5 ms·

Doctors often want to keep pneumonia patients "dry", that is, somewhat dehydrated. (That's maybe contributing to the kidney failure.) To what extent could this

Doctors often want to keep pneumonia patients "dry", that is, somewhat dehydrated. (That's maybe contributing to the kidney failure.) To what extent could this also be resulting in increased clotting?

nickthemagicman 6y ago
Yes something is off here. Corona is totally respiratory virus.
- JoeAltmaier 6y ago
  That seems untrue. Corona attacks almost every organ.
  - nickthemagicman 6y ago
    You should totally check out Wikipedia or some factual scientific source instead of listening to the news. Science is a candle in the dark.
    - JoeAltmaier 6y ago
      I gotta think this is a bot or troll response? So obviously wrong and argumentative.
      - nickthemagicman 6y ago
        I'm not wrong you should open up your mind to the fact that you're wrong. There's hundreds of coronavirus and they're all respiratory viruses. Arrogant ignorance is no way to go through life son.
        DanBC 6y ago
        > There's hundreds of coronavirus and they're all respiratory viruses. How many coronaviruses can infect humans?
        nickthemagicman 6y ago
        That's what Google is for. Take some initiative and educate yourself and stop being so arrogant and ignorant.
        DanBC 6y ago
        There are seven coronaviruses that infect humans. 229E, NL63, OC43, HKU1, MERS-CoV, SARS-CoV, and SARS-CoV-2. You said "hundreds". What did you mean when you said hundreds?
        Supermancho 6y ago
        When talking about viruses, it's a little more complicated than a label. Viruses naturally differentiate in a measurable way from host to host as part of their function (hijacking the host's cells). Scientifically, viruses are lumped into common behavior and generic similarities. Many individual variations do not propagate enough to be noticed, but some do. There was quite a bit of talk from some people about the 112 strains of coronavirus, which was not constructive, but technically correct (re: https://www.medicalnewstoday.com/articles/is-there-more-than-one-strain-of-the-new-coronavirus#Why-are-mutations-significant https://www.medicalnewstoday.com/articles/is-there-more-than...? etc) awhile back.
        nickthemagicman 6y ago
        I've been rate limited by the site until now. Of the 7 strains of Coronavirus that you just listed..which of those cause respiratory illness?
        DanBC 6y ago
        They're all respiratory illnesses, but that doesn't mean the only affect the lungs. MERS caused kidney failure in some patients.
        JoeAltmaier 6y ago
        https://www.webmd.com/lung/news/20200423/the-great-invader-how-covid-attacks-every-organ https://www.webmd.com/lung/news/20200423/the-great-invader-h... There you go, 'son'. So, still obviously wrong and argumentative. Is this even a real account? Or just an insult-bot?
        nickthemagicman 6y ago
        Wellbutrin can cause erections that last for hours but it's not called an erectile dysfunction drug.... Just like coronavirus is a respiratory illness not some multi organ pathogenic illness like Ebola. The fact that a tiny infantesimal fraction of people can have side-effects doesn't change the fact that it's a RESPIRATORY illness. It's depressing that I have to explain statistics to people on hacker news. Are you a troll bot or just a dumb bot? The fact that people with your arrogance and your ignorance exist actually distresses me.
        castis 6y ago
        > The fact that people with your arrogance and your ignorance exist actually distresses me. Weird, your account says you joined in 2012 but it seems like today might be your first day on the internet?
        nickthemagicman 6y ago
        You're right I should have known there are a lot of arrogant dumb people around. Being on hacker news just threw me off because I expected more.
      - ak39 6y ago
        It's very frustrating to read strong views without the views being substantiated. I know it's unrealistic to ask everyone commenting in such threads to prefix their commentary with "IAD" or "IANAD" (I am a medical doctor or I am not a medical doctor) but without such "qualifications" people like me (not a doctor) are left with little to go by.
    - tom_mellior 6y ago
      https://en.m.wikipedia.org/wiki/Coronavirus_disease_2019 https://en.m.wikipedia.org/wiki/Coronavirus_disease_2019: "Common symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste.[6][7][13] While the majority of cases result in mild symptoms, some progress to acute respiratory distress syndrome (ARDS) likely precipitated by a cytokine storm,[14] multi-organ failure, septic shock, and blood clots."
      - nickthemagicman 6y ago
