Beyond the Abstract: Systematic Online Academic Resource Review #2: Endocrine, Metabolic and Nutritional Disorders

Planning to write the next great FOAM post on hyperkalemia, but not sure what’s already been done? Or maybe a less popular topic, that you hope has minimal coverage? Or are you a resident, medical student, or even a curious attending searching for the latest, best FOAM regarding a specific topic?

If so, then we have great news for these answers are here in the recently published second Systematic Online Academic Resource (SOAR) Topic Review.¹ This series aims to identify and evaluate online education resources by topic. The inaugural entry has already revealed the FOAM landscape related to the renal and genitourinary organ system.² We can now share results for endocrine, metabolic and nutritional disorders.

We developed search terms specific to endocrine, metabolic and nutritional Disorders from the American Board of Emergency Medicine’s Model of the Clinical Practice of Emergency Medicine (MPCEM). We then performed a systematic search of both FOAMSearch as well as each site within the social media index top 50.^3,4 We then assessed the quality of those resources using the revised METRIQ score and designated learner levels for each resource.⁵

The search yielded 36,346 resources, of which 756 met the criteria for quality assessment. Table 1 displays the 121 posts identified as high quality (rMETRIQ ≥ 16). Overall, the most covered subtopic was potassium disorders, representing 15% of all posts. Subtopics that did not have a high-quality resource identified include metabolic alkalosis, respiratory alkalosis, fluid overload, phosphorus metabolism, hyperglycemia, malabsorption, malnutrition and thyroiditis. Table 2 graphically describes the number of high-quality posts by subtopic coverage and recommended target audience. Of note, resources that were better categorized under a different MCPEM category were generally not included. For example, fluid overload content specific to heart failure was not included.

We hope that educators and learners can use this information to find relevant educational resources, and that FOAM content creators can use this information to help identify topics to produce new content.

