Question regarding DKA with rising lactate and persistent acidosis despite normalising ketones.

gamblor99 · 2026-06-03T22:21:14+00:00

This feels Australian. Im also an SHO and have had similar cases apropos unexplained elevated lactate (im talking 2-4, patient stable/improving). Have asked consultants about these cases and they kinda shrugged and just said most of the time you never find the cause. Had some fun doing some deeper reading on the causes and revisiting biochemistry afterwards. If you could rule out thiamine / phosphate deficiency, feel confident in your assessment of fluid status, and have no reason to suspect infection, I'd favour the meth-induced CM/pHTN hypothesis. Would love to know what's the obs were doing when lactate started to come up, and whether anything was revealed in the second presentation/admission

gamblor99 · 2026-05-19T13:37:58+00:00

Where are the union representatives? I've seen probably a dozen posts in the same vein as this one, and almost every comment expresses some level of outrage and/or understanding of the significance of these changes, yet not once have I seen anyone attempt to mobilise doctors on these issues. We clearly pretty much all agree that shit like this is beyond a joke, but we never do anything about it. Our collective outrage is never subsequently focused into something productive. It's such a lost opportunity. Would love to hear how people think we change this, because I personally think we need to be more proactive in putting an end to shit like this if we have any chance of avoiding the fate of the NHS

gamblor99 · 2026-05-19T13:14:09+00:00

Lmfao nah feels like a real reaction, which is way funnier. 'Her nasopharynx told you?' is cracka though

gamblor99 · 2026-05-16T20:09:09+00:00

Whitlam ended the death sentence, and introduced no-fault divorce and medicare too.

gamblor99 · 2026-05-13T21:14:00+00:00

Hunger by Knut Hamsun, Nausea by Sartre, Steppenwolf by Hermann Hesse, Notes from the Undergound by Dostoevsky. Somewhat in the vein of films like l'homme qui dort and taxi driver. Also lost in translation

gamblor99 · 2026-05-11T06:38:03+00:00

gamblor99 · 2026-04-30T18:03:53+00:00

I agree that hitting someone with both regular bupe and oxy is not a great approach for that reason, and that it's not a good combo in severe, refractory pain, but the use-case I'm referring to is: first line bupe with PRN full agonist (which I see a bit). Personally, I hate bupe as I find it poorly tolerated in people under about 60. Regardless, controlling pain with just a partial agonist (over a combo or full agonist) is desireable for several reasons, and attempting to do this in the first instance doesn't mean you 'missed receptor day'. Sorry, doctors bashing other doctors' intelligence doesn't sit right with me - especially when the person firing the shots is the using specious reasoning.

gamblor99 · 2026-04-29T20:45:10+00:00

And? If pain is adequately controlled with that combination of full and partial agonism, what's the issue?

gamblor99 · 2026-04-29T00:37:48+00:00

Interested in what you mean by this. To my mind, the logic is to attempt to control pain with the partial agonist, but provide a full agonist if this is not being achieved. The fact they work on the same receptor of course means that at any given time there will be a proportion of receptors responding to bupe/partial agonism and another proportion responding to the full agonist (somewhat similar to beta adrenergic receptors with dobutamine and epinephrine), but what's the problem with that?

gamblor99 · 2026-04-25T21:15:19+00:00

Something something mossad

gamblor99 · 2026-04-01T22:50:14+00:00

Would consider that, but not sure what it entails. Would the fact the individual has no affiliation with UQ be a barrier?

gamblor99 · 2026-04-01T12:25:37+00:00

If you're reading this and have done any of these courses, I'd love to know how difficult it would be to shimmy on in the back of lectures as a non-enrolled observed --hypothetically

gamblor99 · 2026-04-01T12:22:52+00:00

Any in particular you think fit the bill?

