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I had a patient who was admitted for diarrhea - 3 weeks, every day 3-4 times/day. He came to the hospital because his daughter was worried that he looked gray and weak.  Turns out, he was really dehydrated.  So much so that his kidneys became temporally injured (acute on chronic kidney disease) and he was found to be hyperkalemic.  We took care of the hyperkalemia, but what about his diarrhea?  Ironically, his diarrhea disappeared while in hospital, just resolved entirely!  We did the whole workup - fecal cultures, leukocytes, fat, ova and parasites, stool osmolality, celiac disease workup.  It all came back negative.  This patient stayed in the hospital for 4 days.  4 days!  His hyperkalemia we corrected on the first day.  His diarrhea was resolved the minute he landed in the hospital.   In the U.S., we have such luxury.  If we'd been in another country, this guy would have been sent home after day 1, as he wasn't acute ill after his hyperkalemia was corrected.  There's nothing that would have been different had he gotten this diarrhea workup as an outpatient.

Another patient we saw was in her late 80s, who we discovered had a Cr over 7 (baseline in the 1s).  Acute kidney injury and we're starting dialysis on Monday.  Our attending mentioned that in any other country, i.e. Australia, that these individuals would not have the option of dialysis.  In Australia, apparently, individuals over age 65 are not eligible for dialysis.  Is our aggressive approach to care appropriate?  I can't help but think - this is what makes our health care so expensive!  Yet if I were these patients, I'd want the Mercedes Benz workup too!