SPEAKER_00 0:18

Hello, and welcome to Impatient Update. I'm your host, Mason Turner, and this is your podcast for practice changing evidence for the working hospitalist. Today on the show, I'm joined by Dr. Kevin Baker as we discuss faster correction of hypernatremia, whether it's safe or even better, and long-acting antibiotics, specifically Daubavansin for Staph aureus bacteremia. Well, Dr. Baker, thank you so much for joining me.

SPEAKER_01 0:46

Thanks, appreciate it.

SPEAKER_00 0:48

Dr. Kevin Baker is one of my colleagues, an excellent clinical hospitalist, a teacher, a leader, a associate professor of medicine, and a good friend. And I'm so grateful for you for joining the show.

SPEAKER_01 1:00

Thanks. That's maybe more of an introduction than I deserve, but thank you.

SPEAKER_00 1:03

Anything else you think the audience needs to know about you?

SPEAKER_01 1:06

Uh I got a young family, and uh, you know, just uh trying to get by while keeping up to date on evidence, which is not always an easy thing to do.

SPEAKER_00 1:15

Um I will make an admission to the audience, as uh Dr. Baker is well aware. Uh this is my actually our first in-person podcast recording. So congratulations to us, congratulations, impatient update. And with firsts, there come technical issues. So this is uh this is take two. I won't say exactly how far we got into the podcast before I realized that we were not recording. Um, but I'm I'm a solid 90% sure we're recording now. And if not, I'm at least in good company.

SPEAKER_01 1:47

Well, whether we're recording or not, we'll have a great time.

SPEAKER_00 1:49

Yeah. Um, as a reminder of the format, we'll discuss two recent practice-changing articles in less time than it takes you to drink your morning cup of coffee. Or in our case, a glass or now two of bourbon. So, Kevin, tell me again, what are you drinking today?

SPEAKER_01 2:05

This is from a small coastal, this sounds so pretentious, but island near where we live that you can only go to by boat. Had the opportunity to go there uh last summer, brought a delicious bourbon back with me, and I figured it was a treat. So why not share some on uh the first impatient podcast?

SPEAKER_00 2:24

Well, thank you so much, Kevin. And I um when I was talking to Kevin about potentially being on the show, he said, What you need is a drink. And I was like, Oh, yes, you need to be the person on my next episode immediately. You have this figure. That's why I got the you understand the impatient update he does. Um so thank you so much for bringing it, and thank you so much for being here. Sure. Well, Kevin, tell me, uh, have you ever um admitted a say seven seventy-something year old female with some dementia admitted with a sodium high 150s, 160s, um, to the hospital?

SPEAKER_01 3:04

Yeah, I mean, we uh joked uh about the LOLs, the little old ladies that always come in. And uh I just admitted one yesterday, your sodium was I think 158. So uh very recently.

