The Washington Manual of Medical Therapeutics, 37th Edition

Title Page

The Washington Manual® of Medical Therapeutics, 37th Edition. Copyright © 2023 Department of Medicine, Washington University School of Medicine. All rights reserved.

Unbound™ mobile platform © 2000-2023 Unbound Medicine, Inc. All rights reserved.

Editors

Siri Ancha, MD
Christine Auberle, MD
Devin Cash, MD, PhD
Mohit Harsh, MD
John Hickman, MD
Carole Kounga, MD, PharmD

Dedication

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

Siri: To my family Dr. Sudhakar Ancha, Rani, Suma, and Jack; to my mentors Dr. Osama Altayar and Dr. Jeff Crippin.

Christine: To my family Dr. Jacob Beck, Melissa and Jake Studer, Maryanne Tsivitse, and Dr. Jim Auberle; to my mentor Dr. Amanda Cashen.

Devin: To my family Sherrie, Tim, Derek, Therese, Josephine, and Daphne Cash; to my mentors Dr. Cynthia Cornelissen, Dr. Stephanie Call, Dr. Patrick Aguilar, and Dr. Nickole Forget.

Mohit: To my parents and brother. To all of my mentors: Dr. Gerome Escota, Dr. Reza Manesh, Dr. Bob Centor, and Dr. James Jensen. To my academic partners Dr. Lucas Bracero, Dr. Keegan Mullins, and Dr. Eamonn Maher. To my MUSOM family and my college squad. To all of my patients who teach and humble me.

John: To Alex, Joanna, and Elliot; Zachariah and Frank; Dr. Janet and Dr. Robert Hickman; Allison; Dr. Steve Bus; and Dr. Peggie Findlay.

Carole: To the Tabouta family, Dr. Kounga, Drs. Djoko, Papa Maurice, Maman Rebecca, Anne, Melaine, Maggie, Laure, Valery, and my teammate Armand. To my friends, especially Dr. Briana McLaughlin. To my mentors Dr. Battle, Dr. Maynard, Dr. D. Brown, Dr. A. Brown, Dr. Bauch, Dr. Faddis, and Dr. Lenihan.

To the Department of General Medicine Staff: Dr. Ann Ahrens, Jen Bogovich, Julie Byington, Jenae Davis, Megan Dietrich, Amy Foyil, Kirsten Jones, Bethany Millar, Rachel Noon, and Katie Sidler.

Preface

We have the privilege and honor to introduce the 37th edition of The Washington Manual® of Medical Therapeutics. The Manual began as a simple assortment of “Therapeutic Notes” collected by a senior resident, Wayland MacFarlane, in 1943 at the Washington University School of Medicine in St. Louis. That collection of notes has become 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 4000 copies of the 16th edition by Robert Packman, MD, making it available to numerous medical schools across the United States for the first time. The subsequent edition grew to 25,000 copies sold. The Manual has since expanded to incorporate the broad depth of medical knowledge in its increasing complexity. The Manual has sold more than 1 million electronic and print copies worldwide and has been translated into more than 20 languages. Despite the growth of The Manual, the initial mission remains steadfast: to provide relevant, evidence-based clinical support to physicians at the bedside and to positively impact patient care.

With the advent of the COVID-19 pandemic, the editors appreciate the speed at which medical knowledge can advance through interprofessional and global collaboration. This edition of The Manual was compiled through the efforts of generations of physicians and learners who sought to contribute to that growing knowledge.

This edition is foremost a tribute to the Washington University in St. Louis Internal Medicine housestaff, 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 Ciesielski, the executive editor, 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 the Washington University School of Medicine in St. Louis, and our accomplishments would not have been possible without our larger departmental team. We would like to acknowledge the support and collaboration we have experienced from our Associate Program Directors, Drs. Thomas Ciesielski, Geoffrey Cislo, Anthony Dao, Amber Deptola, Michael DeVita, Patricia Kao, Mary Clare McGregor, Jennifer Schmidt, and Megan Wren. Our Program Director, Dr. Dominique Cosco, has provided us with guidance and immense support during the course of this year. The Chair of the Department of Medicine, Dr. Victoria Fraser, has served as an excellent role model and mentor and holds our sincere admiration.

Department Chair’s Note

Medicine and health care delivery continue to evolve based on the significant advances in biomedical science, improvements in patient safety and quality, and diversity of health care settings. It has become more important than ever for physicians to have rapid access to new evidence to guide clinical practice. Tremendous advances in science have led to new molecular diagnostics, more sensitive biomarkers, and novel therapies that improve patient outcomes. The Washington Manual® of Medical Therapeutics provides an excellent source of information focused on practical clinical approaches to the diagnosis, investigation, and treatment of common medical conditions regularly encountered by internists. The online and in-print versions 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 of medical information and efficient approaches to transfer new knowledge into evidenced-based patient care.

