[Verse 1] Creatinine climbing, the nephrons slow their trade GFR below sixty, a CKD cascade Dialysis timing — potassium seals the fate Hyperkalemia at five-five, don't hesitate Renally-cleared medications need a dose reduction Morphine metabolites accumulate — neurotoxic intrusion Hold the NSAIDs, watch the contrast load The failing kidney writes its own strict code [Chorus] Rein it in, les reins qui souffrent — watch the potassium Child-Pugh, MELD score — le foie dit "attention" Coagulopathy bleeds through every hesitation Sang et sel, blood and salt — organ constellation Check the levels, check the function, feel the pulsation C'est l'équilibre fragile — critical foundation [Verse 2] Cirrhotic patient, ascites pooling low Child-Pugh adds the bilirubin, albumin, INR in tow Encephalopathy staged from one to four MELD predicts mortality — the higher, the less in store Hepatorenal syndrome, the kidneys starve in sympathy Pseudo-cholinesterase drops — succinylcholine lasts lavishly Highly protein-bound drugs lose their anchor in the plasma Avoid hepatotoxins — don't compound the miasma [Chorus] Rein it in, les reins qui souffrent — watch the potassium Child-Pugh, MELD score — le foie dit "attention" Coagulopathy bleeds through every hesitation Sang et sel, blood and salt — organ constellation Check the levels, check the function, feel the pulsation C'est l'équilibre fragile — critical foundation [Verse 3] Anemia — optimize the iron before the knife Patient blood management, transfusion sparing life Sickle cell demands hydration, warmth, and oxygen pressure Vasoocclusive spiral — no cold, no tourniquet measure Thalassemia shifts the curve of hemoglobin affinity Factor eight for hemophilia A, nine for B's infinity Von Willebrand — DDAVP releases what's withheld Thrombocytopenia — count below fifty, the surgeon felled [Bridge] Antiphospholipid — the clot that masquerades as lupus kin Warfarin bridges, heparin holds, then taper back again DOAC half-lives — rivaroxaban out in twenty-four Neuraxial block demands a window, nothing less, nothing more VTE prophylaxis — sequential compression while you wait Pharmacologic anticoagulation calibrates the rate Phospholipid antibodies — sanguinolent, a word for blood-soaked fate Meaning: saturated, drenched in the hemorrhagic state [Chorus] Rein it in, les reins qui souffrent — watch the potassium Child-Pugh, MELD score — le foie dit "attention" Coagulopathy bleeds through every hesitation Sang et sel, blood and salt — organ constellation Check the levels, check the function, feel the pulsation C'est l'équilibre fragile — critical foundation [Outro] Miasma — a rare word carried through the hepatic haze Meaning: toxic vapors, corruption of the organ's days Sanguinolent and miasma — wear them in your clinical gaze Renal, hepatic, hematologic — balance through the maze
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