SPEAKER_00 3:18

Yep. And so for those those patients, we have the general dogma of high to low and the brain will blow. And the rule of thumb is don't correct sodium more than 0.5 millimoles per liter per hour. Um, and this was a a recent article challenging that. And so this is an article entitled Fast Compared with Slow Correction Rate and Severe Hypernatremia. It was in the Journal of Critical Care and released in November of last year, 2025. And it sits in into a a couple of relatively recent articles over the past couple of years looking at this specifically in a few different uh patient populations. This was specifically uh ICU patients. It was an observational cohort study with a study designed that they that's referred to as a target trial emulation, which is uh not to get too much in the weeds of the stats, but essentially trying to do a cohort study with as much to the closest rigor as possible as a randomized control study. But essentially the patient population is it's a a retrospective cohort study. This study specifically looked at ICU patients. As I mentioned, there have been some other previous studies that looked at more general hypernatremia. But part of the reason I picked this one is because it looks at the sickest of the sick, which I think is an important population because if it works with them, hopefully it works with others. And also it was the most recent of these studies. Okay, so in the study, patients who were admitted with hypernatremia, they broke up into both a slow and fast correction group. And as in a this was a matched cohort study. So there were equal number of patients in both the fast and slow correction group. Fast they referred to as greater than 0.5 millimoles per liter per hour during the first 24 hours. And slow was less than that, so less than 0.5 millimoles per liter per hour. And the outcome that they looked at specifically in this study was 30-day mortality. And lo and behold, the fast correction group, so going above that dogma level of less than 0.5 millimoles per liter per hour, had a better 30-day mortality. And then also looking at secondary outcomes had shorter hospital length of stay, uh, four versus five days, had shorter ICU and hospital length of stay, both. And so the um really the exciting thing about this article is specifically looking at the sickest of the sick and the ICU, but folding into these other couple of recent articles. There was a 2023 JAMA article, which was a large observational cohort study, somewhat similar idea and design, but looking at over 4,000 patients uh that were on the floor, and also showed that the faster correction had a lower 30-day mortality with an adjusted odds ratio of over two. And they also notably mentioned no neurologic complications attributed to rapid correction of sodium in that study at all in all of those patients. And there was also another in the Journal of Critical Care, another recent large meta-analysis looking at a bunch of different studies on this topic, relatively heterogeneous studies, but similarly found that there was not any worse mortality with faster correction in that, and that there were the added benefits of reduced length of stay, and there were no major neurologic outcomes related to the hypernatureemia. So, Kevin, were you were you aware of aware of this data? Has this been how you've been practicing treating hypernatremia previously, or is this going to be something new and different for you?

SPEAKER_01 7:08

No, I think this is um pretty game-changing for me at least. I work with residents as learners, I work with uh nurse practitioners as learners, and I think that that little lady with the sodium 158 I just submitted the other day, she corrected uh in 12 hours down to like 145. And I was giving them the whole lecture of this is too fast, you got to slow her down. Um, and so you presenting this article makes me feel a little bit better about my patient care. Right. Um, the and the oversight there that, you know, maybe correcting her was actually doing her a favor, not an injustice. But I had learned the same sort of mantra as going slower is never gonna hurt anything. Going faster could be potentially harmful. And I think this sort of um challenges that and to my mind, it makes sense. I mean, is it good for your brain to be sitting in a sodium of 168 for long periods of time or 158? Probably not.

SPEAKER_00 8:02

Yeah, certainly not based on my exam of those patients, typically. Yeah. Um yeah, I I similarly to sort of my my background of part of why I picked this study, despite it being kind of a weird study design and there being other recent articles that hit the same spaces. This was kind of a little a bit of a pet area of data of mine dating back to back when I was a medical student and I was a fourth-year AI, and I had a patient that came in, like we talked about our LOL with hypernatremia, who came in and we had corrected her similarly. I mean, I think something like 20 points over, you know, overnight in a 24 hour span. And I don't remember if it was we just, you know, it just happened, or if it was a cross cover issue and we gave her D5 water instead of half normal, or we miscalculated her free water deficit or what it was. But the next morning we saw, whoa no, we've we've over that threshold. This lady's brain's gotta be swollen. And so I, as the fourth year student following this patient, I'm like running to the patient's room.

SPEAKER_01 9:14

Yeah, you're freaking out.

SPEAKER_00 9:15

Yeah. I and my upper level's like, go check on this patient. Yeah. And I I distinctly remember her sitting in a wheelchair in the hall, and I'm in the hallway doing a neurologic exam, looking to see does she have a blown pupil? Is she able to follow my finger? Like, is she herniating? And to your point, to this study's point, if anything, she was better. She was more alert, and she's kind of like, Well, what's going on? She, you know, chronic dementia, certainly confused, didn't know who I was or where she was, but was more alert than she had been the day before, had perfectly normal neuroexam. And and because of that, I thought, okay, interesting. Did we just play with fire and dodge a bullet and get really lucky? Or is there something more here? So I had to do in my fourth year, I had to do an evidence-based medicine presentation. And I selected to do the literature on this at the time. And anything I found back then was essentially there is no evidence that there's no evidence that uh correcting too quickly causes cerebral edema or bad outcomes in adults, but we didn't have the benefit at that time of this evidence that tells us actually we see that there's decreased mortality if you correct quicker and other positive secondary outcomes. And so I found this this is like really hits home for me because I think of this as sort of exactly what I'm was wanting to do at the time and was wanting to do with the podcast, and that this is one of the little things that I mean, you say you saw someone the other day, you see all the time, and there's not like some fancy new therapy, there's not something crazy out there. But as a hospitalist, if we do the little things we see frequently because our reps are so high, if we do those little things well, if we do those little things better, we have a chance to make a significant improvement and outcomes of focus. And I did sort of back of the envelope, number needed to treat to have a benefit. And I got eight. So, you know, take it with a grain of salt. It wasn't a randomized controlled trial, but if you, if it's anywhere close to that, it wouldn't take long for you to have eight patients with hypernatrium.

