypertension and diabetes, and he comes in with syncope.

Turns out, he had severe urinary retention. I mean, they placed a catheter

in the ED and over a liter of urine came out. A liter? Gosh, that makes me so uncomfortable to

even think about. I know it's one of those things you can just feel. But to figure out why he had

sphere urinary retention, you know, we got an MRI that showed that his prostate wasn't too big and there was no cord compression. But eventually we did find out that his hemoglobin A1C was 12.5 percent. So we start insulin. I was still thinking about that urinary retention. I bet he had a pretty gnarly A.K.I. from that. But thankfully, the A.K.I did resolve with the catheter. He did have some post-substructive diuresis. You know, he got a little

lightheaded since he was peeing a ton, but we gave him fluids and eventually his polyurea resolved. What happened next? So here's the thing. His polyurea resolved, but his lightheadedness did not resolve. I had been giving him a lot of fluids. He had been

...