The Washington Manual of Medical Therapeutics, 36th Edition

Title Page

The Washington Manual® of Medical Therapeutics, 36th Edition. Copyright © 2020 Department of Medicine, Washington University School of Medicine. Copyright ©2020 Wolters Kluwer. All rights reserved.

Unbound™ mobile platform © 2000-2019 Unbound Medicine, Inc. All rights reserved.

Editors
Dedication
Contributors
Chairman’s Note
Preface
Notices and Disclaimers

Editors

Zachary Crees, MD
Cassandra Fritz, MD
Alonso Heudebert, MD
Jonas Noé, MD
Arvind Rengarajan, MD
Xiaowen Wang, MD

Dedication

We thank our families for their love and support and our mentors for their guidance and patience.

To Kristin, Carter, Chip, Dianne, Sharon, and Serene. To Cynthia, Edward, Eric, Nico, and Maxwell.

To Emily, Papa and Mama Heudebert, Goose, and Jota.

To Susanne, Thomas, and Daniel Noé; Tori Wright; Dr. Marc Weidenbusch; Bernd Gänsbacher; Dr. Mark Pecker; Dr. Micky Rust; Dr. Daniel Goodenberger; and Christine Fuhler.

To Naina, Bhooma, Varadachari, Sapna, Sunil, Anita, Mukul, and Anand.

To Yanzhou Wang, Kefeng Lu, Binghong Han, John Hao Wang, Kefang Lu, Zhizhen Wang, Xilan Zhang, Huaguang Lu, and Yufen Zuo.

Contributors

Patrick R. Aguilar, MD
Assistant Professor of Medicine
Division of Pulmonary and Critical Care

Medicine Danish Ahmad, MD
Instructor in Medicine
Division of Pulmonary and Critical Care

Medicine Saad Alghamdi, MD
Clinical Fellow
Division of Gastroenterology

Adam Anderson, MD
Assistant Professor of Medicine
Division of Pulmonary and Critical Care

Medicine Crystal Atwood, MD
Instructor in Medicine
Division of Hospitalist Medicine

Philip M. Barger, MD
Associate Professor of Medicine
Cardiovascular Division

Morey Blinder, MD
Associate Professor of Medicine
Division of Hematology

Angela L. Brown, MD
Assistant Professor of Medicine
Cardiovascular Division

Robert C. Bucelli, MD, PhD
Associate Professor
Department of Neurology

Amanda Cashen, MD
Associate Professor of Medicine
Bone Marrow Transplant

Mario Castro, MD
Professor of Medicine
Division of Pulmonary and Critical Care Medicine

Murali Chakinala, MD
Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine

Alexander Chen, MD
Assistant Professor of Medicine
Division of Pulmonary and Critical Care

Medicine Steven Cheng, MD
Assistant Professor of Medicine
Division of Nephrology

Praveen Chenna, MD
Assistant Professor of Medicine
Division of Pulmonary and Critical Care Medicine

William E. Clutter, MD
Associate Professor of Medicine
Division of Medical Education

Daniel H. Cooper, MD
Assistant Professor of Medicine
Cardiovascular Division

Daniel W. Coyne, MD
Professor of Medicine
Division of Nephrology

Zachary Crees, MD
Instructor in Medicine
Division of Hospitalist Medicine

Siddhartha Devarakonda, MD
Assistant Professor of Medicine
Division of Hematology and Oncology

Brittany M. Dixon, MD
Clinical Fellow Cardiovascular Division

S. Eliza Dunn, MD
Assistant Professor of Emergency Medicine in Medicine
Division of Emergency Medicine

Mitchell N. Faddis, MD, PhD
Associate Professor of Medicine
Cardiovascular Division

Francesca Ferraro, MD
Instructor in Medicine
Bone Marrow Transplant

Avegail Flores, MD
Assistant Professor of Medicine
Division of Gastroenterology

Nathan L. Frogge, MD
Clinical Fellow
Cardiovascular Division

Yuka Furuya, MD
Fellow
Division of Pulmonary and Critical Care Medicine

Brian F. Gage, MD
Professor of Medicine
Division of General Medical Sciences

James A. Giles, MD
Clinical Fellow
Division of Neurology

Anne C. Goldberg, MD
Associate Professor of Medicine
Division of Endocrinology, Metabolism, and Lipid Research

