Welcome to the morbidity and mortality meeting for the blog’s 2025. As 2025 concludes, we wanted to take a quick look back through our blog’s first year: the hits, the misses and what we have in store for 2026. And also, it’s easier to write this than it is to research immunoassays during a brief holiday break.
People’s Choice: (Not) Managing Asymptomatic Hypertension
The best received article of the year was a snappy take-down of our urge to fix one of the most common reasons inpatients are reviewed. So put down the amlodipine, and pick up some of the advice in this piece instead.
Now, some of you may be quick to point out – what does it mean if the most popular article was penned by neither of the blog’s main authors? Well, clearly our skill at picking guest authors exceeds our ability to write. Less sass, more clicks please.
Editor’s Choice: Confessions of a “Penicillin Allergic” Patient
How dare you call this a consolation prize for the author of the least popular article. Blasphemous. Moving swiftly on, my favourite article of the year is the recent essay on the many myths lacing penicillin allergies – delivered with a dash of oversharing.
Thankfully, this seems to be a topic that is gaining traction across physician specialties, with recent guideline changes reflective of our improved understanding of the minimal cross-reactivity between most penicillins and cephalosporins. Unless of course, you are making home-grown organic Penicillium to stick it to big pharma – in which case, all bets are off.
Least Popular Article: Meningitis: The Eternal Headache
Not to point fingers, but the Razzie goes to the meningitis article. Why did this not resonate with our readers? Why were so few interested? All great questions, but ones I thankfully don’t have to contend with as I didn’t write it. So instead I’ll continue posing passive-aggressive rhetoricals.
I suppose the world just wasn’t ready to stop doing CT brains before lumbar punctures. Or so we can tell ourselves. If you have a patient with suspected meningitis, it may be a valuable resource. But instead of reading it out of pity, give antibiotics first.
On The Horizon:
- ”Fortnightly Articles”: We will attempt to get better at understanding the duration of time a fortnight actually corresponds to. But no promises.
- Instagram: The cool kids tell us that this is where the inter-webs has moved on to. Apparently a blog is so 2000s. So is literacy. Our bad. With our combined interpersonal ineptitude, we shall endeavour to birth a digital social media solution. If anyone graphically and chronologically gifted is reading and so inclined, our DMs are open.
Audio Snippets: Another flavour to get with the times – less than five minute snippets that summarise articles, available on podcast platforms of your choosing. Don’t expect Born a Crime levels of sonic goodness. It also justifies one of us having an expensive audio recording setup a well 10 years in advance, predicting this exact moment. Perhaps we should also record a series on how a fitful blog was in fact a long con to turn a shopping addiction into tax deductions.
From our small M&M team, we thank you for your time and support in 2025, and will see you shortly in the new year.
In Case You Missed It: A summary of 17 667 words across 14 articles
1: A blood gas a day keeps the pseudohyponatraemia away
Do a venous blood gas for all hyponatremic patients. Think about pseudohyponatremia if it differs to the formal EUC’s sodium.
2: Magnesium to slow a heart going fast AF
IV Magnesium is of limited utility when given in isolation as the sole agent for non-post-operative rapid atrial fibrillation – especially in patients without significant deficiencies.
3: Diagnosis: It’s all about that Bayes
No diagnosis should be made without considering the pre-test probability. Even a “positive” test can be misleading if the disease is rare. A negative test may not rule out a common cause.
4: Fantastic bacteria and when to culture them
Blood cultures at the exact time of a fever isn’t the best way to increase its diagnostic yield. Taking it prior to antibiotics, and sampling at least 2 sets of blood culture bottles is.
5: Take Thyroid Function Tests with a Grain of Iodine
Interpreting TFTs in hospitalised patients comes with many asterisks, so consider if this is a test that is really worth doing. If they’ve had contrast – you may be looking at a thyroid stress test.
6: (Not) Managing Asymptomatic Hypertension
Severe asymptomatic hypertension is reflexively treated in inpatients but may not necessarily reflect the patient’s baseline BP at home, and cause documented harm if you rapidly lower BP.
7: Meningitis: The Eternal Headache
Meningoencephalitis is rarely a true diagnosis. A lumbar puncture is paramount, but a CT prior rarely changes clinical management. Give early antibiotics, and don’t forget the steroids.
8: Stop trying to make Ammonia happen for hepatic encephalopathy in cirrhosis, it’s never going to happen
There are many more caveats than reasons to do an Ammonia level for hepatic encephalopathy in cirrhotic patients. It’s repeatedly shown to not aid diagnosis, merely confuse it.
9: The Fast and the Furious: Intravenous Fluid Shift
Much like a little teapot, the best intravenous access when you’re in a pickle is short and stout. It’s harder to bolus viscous solutions like blood and albumin when compared to crystalloids.
10: Tirades about TI-RADS
Not every thyroid nodule warrants follow up. In fact, despite all time highs in the diagnoses of thyroid cancer, the early identification of it does not seem to translate to reduced mortality.
11: Sepsis: A Spoonful of Fluid Helps the Lactate Go Down
Clinical judgement should supersede purely utilising the lactate for fluid resuscitation in sepsis. This is because lactate isn’t merely derived from hypoperfusion in sepsis – beta-agonism and many other biochemical mechanisms underlie this useful marker.
12: Learning Statistics – Against All Odds… or is it Risk?
Odds ratios and relative risk are not interchangeable – and the relative risk is much more intuitive. Evidence based medicine recommends the number needed to treat/harm, derived from the relative risk. Hazard ratios are basically compound interest comparisons for survival curves.
13: Confessions of a “Penicillin Allergic” Patient
Most Penicillin allergies will likely not come to fruition when met with modern Penicillin. The cross-reactivity between beta-lactam allergies is grossly overestimated and misunderstood.
14: Furosemide: Flushing out the Misconceptions
Give higher doses of furosemide instead of albumin for hypoalbuminemic fluid overloaded patients. If it’s the only diuretic they’re on, it’s not the cause of their hyponatremia. In APO, furosemide’s immediate efficacy isn’t a result of diuresis but one of vasodilation.
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