Subtopic	Name of First Author	Name of Blog Post	Level of Trainee Recommendation
Metabolic Acidosis	Farkas, Josh	PulmCrit: pH-guided fluid resuscitation & BICAR-ICU	Intern, Junior, Senior, Attending
Metabolic Acidosis	Farkas, Josh	Is correcting hyperchloremic acidosis beneficial?	Intern, Junior, Senior, Attending
Metabolic Acidosis	Rusyniak, Dan	Tox & Hound – aka AKA	Intern, Junior, Senior, Attending
Metabolic Acidosis	Multiple	Alcoholic ketoacidosis – WikEM	Clerk, Intern, Junior, Senior
Metabolic Acidosis	Spiegel, Rory	CC Nerd-The Case of the Neutral Documents	Clerk, Intern, Junior, Senior, Attending
Respiratory Acidosis	Chan, Wendy	VBG vs ABG in Hypercarbia	Clerk, Intern, Junior, Senior
Acid Base (Mixed)	Farkas, Josh	Fluid selection using pH-guided resuscitation	Intern, Junior, Senior, Attending
Acid Base (Mixed)	Weingart, Scott	Acid Base in the Critically Ill – Part V – Enough with the Bicarb Already	Intern, Junior, Senior, Attending
Corticoadrenal Insufficiency	Long, Brit	Mimics of Sepsis: What do ED Physicians Need to Know?	Intern, Junior, Senior
Corticoadrenal Insufficiency	Farkas, Josh	Adrenal crisis – EMCrit Project	Intern, Junior, Senior, Attending
Corticoadrenal Insufficiency	Gaillard, Frank	Adrenal hemorrhage \| Radiology Reference Article \| Radiopaedia.org	Intern, Junior, Senior, Attending
Cushing’s Syndrome	Multiple	Cushing syndrome \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Calcium	Long, Brit	Oncologic Emergencies Part I: Pearls and Pitfalls	Intern, Junior, Senior, Attending
Calcium	Swaminathan, Anand	Hypercalcemia	Intern, Junior, Senior, Attending
Calcium	Multiple	Hypocalcemia – WikEM	Intern, Junior, Senior, Attending
Calcium	Taliaferro, Dustin	[email protected]: Hyper- and HypoCa	Intern, Junior, Senior, Attending
Hypovolemia	Astin, Matt	The SPLIT Trial: Saline vs Plasma-Lyte Fluid Therapy	Intern, Junior, Senior, Attending
Hypovolemia	Rezaie, Salim	SMART Trial Part 2: Secondary Analysis of Balanced Crystalloids vs Saline in Sepsis	Clerk, Intern, Junior, Senior
Hypovolemia	Rezaie, Salim	Is the Great Debate Between Balanced vs Unbalanced Crystalloids Finally Over?	Clerk, Intern, Junior, Senior
Hypovolemia	Rezaie, Salim	Does Lactated Ringers (LR) Raise Serum Lactate?	Clerk, Intern, Junior, Senior
Hypovolemia	Farkas, Josh	PulmCrit- Get SMART: Nine reasons to quit using normal saline for …	Intern, Junior, Senior, Attending
Hypovolemia	Farkas, Josh	IBCC chapter & cast – Fluid selection & pH-guided fluid resuscitation	Intern, Junior, Senior, Attending
Hypovolemia	Farkas, Josh	The SPLIT trial: Internal vs. external validity	Intern, Junior, Senior, Attending
Hypovolemia	Rezaie, Salim	Balanced vs Unbalanced Fluids in Pediatric Severe Sepsis	Clerk, Intern, Junior, Senior
Hypovolemia	Multiple	Fluid Choice in Sepsis: Does it matter?	Clerk, Intern, Junior, Senior, Attending
Hypovolemia	Kenny, Jon-Emile	Are balanced crystalloids better than saline? SMART Talk with Dr …	Intern, Junior, Senior, Attending
Hypovolemia	Farkas, Josh	PulmCrit- Overcoming occult diuretic resistance: Achieving diuresis …	Attending
Hypovolemia	Multiple	CT hypoperfusion complex \| Radiology Reference Article …	Clerk, Intern, Junior, Senior, Attending
Hypovolemia	Multiple	Dehydration (peds) – WikEM	Clerk, Intern, Junior, Senior, Attending
Hypovolemia	Rezaie, Salim	The Great Debate Between Balanced and Unbalanced Crystalloids Continues	Junior, Senior, Attending
Hypovolemia	Morgenstern, Justin	IV fluid choice part 1: The SPLIT trial	Clerk, Intern, Junior, Senior, Attending
Hypovolemia	Drenzla, Adam	SALT OF THE EARTH (PART 1)	Clerk, Intern, Junior, Senior
Potassium	Meyers, Pendell	Critical Hyperkalemia by H. Pendell Meyers, EMCrit Intern – EMCrit	Junior, Senior, Attending
Potassium	Farkas, Josh	Hyperkalemia – EMCrit Project	Clerk, Intern, Junior, Senior
Potassium	Farkas, Josh	Management of severe hyperkalemia in the post-Kayexalate era	Intern, Junior, Senior, Attending
Potassium	Swaminathan, Anand	Is Kayexalate Useful in the Treatment of Hyperkalemia in the …	Clerk, Intern, Junior, Senior
Potassium	Singh, Manpreet	Hyperkalemia – The Great Imitator	Clerk, Intern, Junior, Senior
Potassium	Multiple	Tumor Lysis Syndrome – Diagnosis and Treatment	Clerk, Intern, Junior
Potassium	Multiple	Management of the Sick Dialysis/ESRD Patient	clerk, intern, Junior, senior
Potassium	Meyers, Pendell	A young man with back spasms	Intern, Junior, Senior
Potassium	Helman, Anton	Emergency Management of Hyperkalemia \| EM Cases Podcast	Junior, Senior, Attending