SPEAKER_01 11:20

I mean, a week on service, I'll probably see two to three that are hypernatriumic. So it's not gonna, it's I'll see that in a month, you know. I always get worried though when I get these folks through the emergency room after they've gotten a fluid bolus because inevitably they're dry as a chip, right? And so it's not wrong to give them the fluids, but I used to always get really anxious about them getting the two-liter bolus, like, oh my God, are they gonna start autocorrecting? The sodium's just gonna crash. And I feel like now with this article, I have a little bit of room to breathe. I feel less anxious about it. And now I know I can, if they do start to correct uh more quickly, I know I can keep going with it because it's safe and actually might help them uh to correct them a little bit faster. And I was thinking about it, one what an hour, like 24 mil equivalents in an hour. Like how many patients are coming over, coming in with a sodium more than 164? So I mean, you can just correct them in 24 hours essentially. And I'm not surprised that there's decreased length of stay or hospitalization in the ICU. I mean, if you can crank on them and get their sodium back to normal, yeah, I'm sure their brain's gonna thank them for it.

SPEAKER_00 12:30

Yeah, and I agree with you. And that really, as much as anything, it lets us, it kind of removes that fear that I had that you had recently with your patient when you that you have with these dry patients that I had with that patient back when I was a student, that you know, you just don't have to worry so much. You can set an aggressive target, hope you hit somewhere in that 0.5 inch range, hopefully over it, go for 0.5 to one, but don't have to worry if you correct too quickly, because if anything, you're gonna have better mortality for fo and speaking of me as a a fourth year AI, this this really comes for full circle because you were actually the chief resident on when I was the the fourth year AI at that time. Oh man. And I um distinctly remember you orienting me and and walking me to the the clinical workroom and and sort of talking about what it is to be an AI. And I'll probably never forget that you said AIs are the best thing that ever happened to interns and the worst thing that ever happened to upper levels.

SPEAKER_01 13:33

I can't believe you still came back to work with me after I said that as your chief.

SPEAKER_00 13:37

But it's such a it's such an insight, and anyone who's ever done the physician training knows can can kind of stew on that and know exactly why that might be the case.

SPEAKER_01 13:48

There have been some students that have come up to my wife and had said, like, your husband gave me like a great one-liner. And I always preface it by saying, like, is this gonna be a good one-liner or is it gonna be a bad one-liner? So uh thank you for being kind about the one-liner you shared.

SPEAKER_00 14:04

Uh, should have mentioned in the introduction, honestly, Dr. Baker is probably probably the one of, if not the most widely well respected providers at our institution. Kind of everyone has a a reason to respect Dr. Baker because he uh takes good care of patients. He does right by his patients, he does right by the nurses, but he holds everyone to a high standard and he speaks his mind. I mean it honestly, you're going to respect him from every everyone.

SPEAKER_01 14:32

I'm gonna take that as a compliment.

SPEAKER_00 14:36

All right. Any other any other thoughts on us this article about hypernatriemia?

