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Renal and Electrolytes
Published in Kristen Davies, Shadaba Ahmed, Core Conditions for Medical and Surgical Finals, 2020
Dialysis describes the use of a semipermeable membrane that acts as a filter with a solution to regulate the fluid and electrolytes in the blood. There are three main forms: Haemodialysis: Uses an AV fistula (between radial artery and cephalic vein) with blood flowing from one side of a semipermeable membrane with dialysis solution flowing in the opposite direction. Requires multiple treatments per week. Complications include hypotension, infection, thrombosis (from AV fistula) and dialysis disequilibrium syndrome (cerebral oedema).Haemofiltration: Blood flows through a machine through a semipermeable membrane but no dialysis solution is used. Positive hydrostatic pressure pushes fluid across. Complications are similar to haemodialysis but haemofiltration causes less hypotension.Peritoneal dialysis: Uses the peritoneum as the semipermeable membrane with access gained via a Tenchkoff catheter through the anterior abdominal wall. Cheaper than haemodialysis/haemofiltration and more flexible for patients. Complications include peritonitis (most commonly due to Staphylococcus epidermidis). Contraindications include peritoneal adhesions, abdominal hernias and colostomy.
Anesthesia for Patients with Ventricular Assist Devices
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Patients supported with an LVAD may require inotropes prior to coming off CPB (Table 8.2). Systemic vasodilation may be a problem in this situation if the left atrial pressure is normal and systemic blood pressure low. Administration of moderate doses of norepinephrine bitartrate (0.05–0.1 μg/kg IV) may be necessary and on occasion more than one inotrope may be needed. If right ventricular dysfunction is present, but not severe enough to require an RVAD, administration of amrinone lactate or doubtamine hydrochloride may improve right ventricular function. Bleeding and coagulopathy is a concern after LVAD placement. Packed red blood cells (PRBC), fresh frozen plasma (FFP) and platelets are often necessary. Hemofiltration may be used after the patient has been weaned from CPB. Hemofiltration decreases third space fluid accumulation and reduces the potential for pulmonary and other complications related to interstitial edema. Reversal of heparin sodium is performed once hemodynamic stability is achieved after CPB has been discontinued. A test dose of protamine sulfate is administered and if no reaction occurs the full dose of protamine sulfate is slowly given.
Contrast enhancement agents and radiopharmaceuticals
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
There is action that can be taken to minimise the risks of CIN to the patient: Use of a small volume of low-osmolar or iso-osmolar non-ionic contrast agent.Use of volume repletion (saline/sodium bicarbonate).Review of patient medications and stopping nephrotoxic drugs if necessary.Use of a method of pharmacotherapy.If deemed necessary by a clinician, the patient can be referred for haemofiltration.
Continuous extracorporeal clearance in metformin-associated lactic acidosis and metformin-induced lactic acidosis: a systematic review
Published in Clinical Toxicology, 2022
Matthew S. Correia, B. Zane Horowitz
CKRT/CRRT is not a single modality but may refer to hemofiltration (CVVH), hemodialysis (CVVHD), or hemodiafiltration (CVVHDF). Hemofiltration uses convection to clear solutes as compared to diffusion in hemodialysis. This is a subtly different process whereby solutes travel across a semipermeable membrane via bulk flow along with the solvent (i.e., water within the patient’s blood) rather than down a concentration gradient. The driving force for the bulk flow is hydrostatic pressure – blood is at a higher pressure than the ultrafiltrate (effluent). Net fluid that is eliminated by ultrafiltration may be replaced prior to blood return if absolute fluid removal is not desired. Mechanistically, CVVHD functions similarly to intermittent hemodialysis however at much lower flow rates.
Diagnosis and management of tumor lysis syndrome.
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Isha Puri, Deep Sharma, Krishna S. Gunturu, Andaleeb A. Ahmed
A. Hyperkalemia. It is the most life-threatening electrolyte abnormality due to the risk of fatal cardiac arrhythmias. Continuous telemetryFrequent monitoring of serum potassium (every 4–6 hours)Avoid exogenous potassium intakePotassium lowering agents (Patiromer, & sodium polystyrene sulfonate)Administration of IV Insulin-Glucose, and inhaled beta-agonists (albuterol)IV Calcium administration to prevent cardiac arrythmias.Hemodialysis or hemofiltration.
Spa gene-based molecular typing of nasal methicillin-susceptible staphylococcus aureus from patients and health-care workers in a dialysis center in southeast Iran
Published in Pathogens and Global Health, 2020
Fereshteh Saffari, Ali Radfar, Mohammad Hossein Sobhanipoor, Roya Ahmadrajabi
In this cross-sectional study, within a month (July 2017), non-duplicate nasal swab was collected from anterior nares of both health-care workers and dialysis patients in main Bam dialysis center with 12 health-care workers and 70 permanent patients with 840 cases of dialysis per month. All health-care workers who were full-time workers and dialysis cases were included. Patients receiving acute haemofiltration or those who underwent surgery in the last month were excluded from the study [5]. All participants completed a health questionnaire before sampling. The questionnaire included age, gender, recent hospitalization, recent antibiotic therapy, dialysis duration, and dialysis method (i.e. catheter or intravenous fistula). Furthermore, written consent was obtained from all subjects before the study. Doctors and medical students were also excluded from the study.