Potassium	Long, Brit	Updates in Management of Hyperkalemia	Clerk, Intern, Junior, Senior
Potassium	Weingart, Scott	Treatment of hyperkalemia in the ED	Clerk, Intern, Junior, Senior
Potassium	Farkas, Josh	PulmCrit- BRASH syndrome: Bradycardia, Renal failure, Av blocker …	intern, Junior, senior, attending
Potassium	Farkas, Josh	Myth-busting: Lactated Ringers is safe in hyperkalemia, and is …	Junior, Senior, Attending
Potassium	Multiple	Insulin Dosing in Hyperkalemia	Intern, Junior, Senior, Attending
Potassium	Rezaie, Salim	ECG Changes of Hyperkalemia	Clerk, Intern, Junior, Senior
Potassium	Santistevan, Jamie	emDOCs.net – Emergency Medicine EducationSubtle ECG findings …	Clerk, Intern, Junior, Senior, Attending
Potassium	Morton, A. Ross	Management of Hyperkalemia with ECG Changes	clerk, intern, Junior, senior
Potassium	Awad, Nadia	Thyroid Storm: Treatment Strategies	Intern, Junior, Senior, Attending
Potassium	Grock, Andrew	Bicarbonate: Completely Useless?	Junior, Senior, Attending
Potassium	Hayes, Bryan D	Hyperkalemia Management: Preventing Hypoglycemia From Insulin	Senior, Attending
Sodium	Smarandache, Andrei	When and how to treat hyponatremia in the ED	Intern, Junior, Senior
Sodium	Farkas, Josh	Hypernatremia & dehydration in the ICU – EMCrit Project	Senior, Attending
Sodium	Farkas, Josh	Emergent treatment of hyponatremia or elevated ICP with bicarb …	intern, Junior, senior, attending
Sodium	Farkas, Josh	Taking control of severe hyponatremia with DDAVP	Attending
Sodium	Helman, Anton	Emergency Management of Hyponatremia \| EM Cases	intern, Junior, senior, attending
Sodium	Farkas, Josh	Unconventional therapies for hyponatremia: Thinking outside the …	intern, Junior, senior, attending
Sodium	Farkas, Josh	PulmCrit- Controlled aquaresis: Management of hypervolemic or euvolemic hyponatremia with oral urea	Junior, senior, attending
Magnesium	Morgenstern, Justin	Torsades de Pointes: Approach to resuscitation	intern, Junior, senior
Magnesium	Multiple	Hypermagnesemia – WikEM	Clerk, Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Lodeserto, Frank	Pediatric DKA: Do Fluids Really Matter? – REBEL EM – Emergency …	Clerk, Intern, Junior, Senior
Diabetic Ketoacidosis	Morgenstern, Justin	IV fluids do not cause cerebral edema in pediatric DKA – First10EM	Clerk, Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Farkas, Josh	Blood gas measurements in DKA: Are we searching for a unicorn?	Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Farkas, Josh	Anatomy of a DKA resuscitation – EMCrit Project	Clerk, Intern, Junior, Senior
Diabetic Ketoacidosis	Hughes, Darrel	Is There Any Benefit to an Initial Insulin Bolus in Diabetic …	Clerk, Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Abela, Nikki	Fluid Type and Infusion Rate in Paediatric DKA	Clerk, Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Multiple	Cerebral edema in DKA – WikEM	Clerk, Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Lubberdink, Ashley	TREKK Series \| Diabetic Ketoacidosis	Clerk, Intern, Junior
Diabetic Ketoacidosis	Farkas, Josh	PulmCrit- Dominating the acidosis in DKA	Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Farkas, Josh	PulmCrit – Four DKA Pearls	Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Multiple	emDOCs.net – Emergency Medicine Education Diabetic …	Clerk, Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Multiple	Diabetic ketoacidosis \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Diabetic Ketoacidosis	Multiple	PEM Pearls: Treatment of Pediatric Diabetic Ketoacidosis and the Two-Bag Method	Junior, Senior, Attending
Diabetic Ketoacidosis	Monette, Derek	PEM Practice Changing Paper: Clinical Trial of Fluid Infusion Rates for Pediatric DKA	Junior, Senior, Attending
Hyperosmolar Hyperglycemic State	Multiple	Hyperosmolar hyperglycemic state – WikEM	Clerk, Intern, Junior, Senior, Attending
Hyperosmolar Hyperglycemic State	Multiple	Hyperosmolar hyperglycemic state \| Radiology Reference Article …	Clerk, Intern, Junior, Senior, Attending
Hyperosmolar Hyperglycemic State	Multiple	Non-ketotic hyperglycaemic seizure \| Radiology Reference Article …	Clerk, Intern, Junior, Senior, Attending
Hypoglycemia	Multiple	Hypoglycemic encephalopathy \| Radiology Reference Article …	Clerk, Intern, Junior, Senior, Attending
Insulin Pump	Multiple	Insulin Pumps: Complications and Emergency Department Presentations	Intern, Junior, Senior, Attending