SPEAKER_01 14:40

No, this is great. I mean, I think um certainly is gonna change my practice. Already has. I had to apologize to the nurse practitioner that was helping care for that lady with a Sodoma 158 already. So uh never be too proud to say I messed up and there's new evidence, and here's what it shows. So definitely is gonna change my practice. Awesome. Let's move on. Yep, I've got an uh article that I wanted to share with you that I thought of it because I actually listened to your last podcast with Dr. Ospina, one of our other colleagues, when you talked about shortening duration of antibiotics. This is called the DOTS trial, stands for Dalbovansin for treatment of staphylococcus aureus bacteremia. And basically, this is a um randomized controlled trial that is open label because the two randomized control arms, the control was standard therapy with IV antibiotics for four to eight weeks with either cephalzolin or an anticephylococcal penicillin for the MSSA bacteremias, or if it was MRSA bacteremia, vancomycin or daptomycin, versus the intervention, which was dalbovancin, 1500 milligrams IV on day one and day eight. So dalbovancin is a long-acting inversion of vancomycin with a half-life of 14 days. And so those two injections are essentially enough to complete therapy and eliminates the need for a PIC line or a long-term central access to deliver um antibiotics for patients. And so that's why it was open label. You can't really blind people to having a central line. Um, so this uh randomized trial took place in 23 centers across the US and Canada. Uh, it was from 2021 to 2023. And there were 200 patients enrolled in the trial. 100 were randomized to the Dalbavanson arm, and 100 were in uh randomized to the standard therapy arm. These were all hospitalized patients with complicated staph aureus bacteremia that had cleared their blood cultures by 72 hours in the hospital and on antibiotics, but and uh had at least 10 days of initial therapy. So uh they didn't specify necessarily what the therapy was, but that they had had 10 days of therapy. They did exclude patients with CNS infection. They excluded patients with not right-sided but left-sided endocarditis, retained infected prosthetic material, or severe immunocompromising states. So, as mentioned, they had the Dalbavansin versus standard therapy arms. The primary outcomes that they were looking at was something called DOR DOOR, which is the desirability of outcome ranking. And this was checked at 70 days. So this is new to me. I had never heard of this before, but essentially the DOR or desirability of outcoming ranking is not just a looking at a single endpoint of did it treat the bacteria or did it not treat the bacteria? Simple enough question. But real life is way more complicated than that, right? So things that they included in the desirability outcome ranking were clinical success, obviously, infectious complications, such as spread to other sites, safety complications from the drugs themselves, mortality rate. And then lastly, I think health-related quality of life, which I think was mainly aimed at looking at do you want to have a PIC line and inject yourself with antibiotics for four to eight weeks? So from those results, they were powered to determine whether dalbivansin was superior. It did not demonstrate superiority. But in the secondary outcomes, um, they looked at non-inferiority. And in the dalbivansin group, there was 73% clinical efficacy, and the standard therapy had 72% clinical efficacy. So the dalbovansin therapy actually had 1% more clinical efficacy. And based on this, it was determined to be non-inferior to standard IV antibiotics for four to six, uh, four to eight weeks. Um, the microbiological success of it was 98.8% with dalbivansin versus 96.3% with standard therapy. And in the adverse uh events uh category, the dalbivansin was associated with 40% uh adverse events, uh, whereas the standard therapy was was uh associated with 34% adverse events. And obviously, when you're giving a long-acting uh vancomycin that has a half-life of 14 days, there's no take back seas after you inject it. Uh and so you could imagine that you can't really stop therapy, you can't really alter therapy once it's been given. And so I think that this study was powerful, really to me, for a very specific population. In this study, importantly, they did include patients with right-sided endocardase, they included patients that were IV drug abusers, they included patients with osteomyelitis. And so I think this has a place with patients that have inability to give themselves IV antibiotics at home. We have patients that don't have electricity or power, can't keep antibiotics cold. We have um lack of funding or uh medical literacy and ability to give themselves the antibiotics uh safely, inability to get the monitoring necessary with many of these antibiotics, going in for weekly labs and what have you. And so I think in those patient populations, it's a pretty powerful tool to have in the toolbox. And so I think that that's why I wanted to present this. Antibiotics were getting lesser and lesser durations all the time for various indications. And I think you know, if you can get away with two injections of a long-acting depot vank and avoid a pick line in certain populations, it sounds like a win.