I am very grateful to 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: Drs. Siri Ancha, Christine Auberle, Devin Cash, Mohit Harsh, John Hickman, and Carole Kounga, and Executive Editor Thomas M. Ciesielski, who have produced another outstanding edition of The Washington Manual® of Medical Therapeutics. I also thank Dr. Dominique Cosco for her leadership of our residency training program. 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
Chair, Department of Medicine
Washington University School of Medicine
St. Louis, Missouri

Contributors

Samantha E. Adamson, MD, PhD
Fellow
Division of Endocrinology

Siri Ancha, MD
Instructor in Medicine
Division of General Medicine

Lolwa Al-Obaid, MD
Fellow
Division of Gastroenterology

Crystal Atwood, MD
Assistant Professor of Medicine
Division of Hospital Medicine

Kevin Baumgartner, MD
Assistant Professor of Medicine
Department of Emergency Medicine

Amanda Cashen, MD
Professor of Medicine
Divisions of Hematology and Oncology

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

Miguel A. Chavez, MD, MSc
Instructor in Medicine
Division of Hospital Medicine

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

Steven Cheng, MD
Professor of Medicine
Division of Nephrology

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

Joseph N. Cherabie, MD, MSc
Instructor in Medicine
Division of Infectious Diseases

William E. Clutter, MD
Associate Professor of Medicine
Division of Endocrinology, Metabolism, and Lipid Research

Daniel H. Cooper, MD
Associate Professor
Cardiovascular Division

Zachary D. Crees, MD
Fellow
Divisions of Hematology and Oncology

Jeffrey Crippen, MD
Professor of Medicine
Division of Gastroenterology

Siddhartha Devarakonda, MD
Assistant Professor of Medicine
Division of Medical Oncology

Jason Devgun, MD
Assistant Professor of Emergency Medicine
Department of Emergency Medicine

Katherine Dittman, DO
Fellow
Division of Pulmonary and Critical Care Medicine

Lauren East, MD
Resident
Department of Internal Medicine

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

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

James A. Giles, MD
Fellow
Division of Neurology

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

Seth Goldberg, MD
Associate Professor of Medicine
Division of Nephrology

Ramaswamy Govindan, MD
Professor of Medicine
Division of Medical Oncology

Martin H. Gregory, MD
Fellow
Division of Gastroenterology

Rodrigo Vazquez Guillamet, MD
Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine

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

Laura Halverson, MD
Assistant Professor of Medicine
Division of Pulmonary and Critical Care Medicine

Katrina Han, MD
Fellow
Division of Endocrinology, Metabolism, and Lipid Research

Justin C. Hartupee, MD
Assistant Professor of Medicine
Cardiovascular Division

Cynthia J. Herrick, MD, MPHS
Associate Professor of Medicine
Division of Endocrinology, Metabolism, and Lipid Research

SueLin Hilbert, MD, MPH
Associate Professor of Emergency Medicine
Department of Emergency Medicine

Wut Yi Hninn, MD, MBBS
Fellow
Transplant Nephrology

Daniel T. Ilges, PharmD, BCIDP
Pharmacy Resident
Division of Infectious Diseases

Eric Johnson, MD
Assistant Professor of Medicine
Division of Hospital Medicine

Kai Jones, MD
Resident
Department of Internal Medicine

Paul Kannarkat, MD
Instructor in Medicine
Division of Pulmonary and Critical Care Medicine

Phillip M. King, MD
Fellow
Cardiovascular Division

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, MSCI
Assistant Professor
Division of Pulmonary and Critical Care Medicine

Mark D. Levine, MD
Associate Professor of Emergency Medicine
Department of Emergency Medicine

Stephen Y. Liang, MD, MPHS
Associate Professor of Medicine
Division of Infectious Diseases

Michael Lin, MD
Associate Professor
Division of Hospital Medicine

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

Carlos Mejia-Chew, MD
Assistant Professor of Medicine
Division of Infectious Diseases

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

Daniel Morgensztern, MD
Professor of Medicine
Division of Medical Oncology

Nathaniel Moulton, MD
Fellow
Division of Pulmonary and Critical Care Medicine

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

Blessing Osondu, MD
Fellow
Division of Pulmonary and Critical Care Medicine

Bindiya G. Patel, MD
Fellow
Division of Medical Oncology

Mary E. Petrulis, MD
Clinical Fellow
Division of Neurology

Rachel M. Presti, MD, PhD
Associate Professor of Medicine
Division of Infectious Diseases

Nishath Quader, MD
Associate Professor of Medicine
Cardiovascular Division

Andrea Ramirez Gomez, MD
Fellow
Division of Rheumatology

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

Sana Saif Ur Rehman, MD
Assistant Professor
Division of Hematology

Hilary E. L. Reno, MD, PhD
Associate 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, PharmD
Clinical Pharmacist Specialist
Infectious Diseases
Barnes-Jewish Hospital

Rebecca Roediger, MD
Fellow
Division of Gastroenterology

David B. Rose, MD
Fellow
Division of Pulmonary and Critical Care Medicine

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

Maryam Saleem, MD
Fellow
Division of Nephrology

Kristen M. Sanfilippo, MD
Assistant Professor of Medicine
Division of Hematology

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

Evan S. Schwarz, MD
Associate Professor of Medicine
Department of Emergency Medicine

Gabriel Schroeder, MD
Fellow
Division of Pulmonary and Critical Care Medicine

Deepali Sen, MD
Associate Professor of Medicine
Division of Rheumatology

Parth Shah, MD
Fellow
Division of Gastroenterology

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

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

Sandeep S. Sodhi, MD, MBA
Assistant Professor of Medicine
Cardiovascular Division

Kaharu Sumino, MD
Associate Professor of Medicine
Division of Pulmonary and Critical Care Medicine

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

Dayne Voelker, MD
Fellow
Division of Allergy and Immunology

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

Dominique S. Williams, MD
Assistant Professor of Medicine
Cardiovascular Division

Noah N. Williford, MD
Fellow
Cardiovascular Division

Bin Q. Yang, MD
Fellow
Cardiovascular Division

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

Ray Zhang, MD, PhD
Assistant Professor of Medicine
Department of Pathology & Immunology
Division of Laboratory & Genomic Medicine

Amy Zhou, MD
Assistant Professor of Medicine
Division of Medical Oncology

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