Insulin Pump	Weingart, Scott	Podcast 198 – Insulin Pumps and Such with Josh Miller, MD	Clerk, Intern, Junior, Senior, Attending
Insulin Pump	Rezaie, Salim	Diabetic Gastroparesis Needs HUGS	Intern, Junior, Senior, Attending
Nutritional Disorders	Multiple	Osteoporosis \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Nutritional Disorders	Long, Brit	Protein Shakes and Dietary Supplements: What are their ingredients and how much is too much?	Senior, Attending
Vitamin Deficiencies	Multiple	Rickets \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Vitamin Deficiencies	Groth, Meghan	Mythbusting the Banana Bag	Intern, Junior, Senior, Attending
Wernicke-Korsakoff	Multiple	Thiamine Deficiency	Intern, Junior, Senior, Attending
Wernicke-Korsakoff	Pescatore, Rick	Should You Prescribe Oral Thiamine for Chronic Alcoholics …	Senior, Attending
Wernicke-Korsakoff	Multiple	Wernicke-Korsakoff syndrome – WikEM	Clerk, Intern, Junior, Senior, Attending
Wernicke-Korsakoff	Multiple	Wernicke encephalopathy \| Radiology Reference Article …	Clerk, Intern, Junior, Senior, Attending
Wernicke-Korsakoff	Swaminathan, Anand	Wernicke’s Encephalopathy Archives – REBEL EM – Emergency …	Junior, Senior, Attending
Parathyroid Disease	Multiple	Parathyroid hormone \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Parathyroid Disease	Multiple	Parathyroid glands \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Parathyroid Disease	Newman, Samantha	PTH versus PTHrP — Small Differences, Big Implications – Clinical …	Intern, Junior, Senior
Pituitary Disorders	Multiple	Sheehan syndrome \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Pituitary Disorders	Multiple	emDOCs.net – Emergency Medicine EducationThunderclap …	Intern, Junior, Senior
Pituitary Disorders	Multiple	Pituitary gland \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Pituitary Disorders	Multiple	Optic pathway glioma \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Pituitary Disorders	Multiple	Pituitary apoplexy \| Radiology Reference Article \| Radiopaedia.org	Intern, Junior, Senior, Attending
Pituitary Disorders	Multiple	Empty sella \| Radiology Reference Article \| Radiopaedia.org	Intern, Junior, Senior, Attending
Pituitary Disorders	Multiple	Elevated prolactin (differential) \| Radiology Reference Article …	Clerk, Intern, Junior, Senior, Attending
Hyperthyroid	Multiple	Thyroid storm – WikEM	Intern, Junior, Senior, Attending
Hyperthyroid	Lipp, Chris	CRACKCast E128 – Thyroid and Adrenal Disorders	Intern, Junior, Senior, Attending
Hyperthyroid	Multiple	Hyperthyroidism – WikEM	Clerk, Intern, Junior, Senior
Hyperthyroid	Multiple	Thyroid Storm and Aortoiliac Occlusive Disease	Intern, Junior, Senior, Attending
Hyperthyroid	Multiple	Bedside Rounds Series: Goiter – Clinical Correlations	Clerk, Intern, Junior, Senior
Hyperthyroid	Lee, Terrance	Diagnosing hyperthyroidism: Answers to 7 common questions	Clerk, Intern, Junior, Senior
Hypothyroid	Fox, Sean	Hypothyroidism and Myxedema Coma — Pediatric EM Morsels	Intern, Junior, Senior, Attending
Hypothyroid	Multiple	Myxedema coma – WikEM	Intern, Junior, Senior, Attending
Hypothyroid	Zhao, Leah	Spot the Diagnosis! The case of the Pale Woman	Intern, Junior, Senior
Tumors Of Endocrine Glands	Multiple	Parathyroid adenoma \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Tumors Of Endocrine Glands	Multiple	Central nervous system germinoma \| Radiology Reference Article …	Intern, Junior, Senior, Attending
Tumors Of Endocrine Glands	Multiple	Craniopharyngioma \| Radiology Reference Article \| Radiopaedia.org	Junior, Senior, Attending
Tumors Of Endocrine Glands	Multiple	Carcinoid tumor \| Radiology Reference Article \| Radiopaedia.org	Intern, Junior, Senior, Attending
Adrenal Tumor	Multiple	Pheochromocytoma \| Radiology Reference Article \| Radiopaedia.org	Intern, Junior, Senior, Attending
Adrenal Tumor	Multiple	Adrenal adenoma \| Radiology Reference Article \| Radiopaedia.org	Intern, Junior, Senior, Attending
Adrenal Tumor	Multiple	Adrenal cortical carcinoma \| Radiology Reference Article …	Intern, Junior, Senior, Attending
Pituitary Tumor	Multiple	Acromegaly \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Pituitary Tumor	Multiple	Pituitary adenoma \| Radiology Reference Article \| Radiopaedia.org	Clerk, Intern, Junior, Senior, Attending
Thyroid Tumor	Multiple	Medullary thyroid carcinoma \| Radiology Reference Article …	Clerk, Intern, Junior, Senior
Thyroid Tumor	Multiple	Anaplastic thyroid carcinoma \| Radiology Reference Article …	Intern, Junior, Senior, Attending