SPEAKER_00 20:22

Yeah, super cool. Super cool. My uh just a quick thought on the methods is that I I think the study has a little bit of a PR problem, and the the headline result being that they didn't meet the superiority outcome. I'm a little bit like, I don't care. Yeah. Um, the secondary outcome of non-inferiority from a clinical outcome is is really the headline of the study. And I looked back at the method sum to just like make sure that it was powered for that and all of that, and and it was quite rigorous in its non-inferiority study. And so I I think understandably the authors got excited about like if we can demonstrate superiority, but really just showing non-inferiority for this is is really huge.

SPEAKER_01 21:11

Yeah, I um I I when I first thought about it, you know, we talked about sort of the physiologic um understanding of like changing hypernatremia and like, oh, too fast, it's gotta be bad. And similarly with this, I was thinking, okay, bacteriostatic drugs versus potentially bacterial cytal drugs, um, like cephosolin or anti-cephylococcal penicillins, like of course you're not gonna show show sh superiority unless just everybody's non compliant with them, right? Sure. Um, and you know, I think in this case it's sort of like pushing aside that theoretical and it's showing that it's not inferior. And like I said, the the clinical efficacy was actually one percent higher with the Dalbavantin. Now, is that to, you know, that they're just a lot more compliant. Client, or that it's just the two and done, or you know, they didn't they basically said that if anybody didn't follow up, it was deemed like a failure of treatment in this one. And so I think that's probably one potential critique on the paper. You can't really have a a failure of treatment when you give a depot drug. Sure. Right. Um, and so maybe that played some sort of role in this as well. Um, but they did separate out the MSSA from the MRSA strains, and there didn't seem to be much of a difference when they did subgroup analysis to see, okay, Dalbavancin versus bactericidal drugs used for MSSA or Dalbavancin versus bacteriostatic, just traditional IV vanc or adaptomycin for MRSA. So it doesn't seem to that hypothetical didn't seem to play out in the study. And I agree, I mean, non-inferiority, like all I care is that it's easier and that it's not worse.

SPEAKER_00 22:53

Right. Totally. We can kind of use our our clinical judgment to push into that uh that out the desirability of outcome ranking. Like part of that is, you know, is it easier for people's quality of life? Like we can kind of decide and and talk about patients and kind of do that on a patient-by-patient basis. What I need to know is that it's it's not an inferior treatment.

SPEAKER_01 23:15

I think that the authors were expecting more of a signal to come through too, sure, when it comes to the health-related quality of life, which is one of those desirability of outcome rankings. And it didn't seem like it showed through. And I think, you know, anecdotally, this is my experience. How much of a barrier do your patients put up when you're like, you're gonna have to go home with IV antibiotics? And they're immediately like, I'm not doing it. I don't want to learn.

SPEAKER_02 23:38

I don't know how.

SPEAKER_01 23:39

Yeah. I my my daughter is only there once a day. She's not gonna do that. And then once you get it in, you get the pick line in, you get them trained. I think it's less of a big deal than patients put on in initially. And so I think that kind of bared out in this paper here that it didn't weigh as heavily as I think the authors thought that it was going to. And I think that's probably one of the reasons why it wasn't really superior to the standard therapies.

SPEAKER_00 24:04

Yeah. Every time I discharge someone with IV home infusion of antibiotics who hasn't been on it before, I give a spiel of like, my partners and I send multiple people home every day with this. It's not as big a deal as it sounds. And this kind of backs me up to your point that, you know, apparently it wasn't as big of a deal as it sounds because it didn't move the needle much on this general desirability of outcome ranking. But big picture here, I'm thinking, wow, you know, what an exciting time we live in when it comes to the treatment of bacteremia. Uh, when you mentioned this article to me, you mentioned how it dovetails in so nicely with the article I talked about with Dr. Ospina, and that that article said, you know, you don't need to do 14 days of antibiotics for bacteremia. You can get by with seven days for most things, but it specifically excluded staph aureus that we're seeing, we're studying here, and excluded people with complicated infections that had some sort of lack of source control or some something that we were treating other than just the bacteremia. And this hits that population exactly, and in fact, specifically targeted complicated staph aureus bacteremia, but I don't have any reason I wouldn't feel totally confident treating non-complicated staph aureus bacteremia if I can treat complicated staph aureus bacteremia. Right.

