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Clinical (Management ((1) correcting fluid and electrolyte…
Clinical
Management
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Metabolic acidosis is usually not treated until serum bicarbonate concentration is less than 15 mEq/L
Fluid and electrolyte replacement must be carefully calculated
Diagnosis
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fractional excretion of sodium
(the ratio of filtered sodium to excreted sodium)
1.renal tubular reabsorption
2.sodium in urinary x creatinine in plasma / sodium in plasma x creatinine in urinary
Cystatin C
1.serum protein constantly produced by nucleated cells
2.freely filtered by the glomerulus
3.its concentration can serve as a measure of GFR and may be useful for detecting early changes in glomerular filtration rate
教案上的治療
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Glucose water
加glucose是怕insulin會造成低血糖, 所以如果患者有高血糖的現像, 就不用glucose溶液
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腎衰竭患者
高血鉀
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補充：緊急洗腎適應症AEIOU
Acidosis：嚴重酸血症(pH<7.1)，且不適合給sodium bicarbonate者
Electrolyte：對於藥物反應不佳的高血鉀
Intoxication：部分藥物和毒素可以經由透析除去
Overload：給予利尿劑後，仍無法控制的體液過多
Uremia：出現尿毒症狀
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高血鉀原因
1.細胞內鉀離子外移
代謝性酸中毒，高滲透壓狀態、胰島素缺乏(糖尿病病患)
使用 β-blocker、digoxin中毒(你沒看錯!)
大量細胞壞死(腫瘤溶解、橫紋肌溶解)
去極化神經肌肉阻斷劑(Succinylcholine 插管用，院內品項：Relaxin 能弛聖 500mg/vial)
Cyclosporine
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4.醛固酮(Aldosterone)分泌減少或作用被阻斷
病患腎功能正常，但排出 K減少，導致高血鉀
分泌減少原因為原發性腎上腺病變、使用 ACEI & ARB、Heparin、Ketoconazole等
抑制醛固酮作用，如使用Spironolactone、Baktar(Sulfamethoxazole+Trimethoprim)
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