RULE I: THE LASIX DOSING AXIOM
"Initial IV Lasix Dose = Patient's Age + BUN (mg/dL). If the attending winces or whispers 'let's be conservative,' double the dose immediately and administer 5-10 mg of metolazone exactly 30 minutes prior to break the distal tubule's will to live."
RULE II: THE CARDIOLOGY DIURESIS PARADOX
"Cardiology will stop diuretics the moment serum creatinine twitches upward by 0.1 mg/dL, thereby declaring the kidneys have catastrophically failed, while the patient drowns in 14 liters of biventricular pulmonary edema. Congested kidneys are suffocated kidneys: give the loop diuretic."
RULE III: THE EMERGENCY DEPARTMENT REFLEX
"To the Emergency Department, every sodium under 135 mEq/L is hypovolemic hyponatremia requiring two wide-bore liters of 0.9% Normal Saline. Under no circumstances shall urine electrolytes or osmolality be checked before the bag is hung."
RULE IV: THE CTICU ACIDOSIS THEOREM
"If the pH drops below 7.20 or serum lactate tops 2.0, the CTICU will demand emergent CRRT, even if the patient's urine output is 250 mL/hr and the underlying problem is septic vasodilatory shock. They will then fail to tell Nephrology for 72 hours."
RULE V: THE ATN TIMELINE FALLACY
"No consult placed at 03:15 AM has ever sped up the biological regeneration of proximal tubular brush border epithelium. Established ATN is histological damage; there is no stat IV fluid, dopamine drip, or prayer in Epic that can replace the passage of 7 to 14 solar days."