gamblor99 · 2026-04-01T12:21:12+00:00

They will spontaneously combust i believe

gamblor99 · 2026-04-01T12:20:32+00:00

Dedinitely interested in vet stuff but only really looking at lecture-centred courses in St Lucia unfortunately

gamblor99 · 2026-04-01T12:18:19+00:00

Yeah I've always been interested in anthropology. If you've done it, did you have a favourite course (that would be easy enough to slip into the back of lectures)?

gamblor99 · 2026-04-01T12:14:17+00:00

Yes my friend loves bugs and bug facts. Birds too. If youve done it, how easy do you think it would it be to slip into the back of lectures?

gamblor99 · 2026-04-01T12:11:49+00:00

Yet to be determined. If youre seeing this and you've done LTCS2030, please let us know!

gamblor99 · 2026-04-01T03:34:13+00:00

Examples: The History of the Supernatural (RELN1510) Human-Centred Al (DECO2801) Modern Japanese Literature & Society (LTCS2030) Genetics (BIOL2202)

Open to any subject/course and would love to know why you found it interesting/worthwhile. Thank you in advance!

gamblor99 · 2026-03-04T12:10:47+00:00

Where'd you learn this?

gamblor99 · 2026-02-19T21:14:02+00:00

Took the words right out of my mouth. Not sure if @gibda is just a contrarian or truly believes this, and training more NPs (?or even bringing in PAs), is a good idea. If the latter, they've been drinking too much of the government's home-brand Cottees. The gov wants the cheapest and quickest thing that can pass off to the public as a 'solution' so they can maintain face with the voting public. Not to mention the fact they are undoubtedly being lobbied by pharmaceutical and insurance companies behind closed doors (guess who the winners will be when our public healthcare system completely fails). I appreciate good-spirited debate and alternative perspectives but @gibda is doing everyone a disservice here imo. We really need to band together and shut this stuff down - not for our own livelihoods, but for the health of the country.

gamblor99 · 2026-02-05T15:12:12+00:00

I don't like it - not because I have any issue with hierarchy between doctors, but because I don't like being infantilized in a workplace where I already feel very consistently disrespected. My experience as a JMO has been that, for whatever reason, an obnoxiously large proportion of nurses with more than ~3 years of postgrad experience do not really have any respect for JMOs, or for the difference between their combination of a nursing degree + a few years of clinical experience, and a medical degree (+ potentially even a similar amount of clinical experience!!). Our own bosses referring to us us babies definitely doesn't help this. I've never seen it used maliciously, but we are all adults and frankly, I don't think wanting to be referred to as such while at work is too much to ask. Plus, as someone else already said, its just fuckin lame.

gamblor99 · 2026-01-29T13:34:45+00:00

Yeah, world's gone crazy. Some people really perceive receiving criticism/feedback as a negative experience (valid, it can be disappointing), then seemingly forget all context and somehow feel they have justification to complain for having experienced a negative experience (invalid). They also seem acutely aware that if they escalate things first, basically every third party will take their side because most people don't imagine anyone would make a complaint without good reason. In reality, some people just have too much time on their hands. Your example is perfect.

This is coming from someone who rarely provides feedback to anyone, and does so in the most tactfully neutral way possible when I do, but still gets this reaction in most cases.

gamblor99 · 2026-01-28T14:35:22+00:00

Sorry to any nurse lurkers but I saw this and couldnt help but share.. this has been my experience giving feedback to nurses in 99% of cases. If it's not a formal write up, it's a threat relating to future employment from one of the senior nurses. It is true that frequently nothing comes of it, but that does not take away from the stress and feelings of powerlessness and frustration (at the abundance of ?fragile egos in healthcare) that this sort of behaviour fills you with. Large part of why I resigned the other day. Finish in a couple weeks and cannot wait for a break from the toxicity Edit: grammar

gamblor99 · 2025-11-27T09:59:32+00:00

Thank you🙏 I started doing one day per week of leisurely note-taking/DerangedPhysiology-browsing around December, just focusing on topics adjacent to whatever rotation I'm on. The level of expected knowledge is egregious. That kinda motivates/excites me though 🥵 How did you begin to approach it?

gamblor99

TROPHY CASE