Core IM | Internal Medicine Podcast

Throwback: Should you really fluid-restrict every patient with SIADH? When can IV fluids make hyponatremia better or worse? Are salt tabs actually doing enough? And what can urine studies tell you before you start treatment? Join us for a practical, physiology-driven approach to hyponatremia management, from fluids and solutes to loop diuretics and identifying the underlying cause. 

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🔹Transcript and Shownotes

6:46 | Pearl 1: Key Principles
15:13 | Pearl 2: Fluids in hyponatremia
26: 03 | Pearl 3: Solutes in hyponatremia management
35:49 | Pearl 4: Lasix in hyponatremia management
40:05 | Pearl 5: Etiologies

Tags: CoreIM, Internal Medicine, Medical Education, SIADH, Fluid Restriction, Nephrology, Hospital Medicine, Urine Osmolality

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Why can lower-dose combinations be more effective and better tolerated than maximizing one medication? How to troubleshoot common challenges such as amlodipine edema, gout, electrolyte abnormalities, and the patient who says they cannot tolerate anything? Why ACT (ARBs, Calcium Channel Blockers, Thiazides) is the preferred first-line framework, and how to personalize medication choices based on comorbidities and side effects.

🔹Sponsor: Oakstone CME
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🔹Transcript and Shownotes

03:00 | Diagnosing Hypertension 
04:10 | When to Start Combination Therapy Instead of Monotherapy 
07:00 | Choosing First-Line Therapy Using the ACT Framework 
13:23 | Why ARBs Are Often Preferred Over ACE Inhibitors 
16:02 | Choosing the Right ARB: Candesartan vs Losartan 
18:39 | Comparing Potency & Duration Across First-Line Antihypertensives 
20:54 | Amlodipine Edema: Why It Happens and How to Fix It 
23:54 | Thiazides: Practical Tips, Electrolyte Problems & Class-Killer Side Effects 
29:33 | Managing Patients Who 'Can't Tolerate' Blood Pressure Medications 

Tags: Hypertension Management, High Blood Pressure, Primary Care, Internal Medicine, Core IM

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Learn from primary care docs what has been practiced and changed from the 2026 ACC/AHA Lipid Guidelines! Learn how the new CPR framework (Calculate, Personalize, Reclassify) and PREVENT risk calculator change statin decisions, why LDL targets are back, and when to use Lp(a), ApoB, and coronary artery calcium (CAC) testing. Discover updated risk-enhancing factors, expanded indications for non-statin therapies, and practical strategies to personalize lipid management for both primary and secondary

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🔹Transcript and Shownotes:  
01:17 | Highlight #1 & #2: CPR and PREVENT Score
03:14 | Highlight #3: Updated ASCVD Risk Categories Using the PREVENT Score
05:30 | Highlight #4: LDL Targets Are Back
07:20 | Highlight #5: High-Risk Conditions That Bypass the PREVENT Score
08:41 | Highlight #6: Lp(a) Screening for Everyone
11:51 | Highlight #7: When to Use ApoB Testing
13:16 | Highlight #8: Reproductive Risk Factors
15:29 | Highlight #9: Using CAC to Guide Statin Therapy
19:09 | Highlight #10: Non-Statin Therapies

Tags: CoreIM, Internal Medicine, Medical Education, Cholesterol, Statins, LDL, ASCVD, Preventive Cardiology, LpA, ApoB, CAC, ACC2026, Cardiology, PrimaryCare 

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MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?
In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.
Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.
This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.

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🔹Transcript and Shownotes:  
01:57 | Understanding MASLD as a Systemic Disease 
05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease 
08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan) 
16:15 | Lifestyle Treatment & Weight Loss Targets 
19:00 | ESSENCE Trial: Semaglutide for MASH 
21:58 | MAESTRO-NASH Trial: Resmetirom 
27:27 | Future Treatments for MASH 
30:51 | Key Takeaways for Clinicians 

Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver Fibrosis

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What blood pressure should we target in patients on hemodialysis? Why volume control remains the foundation of treatment? How blood pressure targets differ from the general population. Learn practical pearls on medication timing around dialysis, drug dialyzability, antihypertensive selection, and strategies to prevent intradialytic complications while optimizing long-term outcomes. 

🔹Sponsor: Search “Amazon Pharmacy Nationwide Home Delivery" in your EHR to get home delivery (often same-day). Learn more here. 

🔹Transcript and Shownotes:  
02: 19 | Pearl 1: Blood Pressure Targets 
09: 40 | Pearl 2: Timing Medications and Dialyzability 
15: 31 | Pearl 3 - Pharmacologic Management Nuances in Dialysis Patients 
22: 57 | Putting It All Together: The Medication Hierarchy 

Tags: CoreIM, Internal Medicine, Medical Education, Nephrology, ESRD, End-Stage Kidney Disease, Hypertension, Kidney Health, Dry Weight, Volume Overload

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