SPEAKER_01 25:22

Yeah, I um I'm less and less finding reasons to put PIC lines in people these days. I mean, by the time you get negative blood cultures, a lot of the times, you know, you've almost treated for three or four days of antibiotics already. And so for your the prior study you're you were talking about, Dr. Espina, you're almost it's it's almost a shame to send them home with PIC line for three, four days of antibiotics, right? Oh, totally. And then, you know, similarly here, like if you can get away with an injection on day one and day eight of a long-acting vank, that's awesome. And especially in the patient population I mentioned, people that can't get it, can't afford it, are unsafe with central lines like um people with polysubstance abuse history, or people going to rehab facilities where the rehab facility doesn't want to foot the bill for the adaptomycin or whatever it might be. So I think this is a huge game changer for hospitalists who are having to deal with sticky social financial situations.

SPEAKER_00 26:15

Certainly. Yeah, we're gonna put our vascular vascular access team uh colleagues out of business, which like in a sense, a good thing. Uh uh only tangentially related. I had a patient that recently was sent to the ICU during a pick line placement. I mean, it's it's not, I mean, and that's the obvious like on top of the risk of infections that, but but certainly it's it's not benign, it's not without risk. So if we have another option of something we can do that we know is not non-inferior, that's really exciting. And so my question for you is if it was you who had the right-sided endocarditis and bacteremia or loved one, or the the osteo or what have you, would would you choose to go the more traditional route, get a pick, get the IV antibiotics daily, two times a day, whatever it is, or would you go with Dalbavansin based on the study?

SPEAKER_01 27:09

Man, two young kids with uh an IV sticking out of my arm and a dog at home. I don't know. I might opt for the Dalbavansin to be truthful. You know, I joke, and you know, what if it's a a Q8 hour IV instead of a Q for Q day drug? I mean, I would have to really think about it. I think I probably would still recommend if if people have coverage, are trainable, good social situation, probably to do the standard therapy, but I would have to really think hard about it. It's pretty tempting to just get a one-time injection in the hospital, come back to ID clinic a week later and get the second injection, and then you're treated.

SPEAKER_00 27:50

Yeah. I I agree. I'm kind of it now puts it so that it's it's almost 50-50 for me. And like if if it's really easy to do the home IVA antibiotics, and like we talked about, like it didn't seem like patients cared that much about the difference based on their quality of life, then I'd probably just err on the side of let's do the normal thing, the classic thing of putting in a pick. But if anyone gives me any reason that it might be beneficial, the fact that I know it's not inferior is really helpful and and certainly like, yeah, same, same here. I'd I'd I'd seriously think about it.

SPEAKER_01 28:22

I did have a recent example where um I was getting verbal sign out from one of my colleagues before I came onto service and it was on a teaching to service, and they had a patient that was uh had a drug abuse history, had MERSA bacteremia, needed to go to a rehab. Uh no rehabs are accepting her because of her drug abuse history. And uh they were trying to figure out where to put her. And I had just said, why don't you just give her Delva Vansin and let her go and have the rehab bring her back in a week for her next injection, and then you're good. And the hospice I was talking with hadn't heard of the study just yet because it just came out recently. And uh they called ID that day and actually gave her the injection. She was discharged before I showed up the next day. So it definitely is at least worthwhile asking, I think. I don't know if it's um gonna be ready for the main stage with infection disease folks, but I think from a hospitalist perspective, it's a great way for helping to solve some of those really difficult problems that we encounter.