        Severe acute RESPIRATORY syndrome. It's literally in the name of the disease in the first line of the link you posted. You owe me an apology for lying to support your false narrative. I have a degree in molecular biology. There are hundreds of coronaviruses and every single one of them is a respiratory illness. Not going to defend the fact that an infintesimal fraction of people can have side effects. That happens in every disease with every medication. It doesn't change the fact that this is a respiratory illness. You should try science sometime and get your facts straight instead of promoting false information. People like you who will lie and distort narratives so not to be seen as wrong are hurting the world. You should be ashamed of yourself for your arrogance and your ignorance.
        tom_mellior 6y ago
        You said to check Wikipedia. I checked Wikipedia. Where did I lie?
        nickthemagicman 6y ago
        You purposefully misrepresented your argument by ignoring information that would prove you wrong. One piece of information for example is THE NAME OF THE DISEASE STATING THAT ITS A RESPIRATORY ILLNESS. You do you. Believe what you want to believe. Science will carry on despite your immense ignorance.
        tom_mellior 6y ago
- tom_mellior 6y ago
  Serious question: What motivation do you have for believing this, or at least for claiming to believe it?
robbiep 6y ago
When we keep patients ‘dry’ in ICU we aim to keep their urine output at a level that indicates safe glomerular filtration rates. ACE2 is expressed extensively in renal tissue, so the virus is transported there in the blood, infects cells, hijacks the cellular apparatus to replicate, and then explodes to cell to continue its march of death. So I think your speculation is a bit misplaced
- phyzome 6y ago
  Ah, thanks!
actualdc1 6y ago
As someone who has been treating COVID patients since early April, my working theory has been that many if not most of the secondary disease processes (non-respiratory effects of the virus), and even to some extent the worsening of respiratory function, have been largely driven by micro-thrombotic disease. Delicate capillary beds, like the ones seen in the lungs and kidneys, are highly susceptible to becoming blocked in this sort of setting. When these small vessels get plugged up, end-organ dysfunction necessarily follows. The kidney won't work properly if the blood needing filtration can't reach the nephron (functional unit of the kidney). I'm in large part guessing here based on clinical observation, but my feeling is that you can extend this logic to other syndromes that accompany COVID-19. For example, we often see worsening liver function in the setting of this illness (albeit delayed by a few days). This could be explained in a number of ways, one of which is by impaired perfusion within capillary beds in the liver. Further, there is a myocarditis-like picture we sometimes see as well that could be explained by direct viral infection or again by impaired perfusion of the cardiac muscle by small vessel clotting. When the thrombotic disease progresses, you start to see a more macro version: think strokes and pulmonary emboli in patients who are otherwise low risk at baseline. Thus, there's some interpolation going on here. Hope that makes some sense.
- mirimir 6y ago
  Hey, it's great to see something from a professional !!! A dear friend is dying of pancreatic cancer. And one of the key reasons that she's still alive was getting thrombosis under control. Initially with IV heparin, and now with Lovenox. Are those commonly used for COVID patients? Or do they use oral anticoagulants?
  - actualdc1 6y ago
    I'm sorry to hear about your friend. Unfortunately, cancer is one of the big predisposing factors for thromboembolic disease, so I'm glad to hear that controlling this issue has helped her along. Based on our institutional protocol, hospitalized COVID-19 patients receive therapeutic dose Lovenox, Eliquis, or IV heparin.[1] Lovenox is the first line treatment, but is contraindicated in patients with, among others things, severely impaired renal function. If these patients are able to tolerate oral medications, they can be given Eliquis. If not, they’re typically put on IV heparin drips (and are subject to the uncomfortable and burdensome blood draws that come with them). Typically, all of these patients are discharged on two weeks of Eliquis if there are no major contraindications. The thinking is that the risk of damage to the body by microthrombi doesn’t necessarily end just because the patient is stable enough to go home. Of course, with all of these medications, preventing clotting has to be balanced with preventing bleeding. We’ve had to stay vigilant for things like GI bleeds and hemorrhagic strokes, as these things become more common when everyone in the hospital is being heavily anticoagulated. [1] Therapeutic dosing in this case is higher than typical prophylactic dosing. In the case of Lovenox, it would be something like 40 mg twice a day for the therapeutic dose versus 40 mg once a day for the prophylactic dose, which is what would be used in non-COVID-19 patients to prevent thromboembolism.

nickthemagicman 6y ago

Yes something is off here. Corona is totally respiratory virus.

