By Carlos Rotellar
A quick, transparent, sensible, and funny method of acute renal insufficiency.
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Additional info for Acute Renal Insufficiency Made Ridiculously Simple (MedMaster Series, 2005 Edition)
Kayexalate can be administered with or without 30% sorbitol. 41 o NUT~CI~~ &AHIINAS.. ·· CITRUS Figure 42 Control of hyperkalemia includes: diet and Kayexalate . Hypocalcemia occurs as a consequence of decreased production of 1,25 (OH) 2 vitamin D 3 and skeletal re sistance to parathyroid hormone. Both hyp erphosphatemia and hypermagnesemia are the result of decreased urinary excretion in the presence of persistent dietary intake. Oral c alci um salts (calcium carbonate, c alcium citrate or calcium acetate) and aluminum salts can be given to co n tro l the hyperphosphat emia.
Aggressive calcium replacement in the hypocalcemic phase in this setting can lead to severe hypercalcemia in the recovery phase . Indications for Acute Dialysis BUN > 100 mg/dl and/or severe uremic symptoms K + > 7 mEq/1 Fluid overload (pulmonary edema) Severe acidosis (Fig. ~\ I ! -~~ AClDOS/S Figure 43 Indications for dialysis . Usual Complications of Hemodialysis Hypotension Bleeding Arrhythmias Disequilibrium syndrome. Usually occurs at the end of the first and second dialysis. The symptoms includes headache, muscle twitching, nausea, vomiting, somnolence, confusion, coma and seizures.
Decrease of both oral phosphate and magnesium should be prescribed. In rhabdomyol ysis , both sev e re hyperphosphatemia and hyperkalemia can occur due to the releas e of phosphate and potassium from the damaged muscle. In the rhabdomyolysis recovery phase , hypercalcemia can occur as a result of calcium mobilization (previously deposited in the damaged muscle) , decrease of serum phosphate due to increase of urinary phosphate and increase of calcitriol. Aggressive calcium replacement in the hypocalcemic phase in this setting can lead to severe hypercalcemia in the recovery phase .
Acute Renal Insufficiency Made Ridiculously Simple (MedMaster Series, 2005 Edition) by Carlos Rotellar