References:

Special thanks to SOAR co-authors Ryan Pedigo, Lisa Zhao, JooYeon Jung, Shirley W Bae, Teresa Chan, and Andrew Grock.

Hsiao, JJ, Pedigo, R, Bae, SW, et al. Systematic online academic resource (SOAR) review: Endocrine, metabolic, and nutritional disorders. AEM Educ Train. 2021; 5:e10716. doi:1002/aet2.10716
Grock A, Bhalerao A, Chan T, Thoma B, Wescott A, Trueger N. Systematic Online Academic Resource (SOAR) Review: Renal and Genitourinary. AEM Educ Train. 2019;3(4):375-386. doi:10.1002/aet2.10351
Raine T, Thoma B, Chan T, Lin M. FOAMSearch.net: A custom search engine for emergency medicine and critical care. Emerg Med Australas. 2015;27(4):363-365. doi:10.1111/1742-6723.12404
Thoma B, Sanders J, Lin M, Paterson Q, Steeg J, Chan T. The social media index: measuring the impact of emergency medicine and critical care websites. West J Emerg Med. 2015;16(2):242-249. doi:10.5811/westjem.2015.1.24860
Colmers-Gray I, Krishnan K, Chan T, et al. The Revised METRIQ Score: A Quality Evaluation Tool for Online Educational Resources. AEM Educ Train. 2019;3(4):387-392. doi:10.1002/aet2.10376

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