Why can’t people with familial fatal insomnia fall asleep?Have you ever wondered why you feel so awful when you don’t get enough sleep? Well, that’s because it is no exaggeration when we say we need sleep to survive, so much so that we spend approximately ? of our lives sleeping. Insomnia can certainly feel exhausting, overwhelming, and even lonely – while everyone is asleep, there you are – wide awake and unable to fall asleep no matter how much you try. Except, now imagine that other ...

Why does cirrhosis cause high SAAG ascites?Other than when there’s Thai food at noon conference, it’s the best part of the day on inpatient medicine. A patient comes in with ascites, they get a diagnostic paracentesis, you look at the fluid albumin and subtract it from that serum albumin that you pray you remembered to order before the tap. This is the serum ascites-albumin gap (SAAG). You google that chart that you’ve somehow never remembered to bookmark, and, unlike most other lab val...

How does a bacterial species called Deinococcus radiodurans withstand extreme levels of radiation?What comes to mind when we say tiny but mighty? Well, if Deinococcus radiodurans didn’t cross your mind, maybe it will earn your respect after this segment, so much so that it may come to mind the next time someone asks you that question. In our previous episode, “Wherefore Iodine?”, we learned about why iodine administration was a key public health intervention in Eastern Europe followin...

Why does valproic acid cause elevated ammonia?Ah, serum ammonia. A lab that is often sent and often a head-scratcher. Sometimes an altered patient with cirrhosis and the most textbook asterixis will have a normal serum ammonia. And other times a patient has a sky-high ammonia and you have no idea why. Have you ever stopped and checked if they’re on valproic acid?

What’s with the black mold growing inside Chernobyl?In recent Curious Clinicians episode about the tragedy of Chernobyl and the public-health effort to distribute iodine pills to the victims, we mentioned that the reactor that exploded (and even some of the wider fallout area) is now host to a curious organism: A black fungus that apparently eats radiation. How does radiation, which usually kills living things, end up sustaining something?

Why does calcium deposit in blood vessels?Ever heard of bone forming inside blood vessels? Even if you haven’t heard it expressed in those exact words, you most likely have come across the concept of vascular calcification. And in certain instances, fully formed bone is precisely the endpoint of calcium deposition in vessels.

Why was iodine given to people exposed to radioactivity after Chernobyl?Chernobyl. Even those who don’t actually know where it is or what happened there use the word as a metaphor for catastrophe and irrevocable destruction. At 1:23 in the morning on April 26, 1986, in the northern Ukranian city of Pripyat, a nuclear power plant called Chernobyl exploded and sent an enormous radioactive plume into the atmosphere, spreading radiation for hundreds of miles. You may be wondering why we’re ...

Why is Duffy Null status associated with lower neutrophil counts?What if we told you not everyone with a low neutrophil count is at a higher risk of infection? One cause of this fascinating phenomenon is known as the Duffy Null Associated Neutrophil Count, sometimes referred to as Duffy Null or DANC. It’s found in some individuals of African ancestry. It was previously named “Benign Ethnic Neutropenia,” but has largely been replaced by “Duffy-null associated neutrophil count” due to our...

Why does rubbing salt in a wound hurt so much?As a metaphor, “rubbing salt in a wound” means to make an already-bad situation worse for someone, especially in an unnecessary or gratuitous way. One hears the phrase constantly, about everything from taxes to sports. Perhaps one reason it’s so common is that, even if most of us have never literally had a handful of Diamond Crystal rubbed into an open blister, we intuitively understand it to be painful, even unusually painful (after all, th...

Why don’t we all get heparin-induced thrombocytopenia?Way back in episode 59, we discussed why heparin, a commonly-used anticoagulant in the hospital, can cause mild hyperkalemia. The more widely-known side effect of heparin, though, is heparin-induced thrombocytopenia (HIT), of which there are two types: Type 1 (non-immune mediated) and Type 2 (immune-mediated). If a hospitalized patient suddenly has low platelets and is being anti-coagulated, HIT is always on the differential. However...