Yes, this is E.MK's best case ever mini podcast series, and I'm your host, Dr. Anton Hellman.

Before we dive into this month's best case ever on alcohol withdrawal with my longtime friend Sarah Gray, I got an audio note, or rather a rant, you might call it, from

a non-Swami Nathan, otherwise known as Swami, the great EM educator out of New York,

who you probably heard on Corey M or Rebel E.M or MRAP or through the teaching institute, he seems to be

everywhere. Actually, we're on the organizing committee for the podcasting

course together coming up in April, and he's been great to work with, very creative dude with

amazing ideas. Anyhow, he had some interesting opinions on how we should handle dig toxicity

in the setting of hypercalemia that I won't give away now. I'll let him explain. Then I'll give you

my two cents based on further conversations with Ed Etchols, who was the guest expert on the HyperK

episode. And then we'll go right on to Sarah Gray's best case ever. So here's Swami.

Hey, Anton, Swami here. Just finished listening to your EM cases podcast on hypercalemia, and I just wanted to share a couple of thoughts.

First of all, thanks for taking on hypercalemia EM cases style. This is a great primer on the topic for students and residents, and it was a great review for season faculty as well.

You guys did a great analysis of the

literature that guides management. I was particularly happy to see that you glossed over the binding

agents since there's clearly no utility in the emergent setting, but there was lots of other

great stuff here as well. One area I wanted to comment on was the issue of giving calcium-indig-toxic patients with hypercalaemia and the phenomena of Stoneheart.

Now, I'm no toxicologist, and I don't even play one on TV, but I have discussed this particular dogmatic teaching with our tox-goos here at Bellevue.

Now, it wasn't stated in the podcast, and I know this

wasn't a podcast dedicated to Dig toxicity, but that the presence of a potassium over five with

dig toxicity is a clear marker of badness. These patients do not do well unless they're treated

very aggressively for the Digit toxicity with Dijabind.

I just want to make sure that everyone's very clear on that particular point.

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