JoeAltmaier 6y ago
That seems untrue. Corona attacks almost every organ.
- nickthemagicman 6y ago
  You should totally check out Wikipedia or some factual scientific source instead of listening to the news. Science is a candle in the dark.
  - JoeAltmaier 6y ago
    I gotta think this is a bot or troll response? So obviously wrong and argumentative.
    - nickthemagicman 6y ago
      I'm not wrong you should open up your mind to the fact that you're wrong. There's hundreds of coronavirus and they're all respiratory viruses. Arrogant ignorance is no way to go through life son.
      - DanBC 6y ago
        > There's hundreds of coronavirus and they're all respiratory viruses. How many coronaviruses can infect humans?
        nickthemagicman 6y ago
        That's what Google is for. Take some initiative and educate yourself and stop being so arrogant and ignorant.
        DanBC 6y ago
        There are seven coronaviruses that infect humans. 229E, NL63, OC43, HKU1, MERS-CoV, SARS-CoV, and SARS-CoV-2. You said "hundreds". What did you mean when you said hundreds?
        Supermancho 6y ago
        When talking about viruses, it's a little more complicated than a label. Viruses naturally differentiate in a measurable way from host to host as part of their function (hijacking the host's cells). Scientifically, viruses are lumped into common behavior and generic similarities. Many individual variations do not propagate enough to be noticed, but some do. There was quite a bit of talk from some people about the 112 strains of coronavirus, which was not constructive, but technically correct (re: https://www.medicalnewstoday.com/articles/is-there-more-than-one-strain-of-the-new-coronavirus#Why-are-mutations-significant https://www.medicalnewstoday.com/articles/is-there-more-than...? etc) awhile back.
        nickthemagicman 6y ago
        I've been rate limited by the site until now. Of the 7 strains of Coronavirus that you just listed..which of those cause respiratory illness?
        DanBC 6y ago
        They're all respiratory illnesses, but that doesn't mean the only affect the lungs. MERS caused kidney failure in some patients.
      - JoeAltmaier 6y ago
        https://www.webmd.com/lung/news/20200423/the-great-invader-how-covid-attacks-every-organ https://www.webmd.com/lung/news/20200423/the-great-invader-h... There you go, 'son'. So, still obviously wrong and argumentative. Is this even a real account? Or just an insult-bot?
        nickthemagicman 6y ago
        Wellbutrin can cause erections that last for hours but it's not called an erectile dysfunction drug.... Just like coronavirus is a respiratory illness not some multi organ pathogenic illness like Ebola. The fact that a tiny infantesimal fraction of people can have side-effects doesn't change the fact that it's a RESPIRATORY illness. It's depressing that I have to explain statistics to people on hacker news. Are you a troll bot or just a dumb bot? The fact that people with your arrogance and your ignorance exist actually distresses me.
        castis 6y ago
        > The fact that people with your arrogance and your ignorance exist actually distresses me. Weird, your account says you joined in 2012 but it seems like today might be your first day on the internet?
        nickthemagicman 6y ago
        You're right I should have known there are a lot of arrogant dumb people around. Being on hacker news just threw me off because I expected more.
    - ak39 6y ago
      It's very frustrating to read strong views without the views being substantiated. I know it's unrealistic to ask everyone commenting in such threads to prefix their commentary with "IAD" or "IANAD" (I am a medical doctor or I am not a medical doctor) but without such "qualifications" people like me (not a doctor) are left with little to go by.
  - tom_mellior 6y ago
    https://en.m.wikipedia.org/wiki/Coronavirus_disease_2019 https://en.m.wikipedia.org/wiki/Coronavirus_disease_2019: "Common symptoms include fever, cough, fatigue, shortness of breath, and loss of smell and taste.[6][7][13] While the majority of cases result in mild symptoms, some progress to acute respiratory distress syndrome (ARDS) likely precipitated by a cytokine storm,[14] multi-organ failure, septic shock, and blood clots."
    - nickthemagicman 6y ago
      Severe acute RESPIRATORY syndrome. It's literally in the name of the disease in the first line of the link you posted. You owe me an apology for lying to support your false narrative. I have a degree in molecular biology. There are hundreds of coronaviruses and every single one of them is a respiratory illness. Not going to defend the fact that an infintesimal fraction of people can have side effects. That happens in every disease with every medication. It doesn't change the fact that this is a respiratory illness. You should try science sometime and get your facts straight instead of promoting false information. People like you who will lie and distort narratives so not to be seen as wrong are hurting the world. You should be ashamed of yourself for your arrogance and your ignorance.
      - tom_mellior 6y ago
        You said to check Wikipedia. I checked Wikipedia. Where did I lie?
        nickthemagicman 6y ago
        You purposefully misrepresented your argument by ignoring information that would prove you wrong. One piece of information for example is THE NAME OF THE DISEASE STATING THAT ITS A RESPIRATORY ILLNESS. You do you. Believe what you want to believe. Science will carry on despite your immense ignorance.
        tom_mellior 6y ago
tom_mellior 6y ago
Serious question: What motivation do you have for believing this, or at least for claiming to believe it?