SPEAKER_00 29:20

Yeah, I think we'll see. I think maybe we're starting to see our RID department sort of think about this first in a lot of patients. Uh, I used it a couple of times in residency, and then when I started working at this institution, hadn't really used it since, and it didn't really seem like it was much of the practice pattern. In training, we used it only in the most extreme cases. Basically, if someone's like gonna leave AMA, has a history of IV drug use, we don't want to send them with a pick, they say, get me out of the hospital, we give them a dose and let them run and hope it's good enough. Not having this data to back us up, but I know it's not inferior. But now I feel like our ID apartment's getting more and more excited about use it. And I similarly had a patient I discharged recently with osteomyelitis who had a little bit of a difficult funding situation and was going to a rehab facility. And we did that just to make it easy on them to not have to worry about getting him the vancomycin, to not have to worry about getting him regular level checks. We could just do this once and then again in two weeks and be be done with it and call it a day, and it made everything easier. And the facility was actually totally on board as long as it was a limited number of doses, which of course it is. Right.

SPEAKER_01 30:27

Yeah, and I think importantly in this study, just so people don't think that they're being totally cavalier, it's not like you got the immersive bacteremia, you clear it, immediately discharge them. I mean, this is after 10 days of initiation of therapy. So you've had them in the hospital, you've been checking drug levels, you've been making sure that it's not going super therapeutic, you know, you're making sure they're not having adverse side effects from it. It's not like you're just shoving them with an IV and the ER and saying, like, have a great day. Right. Um, so this is this is definitely for more of the transition out of the hospital after you've made sure that there's really no sort of um side effects or or significant adverse events related to the antibiotic therapy.

SPEAKER_00 31:03

Yeah, to your point, clearly they have to clear cultures and and all of that before they roll. Any other thoughts on this study?

SPEAKER_01 31:10

No, I think pretty soon we're gonna be given IV antibiotics for less and less and less time. I think we're just realizing as time goes on that we used to give antibiotics for way too long, seeing way too many side effects and complications of long-term antibiotics. And so I think there's gonna be a lot more studies like this coming out in the future.

SPEAKER_00 31:31

Let's recap. First off, when you admit a patient with hypernatremia, correct their hypernatremia aggressively. Uh, you do not need to um sort of be gentle and just do 0.5 millimoles per liter per hour, doing up to one millimole per liter per hour, 24 points in that first 24 hours, is shown to have better mortality benefits. So be aggressive when you're treating these folks. And when you have a patient with complicated staph aureus bacteremia, MRSA or MSSA, it doesn't matter. Um, and you're trying to get them out of the hospital. Think, do I really need to do a PIC line or can I not do a PIC line? Because there is another option you have that is non-inferior that requires the patient only to get antibiotic injections every two weeks. So super exciting. Did you have any any final thoughts on these studies?

SPEAKER_01 32:24

No, I I think uh I just want to say thanks for having me. It's been a pleasure. And um, I'll have to bring you a different bourbon to taste next time we have another inpatient update.

SPEAKER_00 32:32

Oh, certainly. Uh I appreciate it. I've actually graciously gotten two different glasses of bourbon given the technical issues. But Dr. Baker, so grateful for you coming on. It's been an awesome discussion, and I hope to have you again.

SPEAKER_01 32:44

Thanks, appreciate it.

SPEAKER_00 32:48

And to our listeners, um, as always, if you're a provider, pharmacist, nurse, resident, or student with any value-added insight into the management of hospitalized patients, I'd love to have you on the show. You can reach out to me directly, contact me on social media, or email me at podcast at inpatientupdate.com. Um, also certainly subscribe to the show if you find it helpful, rate it, share it on social media, but most importantly, um share it with your colleagues. Uh again, I talked about the number needing to treat being about eight for that hyper correcting hypernatremia more aggressively. So if you share this with eight other clinicians, you can sit back and know that you've helped at least one patient. So please share. Uh, and thanks so much. I think uh Dr. Baker and I are gonna need to pour ourselves another drink. So cheers. Appreciate you. All right, thanks so much for listening. This has been Impatient Update.

SPEAKER_01 34:11

I didn't realize that half off was a bad thing.