Instructions

Date & Location
Tuesday, May 9, 2023, 12:00 AM - Saturday, May 9, 2026, 11:00 PM

Target Audience
Specialties - Physicians
Professions - Physician

Overview

In this episode, The Curious Clinicians examine why upper gastrointestinal bleeding raises BUN. The answer involves experiments where participants were asked to drink blood (!) and the 700 sextillion (7 x 1023) amino acids that comprise the hemoglobin content in a liter of blood. 

 Why does an upper GIB increase the BUN/Cr ratio?

The idea that something other than kidney injury might lead to elevations in BUN was first identified in 1912 in infants with cholera. The entity was called extrarenal azotemia. In retrospect, these were likely instances of prerenal azotemia, but the clinicians could not identify renal abnormalities histologically and therefore considered the condition to be outside the kidneys. In 1933, LV Sanguinetti was the first to note that GI bleeding is associated with an elevated BUN. The next two decades were the golden age of experimentation on this question, with dozens of studies done with the goal of identifying the cause.


Objectives
Upon completion of this activity, you will be able to:

  1. Review the mechanisms by which ingested proteins are degraded to amino acids and absorbed.
  2. Apply this mechanism to understand why upper gastrointestinal bleeding results in an increased blood urea nitrogen.
  3. Assess the biological value of hemoglobin and utilize this concept to the increased BUN/Cr ratio in upper gastrointestinal bleeding.

Registration

There is no registration fee to participate in this activity.  Login and click "Content and Tests" above to view content.

In order to receive continuing education credit, learners must listen to the 30 minute podcast, pass the post-test (3 questions, 100% required score, unlimited attempts), and complete an evaluation form.

Please contact us if you have any questions or problems with the system.

The planning committee members report having no relevant financial relationships to disclose:

Hannah Abrams 
Tony Breu
Avi Cooper

No commercial or in-kind support was provided for this activity.

Accreditation

In support of improving patient care, this activity has been planned and implemented by Curious Clinicians and VCU Health Continuing Education. VCU Health Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

 

VCU Health Continuing Education designates this enduring material activity for a maximum of 0.50 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

It is the responsibility of the participant to provide the correct information [ABIM ID Number and DOB (in MMDD format)] in order to receive MOC credit for participating in a CE activity. 

Disclaimers 
Minimum and maximum numbers for attendance at this event have been established, and we reserve the right to substitute speakers/topics, adjust credit hours, or cancel if necessary.

By attending this event you grant VCU Health Continuing Education the right at the event to record, film, photograph, or capture your likeness in any media and to distribute, broadcast, use, or otherwise disseminate, in perpetuity, such media without any further approval from or any payment to you.  

 

Credits
AMA PRA Category 1 Credits™ (0.50 hours), ABIM MOC Part 2 (0.50 hours), Non-Physician Attendance (0.50 hours)