robbiep 6y ago

When we keep patients ‘dry’ in ICU we aim to keep their urine output at a level that indicates safe glomerular filtration rates. ACE2 is expressed extensively in renal tissue, so the virus is transported there in the blood, infects cells, hijacks the cellular apparatus to replicate, and then explodes to cell to continue its march of death. So I think your speculation is a bit misplaced

phyzome 6y ago
Ah, thanks!

actualdc1 6y ago

As someone who has been treating COVID patients since early April, my working theory has been that many if not most of the secondary disease processes (non-respiratory effects of the virus), and even to some extent the worsening of respiratory function, have been largely driven by micro-thrombotic disease. Delicate capillary beds, like the ones seen in the lungs and kidneys, are highly susceptible to becoming blocked in this sort of setting. When these small vessels get plugged up, end-organ dysfunction necessarily follows. The kidney won't work properly if the blood needing filtration can't reach the nephron (functional unit of the kidney). I'm in large part guessing here based on clinical observation, but my feeling is that you can extend this logic to other syndromes that accompany COVID-19. For example, we often see worsening liver function in the setting of this illness (albeit delayed by a few days). This could be explained in a number of ways, one of which is by impaired perfusion within capillary beds in the liver. Further, there is a myocarditis-like picture we sometimes see as well that could be explained by direct viral infection or again by impaired perfusion of the cardiac muscle by small vessel clotting. When the thrombotic disease progresses, you start to see a more macro version: think strokes and pulmonary emboli in patients who are otherwise low risk at baseline. Thus, there's some interpolation going on here. Hope that makes some sense.

mirimir 6y ago
Hey, it's great to see something from a professional !!! A dear friend is dying of pancreatic cancer. And one of the key reasons that she's still alive was getting thrombosis under control. Initially with IV heparin, and now with Lovenox. Are those commonly used for COVID patients? Or do they use oral anticoagulants?
- actualdc1 6y ago
  I'm sorry to hear about your friend. Unfortunately, cancer is one of the big predisposing factors for thromboembolic disease, so I'm glad to hear that controlling this issue has helped her along. Based on our institutional protocol, hospitalized COVID-19 patients receive therapeutic dose Lovenox, Eliquis, or IV heparin.[1] Lovenox is the first line treatment, but is contraindicated in patients with, among others things, severely impaired renal function. If these patients are able to tolerate oral medications, they can be given Eliquis. If not, they’re typically put on IV heparin drips (and are subject to the uncomfortable and burdensome blood draws that come with them). Typically, all of these patients are discharged on two weeks of Eliquis if there are no major contraindications. The thinking is that the risk of damage to the body by microthrombi doesn’t necessarily end just because the patient is stable enough to go home. Of course, with all of these medications, preventing clotting has to be balanced with preventing bleeding. We’ve had to stay vigilant for things like GI bleeds and hemorrhagic strokes, as these things become more common when everyone in the hospital is being heavily anticoagulated. [1] Therapeutic dosing in this case is higher than typical prophylactic dosing. In the case of Lovenox, it would be something like 40 mg twice a day for the therapeutic dose versus 40 mg once a day for the prophylactic dose, which is what would be used in non-COVID-19 patients to prevent thromboembolism.