Download A Practical Manual of Renal Medicine: Nephrology, Dialysis by Kar Neng Lai PDF

By Kar Neng Lai

This guide offers sensible and available info on all features of common nephrology, dialysis, and transplantation. It outlines present remedies in easy language to aid readers comprehend the remedy motive, and doesn't imagine wide wisdom of anatomy, biochemistry, or pathophysiology. such as 33 chapters written by way of 31 specialists from 4 continents, this quantity covers the entire useful advice within the emergency and long term administration of sufferers with electrolyte disturbance, acid-base disturbance, acute renal failure, universal glomerular ailments, high blood pressure, pregnancy-related renal issues, persistent renal failure, and renal alternative treatment. it's therefore a necessary resource of quickly reference for nephrologists, internists, renal fellows, and renal nursing experts, and is additionally compatible for graduate scholars and study scientists within the box of kidney ailments.

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Extra info for A Practical Manual of Renal Medicine: Nephrology, Dialysis and Transplantation

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In cases where acetazolamide is ineffective or contraindicated, one can administer isotonic hydrochloric acid, preferably buffered in amino acid or fat emulsion via a large central vein. If the alkalosis is due to excessive gastric acid losses, then gastric H+ secretion should be blocked with either a proton pump inhibitor or a H2 blocker. Finally, hemodialysis, peritoneal dialysis, hemofiltration, or hemodiafiltration using chloride-rich and bicarbonate-poor or bicarbonate precursor-poor dialysate or replacement solutions can be effective in the treatment of metabolic alkalosis in patients with compromised renal function.

Hemodialysis patients on conventional thrice-weekly dialysis with a dialysate [HCO3−] of 35 mmol/L are usually slightly acidotic, with an average predialysis serum [HCO3−] of 22 mmol/L. Raising dialysate [HCO3−] to 40 mmol/L normalizes predialysis serum [HCO3−] in the majority of patients. However, patients who consume a high protein diet may not normalize even with this higher dialysate [HCO3−]; under such circumstances, oral sodium bicarbonate therapy may be necessary. Another factor contributing to the acidosis is a large interdialytic fluid gain, which dilutes the total amount of HCO3− in the body, thus lowering the serum [HCO3−].

In such cases, measurement of the urinary osmolal gap will be helpful. 5 Urinary Osmolal Gap (UOG) UOG is useful in estimating urinary NH4+ excretion if UAG− is 0 or positive and there is a high suspicion of an increased excretion of urinary unmeasured anions. UOG (mmol/kg) = measured Uosm − calculated Uosm = measured Uosm – {2 × [Na mmol/L] + 2 × [K mmol/L] + [urea nitrogen, mg/L]/28 + [glucose, mg/L]/180}, where Uosm is the urine osmolality. If the urine dipstick is negative for glucose, one can ignore urine glucose for the osmolality calculation.

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