China
Africa
Explore chapters and articles related to this topic
Ventricular Assistance for Postcardiotomy Cardiogenic Shock
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
Particular attention should be directed toward fluid balance. The systemic inflammatory response associated with CPB creates a capillary leak syndrome that is manifest by interstitial edema. It is imperative that fluid intake be minimized while output is maximized. To achieve this goal all intravenous infusions are maximally concentrated. No maintenance intravenous fluids are provided. A forced diuresis is accomplished with a continuous furosemide infusion (10 mg/100 ml normal saline, titrate intravenous infusion rate to achieve a urine output 100–200 ml greater than input each hour). Bolus furosemide administration leads to a precipitous fall in cardiac filling pressures and a reduction in VAD flow. Continuous furosemide infusion, on the other hand, allows a steady ongoing diuresis without the attendant fall in filling pressures. Accurate intake and output records are maintained. Output should always exceed input during the first 24–48 hours. Diuresis continues until the patient’s weight falls below its baseline level or the patient develops significant prerenal azotemia.
Controlled Clinical Trials — Necessity and Progress
Published in James L. MacPherson, Duke O. Kasprisin, Therapeutic Hemapheresis, 2019
All patients entered in the study undergo a kidney biopsy which is studied by light microscopy, electron microscopy, immunofluorescence, and special stains. Initially, in both groups forced diuresis is employed followed by chemotherapy. The criteria for inclusion include unequivocal diagnosis of multiple myeloma with at least one of the following ancillary diagnostic laboratory criteria, monoclonal protein in the serum, monoclonal protein in the urine or radiologic evidence of osteolytic lesion. In addition, the patients must have oliguria or anuria with a rising plasma creatinine of >0.2 mg/dℓ/day or a creatinine of 3.0 mg/dℓ and progressive decrease in the urinary volume to <0.4 ℓ/day. Alternatively, patients with creatinine of >10.0 mg/dℓ regardless of the urinary volume or a progressive fall in the glomerular filtration rate (GFR) of >15% if the GFR is between 10 m£/min and 30 mℓ/min or greater than 2 mℓ/min if the GFR is below 10 m£/min. Hyperuricemia is treated with allopurinol and hypercalcemia with large doses of prednisone.
Urinary Excretion
Published in John G. Wagner, Pharmacokinetics for the Pharmaceutical Scientist, 2018
Passive reabsorption depends upon: (1) the degree of ionization and the lipophilicity of the drug; (2) the urine flow rate; and (3) the pH of the luminal fluid in the renal tubule. Forced diuresis hastens the renal elimination of drugs and shortens the time required to detoxify patients overdosed with certain drugs. Renal clearances of small molecules, such as ethanol, barbiturates, and theophylline, are flow-dependent as a result of convective reabsorption, but the phenomenon is not important for molecules with molecular weights greater than about 200. Basic drugs are renally eliminated faster under acidic urinary conditions because the drugs are more ionized; basic drugs are renally eliminated slower under basic urinary conditions because the concentration of unionized molecules is greater and these are back-extracted to a greater degree than ions. Acidic drugs are renally excreted faster under basic urinary conditions since the drugs are more ionized and less back-extracted; acidic drugs are renally excreted slower under acidic urinary conditions since the concentration of unionized molecules is greater and these are back-extracted to a greater degree. In therapeutics, ammonium chloride and ascorbic acid are used to acidify the urine and sodium bicarbonate is used to alkalinize the urine.
Severe hypercalcaemia and acute renal failure in an infant with subcutaneous fat necrosis
Published in Paediatrics and International Child Health, 2021
Tülay İnce Becerir, Ayça Altincik, Bayram Özhan, Selçuk Yüksel
Severe hypercalcaemia is a life-threating emergency [10,19]. First-line therapy includes hyperhydration with 0.9% sodium chloride and forced diuresis with furosemide. Bisphosphonates act by inhibiting the activity of osteoclasts and are therefore the treatment of first choice when there is resistance to first-line treatment and the hypercalcaemia is severe (>3.5 mmol/L) [20]. Two-to-four doses of pamidronate 0.25–0.5 mg/kg have been found to be effective [10,12,19]. In the present case, three doses (0.25 mg/kg) of pamidronate were administered on consecutive days. Serum calcium levels normalised on Day 7 of hospitalisation; however, the hypophosphataemia and hypomagnesaemia were also detected at the same time. Transient electrolyte disturbances, mainly hypophosphataemia owing to increased urinary excretion, have been reported after administration of pamidronate [21,22]. Tubular phosphate re-absorption was 82% in this case, which suggested increased urinary excretion.
Minimizing and managing treatment-associated complications in patients with chronic lymphocytic leukemia
Published in Expert Review of Hematology, 2020
Elżbieta Iskierka-Jażdżewska, Tadeusz Robak
In CLL patients initiating therapy with venetoclax, laboratory test results should be assessed every six to eight hours, and at 24 hours following each first new dose level [114]. Adequate hydration to elicit excretion of phosphate and uric acid is critical in the prevention of TLS. Intravenous fluids are intended for patients at high risk of TLS and should be considered for some patients at medium risk. In hyperkalemia, forced diuresis is rarely recommended because it may be harmful. Careful administration of furosemide may be considered in patients with a low urine output and to prevent severe fluid overload in patients receiving aggressive intravenous hydration [105,115,116]. In mild hyperphosphatemia, phosphate binders and urate control can be effective; however, patients with severe hyperphosphatemia may require dialysis. To avoid the risk of nephropathy due to calcium phosphate deposition, treatment of asymptomatic hypocalcemia is generally not recommended [107,115,117]. Patients at risk of TLS should receive oral hypouricaemic agents, including allopurinol or febuxostat. Current studies indicate that in patients at intermediate to high risk of TLS, febuxostat is more effective than allopurinol [118]. For patients with any high-risk feature (e.g. bulky disease requiring immediate therapy) in whom allopurinol is ineffective or adequate hydration is not possible, or in patients with acute renal failure, the National Comprehensive Cancer Network (NCCN) recommends the application of rasburicase at a single dose of 0.15–0.2 mg/kg, with a second dose the following day if the uric acid level does not return to within normal range [109,119]. Before the use of rasburicase, patients should be tested for glucose-6-phosphate dehydrogenase deficiency, because this disorder may lead to hemolysis and methaemoglobinaemia.
Management of BK-virus infection – Swedish recommendations
Published in Infectious Diseases, 2019
Tina Dalianis, Britt-Marie Eriksson, Marie Felldin, Vanda Friman, Anna-Lena Hammarin, Maria Herthelius, Per Ljungman, Johan Mölne, Lars Wennberg, Lisa Swartling
The treatment is primarily symptomatic with forced diuresis and analgesics. In severe cases, irrigation of the urinary bladder is performed. Upon extended bleeding and anaemia, erythrocyte and thrombocyte transfusions are given. Surgery can be necessary upon obstruction of the urinary tract (recommendation grade B). Depending on the risk for graft versus host disease (GVHD), the immunosuppression of each patient should be individualized.