Seth Goldberg, MD
Assistant Professor of Medicine
Division of Nephrology

Ramaswamy Govindan, MD
Professor of Medicine
Division of Medical Oncology

C. Prakash Gyawali, MD
Professor of Medicine
Division of Gastroenterology

Cynthia J. Herrick, MD
Instructor in Medicine
Division of Endocrinology Metabolism, and Lipid Research

Matthew Hevey, MD
Clinical Fellow
Division of Infectious Diseases

SueLin Hilbert, MD
Assistant Professor of Emergency Medicine in Medicine
Division of Emergency Medicine

Ronald Jackups, MD
Assistant Professor of Pathology and Immunology
Laboratory and Genomic Medicine

Eric Johnson, MD
Instructor in Medicine
Division of Hospital Medicine

Nigar Kirmani, MD
Professor of Medicine
Division of Infectious Diseases

Marin H. Kollef, MD
Professor of Medicine
Division of Pulmonary and Critical Care Medicine

James G. Krings, MD
Clinical Fellow
Division of Pulmonary and Critical Care Medicine

Shane J. LaRue, MD
Instructor in Medicine
Cardiovascular Division

Mark D. Levine, MD
Clinical Fellow
Division of Pulmonary and Critical Care Medicine

Stephen Y. Liang, MD
Instructor in Medicine
Division of Infectious Diseases

Caline Mattar, MD
Assistant Professor of Medicine
Division of Infectious Diseases

Janet B. McGill, MD
Professor of Medicine
Division of Endocrinology, Metabolism, and Lipid Research

Shail Mehta, MD
Postdoctorate Research Associate
Division of Pulmonary and Critical Care Medicine

Carlos Mejia-Chew, MD
Fellow
Division of Infectious Diseases

Jennifer M. Monroy, MD
Assistant Professor of Medicine
Division of Allergy and Immunology

Daniel Morgensztern, MD
Associate Professor of Medicine
Division of Medical Oncology

Michael E. Mullins, MD
Associate Professor of Emergency Medicine
Division of Emergency Medicine

Johnathan Seth Parham, MD
Clinical Fellow
Division of Endocrinology, Metabolism, and Lipid Research

Suchitra Pilli, MD
Instructor in Medicine
Division of Pulmonary and Critical Care Medicine

Rachel Presti, MD
Assistant Professor of Medicine
Division of Infectious Diseases

Farhan Quader, MD
Clinical Fellow
Division of Gastroenterology

Nishath Quader, MD
Assistant Professor of Medicine
Cardiovascular Division

Rungwasse Rattanavich, MD
Fellow
Division of Renal Diseases

Dominic Reeds, MD
Associate Professor of Medicine
Division of Geriatrics and Nutritional Science

Zhen Ren, MD
Clinical Research Associate
Division of Immunology

Hilary E. L. Reno, MD
Assistant Professor of Medicine
Division of Infectious Diseases

Amy E. Riek, MD
Assistant Professor of Medicine
Division of Endocrinology, Metabolism, and Lipid Research

David J. Ritchie, Pharm D
Clinical Pharmacist
Division of Geriatrics and Nutritional Science

Tonya D. Russell, MD
Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine

Sandeep S. Sodhi, MD
Fellow Cardiovascular Division

Kristen M. Sanfilippo, MD
Instructor in Medicine
Division of Hematology

Rowena Delos Santos, MD
Assistant Professor of Medicine
Division of Nephrology

Evan S. Schwarz, MD
Assistant Professor of Emergency Medicine
Division of Emergency Medicine

Deepali Prabir Sen, MD
Assistant Professor of Medicine
Division of Rheumatology

Adrian Shifren, MD
Assistant Professor of Medicine
Division of Pulmonary and Critical Care Medicine

Marc A. Sintek, MD
Assistant Professor of Medicine
Cardiovascular Division

Mark Thoelke, MD
Associate Professor
Division of Hospital Medicine

Niharika Thota, MD
Division of Allergy and Immunology

Justin M. Vader, MD
Assistant Professor of Medicine
Cardiovascular Division

Tzu-Fei Wang, MD
Assistant Professor of Internal Medicine
Division of Hematology
The Ohio State University

