Internal medicine

  Pseudohyperkalemia and Pseudonormokalemia in Hematologic Disorders: A Clinician's Guide to Laboratory Artifacts  Dr Neeraj Manikath , claude.ai Abstract Spurious potassium measurements represent a frequently overlooked diagnostic challenge in hematologic malignancies and disorders, leading to unnecessary interventions, delayed recognition of true dyskalemias, and occasional catastrophic management errors. This comprehensive review examines the pathophysiology, clinical recognition, and laboratory diagnosis of pseudohyperkalemia and the less commonly recognized pseudonormokalemia in patients with hematologic conditions. We emphasize practical bedside pearls, diagnostic algorithms, and clinical hacks derived from decades of experience managing these complex patients. Introduction: The Clinical Conundrum A 65-year-old woman with chronic myeloid leukemia presents to the emergency department with fatigue. Routine laboratory testing reveals a serum potassium of 6.8 mEq/L. The...

  Monogenic Causes of Adult-Onset Diabetes: A Clinician's Guide to Recognition and Management Dr Neeraj Manikath , claude.ai Abstract Monogenic diabetes accounts for 1-2% of all diabetes cases but remains significantly underdiagnosed in clinical practice. Unlike polygenic type 2 diabetes, these single-gene disorders present with distinctive clinical phenotypes that, when recognized, fundamentally alter therapeutic approach and family counseling. This review focuses on five clinically important monogenic diabetes subtypes that present in adulthood, emphasizing bedside diagnostic clues, therapeutic pearls, and practical management strategies for the internist and endocrinologist. MODY Type 3 (HNF1A): The Low Renal Threshold for Glucose and Sulfonylurea Hypersensitivity The Clinical Signature HNF1A-MODY represents the most common form of maturity-onset diabetes of the young worldwide, accounting for 30-65% of all MODY cases. The hepatocyte nuclear factor 1-alpha gene encodes a t...

  Drug-Induced Atypical Hemolytic Uremic Syndrome (DI-aHUS): A Comprehensive Clinical Review Dr Neeraj Manikath , claude.ai Abstract Drug-induced atypical hemolytic uremic syndrome (DI-aHUS) represents a critical intersection of pharmacology, hematology, and nephrology that challenges clinicians in both diagnosis and management. Unlike classic complement-mediated aHUS, drug-induced variants demonstrate unique pathophysiological mechanisms ranging from complement amplification to direct endothelial toxicity and immune-mediated platelet destruction. This review synthesizes current evidence on the most clinically significant drug triggers—gemcitabine, VEGF inhibitors, calcineurin inhibitors, quinine, and cocaine—while providing practical guidance on differential diagnosis from thrombotic thrombocytopenic purpura (TTP) and evidence-based approaches to eculizumab therapy. Understanding the mechanistic diversity of DI-aHUS is essential for post-graduate physicians and consultants manag...