Xiaowen Wang, MD
Chief Resident
Division of Medical Education

Miraie Wardi, MD
Clinical Fellow
Division of Nephrology

Dominique S. Williams, MD
Clinical Fellow
Cardiovascular Division

Chad Witt
Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine

Roger D. Yusen, MD, MPH
Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine

Tina Zhu, MD
Resident
Division of Medical Education

R. Mei Zhang, MD
Fellow
Division of Endocrinology, Metabolism, and Lipid Research

Amy Zhou
Fellow
Division of Medical Oncology

Chairman’s Note

Clinical medicine continues to evolve based on the rapid advances in medical research. It has become more important than ever for physicians to commit to lifelong learning and continuing medical education and use new evidence to guide clinical practice. Tremendous advances in science have led to new biomarkers, better diagnostics, and novel therapies that improve patient outcomes. The Washington Manual® of Medical Therapeutics provides an outstanding source of current information focusing on practical clinical approaches to the diagnosis, investigation, and treatment of common medical conditions regularly encountered by internists. The online version and the pocket-book size of the Washington Manual® ensure that it will continue to be of enormous assistance to interns, residents, medical students, and other practitioners. The Washington Manual® provides an important resource to optimize learning and transfer learning into evidenced-based patient care.

I am very appreciative of the authors, who include outstanding house officers, fellows, and attendings at Washington University/Barnes-Jewish Hospital. Their efforts and exceptional skills are evident in the quality of the final product. In particular, I am proud of our editors: Zachary Crees, Cassandra Fritz, Alonso Heudebert, Jonas Noé, Arvind Rengarajan, and Xiaowen Wang, and series editors Drs. Tom De Fer and Thomas Ciesielski, who have worked tirelessly to produce another outstanding edition of the Washington Manual® of Medical Therapeutics. I also thank Dr. Melvin Blanchard, Chief of the Division of Medical Education in the Department of Medicine at Washington University, for his outstanding commitment to our residency training program and his excellent bedside teaching. I am confident that this edition will meet its desired goal of providing practical knowledge that will be directly applied to improving patient care.

Victoria J. Fraser, MD
Adolphus Busch
Professor of Medicine
Chairman, Department of Medicine
Washington University School of Medicine
St. Louis, Missouri

Preface

It is our privilege and honor to introduce the 36th edition of The Washington Manual® of Medical Therapeutics. This edition marks the 75th anniversary of The Manual and gives opportunity for both celebration and reflection.

In drafting the first edition of The Manual in 1943 as a local resource for the Washington University house staff, Wayland MacFarlane likely had little idea he was laying the foundation stone of one of the most successful medical reference manuals in the history of medicine. During the mid-1960s The Manual grew in popularity with the publishing of 4,000 copies of the 16th edition by Robert Packman, MD, making it available to numerous medical schools across in the United States for the first time. The subsequent edition grew to 25,000 sold copies. The Manual has since expanded to incorporate the broad depth of medical knowledge in its increasing complexity. Seventy-five years after Dr. MacFarlane first put pen to paper, The Manual has sold more than 1 million electronic and print copies worldwide and has been translated into over 20 languages, without losing sight of the initial mission of providing relevant, evidence-based clinical support to physicians at the bedside and positively impacting patient care.

This enormous work has been made possible by the tireless efforts of generations of physicians. The well-known quote, “If I have seen a little further, it is by standing on the shoulders of giants” accurately reflects the constant progress of the series, each edition advancing by building on the work of those who have gone before us.

This edition is foremost a tribute to the Washington University medicine house staff, fellows, medical students, and attendings with whom we work daily. Their role modeling, mentoring, compassion, teaching, brilliance, and hard work are an unlimited source of enthusiasm, inspiration, and dedication. We consider ourselves very lucky and grateful to have trained alongside them, in service to our patients.

We have great appreciation for the substantial support and direction that Dr. Thomas De Fer and Dr. Thomas Ciesielski, the series editors, provided in the creation of this edition. We also sincerely thank Katie Sharp and the editorial staff at Wolters Kluwer for their assistance and guidance in this effort.

We have had the distinction of serving as chief residents in the Department of Medicine at Washington University School of Medicine in St. Louis. Our firm chiefs, Drs. Megan Wren, Emily Fondahn, Geoffrey Cislo, Dominique Cosco, Amber Deptola, and Patricia Kao, have been instrumental over the course of the year, serving as mentors and role models. Our program director, Dr. Melvin Blanchard, provided guidance and support in the production of The Manual. Our Chairman of Medicine, Dr. Vicky Fraser, has served as wonderful role model and mentor and holds our sincere admiration.

Zachary Crees, MD
Cassandra Fritz, MD
Alonso Heudebert, MD
Jonas Noé, MD
Arvind Rengarajan, MD
Xiaowen Wang, MD

Notices and Disclaimers

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