detoxification review

detoxification

• the removal of toxic substances from the human organism to promote homeostasis

attributes

• hepatic

• renalscope

scope

• impaired detoxification leads to waste accumulation

• normal function

kidneys

• remove metabolic waste and other elements from blood in the form of urine

GI tract

• remove digestive waste in the form of stool

nitrogenous waste

• waste compounds that contain nitrogen and are produced as byproducts of metabolism in living organisms a

azotemia

• refers to the elevated levels of nitrogen-containing compounds, such as urea and creatinine, in the blood

uremia

• medical condition that occurs when there is a buildup of waste products, particularly urea and other nitrogenous substances

variations

• detox relies on both the kidneys and the liver to help process and eliminate wastes

• Ammonia → To liver → Converted to Urea → To kidneys for removal

Consequences

• Problems with the liver

  • ammonia accumulates → not converted to urea

• problems with the kidneys

  • urea and creatinine accumulate → not eliminated from the body

• waste products can be toxic to the body in high concentrationslif

infants, toddlers, children

• immature systems

• may see jaundice at birth

• child dosing of medications

• some medications are avoided

older adults

• organ function begins to decline at 40 years

• increased risk of issues with medications → nephrotoxicity and hepatotoxicity

risk factors

• diseases of the liver or the kidneys

  • Cirrhosis, Hepatitis, and CKD

• chronic conditions which can damage the liver / kidneys

  • heart failure and diabetes

  • medications → nephrotoxic / hepatotoxic

  • chronic alcohol use

ammonia signs and symptoms

• easy to cross blood-brain-barrier and cause neuron dysfunction → hepatic encephalopathy

• asterixis, changes in personality, agitation, restlessness, impaired judgement, slurred speech → incoherence, confusion, disorientation

urea / creatinine signs and symptoms

• uremia → nausea, apathy, weakness, fatigue

• can also lead to mental status changes, decline in cell / organ function

• multisystem effects

cirrhosis of liver

• all functions of liver decline

• increased ammonia

other functions of liver

• med breakdown

• metabolism of foods

• production of clotting factors

• storage of vitamin K

• bile secretion

chronic kidney disease

• all functions of the kidney decline

• increased urea / creatinine

other functions of the kidney

• eliminate urine

• balance electrolytes

• balance acid base

laboratory tests

• blood urea nitrogen

• serum creatinine

• creatinine clearance → 24-hour urine

• glomerular filtration rate

• liver function tests (ALT/AST)

other diagnostic tests

• metabolic panel

• CBC

• urinalysis

primary prevention

• decreasing risk of developing chronic condition and lifestyle changes

secondary prevention

• routine lab work for both organs

• metabolic panel and LFTs

collaborative interventions

• treatment strategies depend on the underlying condition, and often involve the multidisciplinary team

• common strategies:

  • nutrition support

  • invasive procedures

  • pharmacotherapy

dialysis

• method to remove waste products from the body

• required in end stage renal disease

• replaces function of the kidney → removes urea and creatinine, remove fluid, balances electrolytes and acid base

• may be used in cirrhosis

  • removes ammonia, typically reserved for hepatic encephalopathy flares

• uses diffusion and osmosis to filter blood

  • by machine → hemodialysis

  • internally → peritoneal dialysis

• can draw out too much fluid → hypovolemia

hemodialysis

• assessment of fistula

• palpate to feel “thrill”

• auscultate to hear the “bruit”

• exam the site visually for signs of infection and bleeding

thrill

• vibration which indicates venous blood flow and patency

bruit

• swishing sound

peritoneal dialysis

• inspect catheter insertion site

• look for signs of inflammation and infection

• inspect drainage → cloudy is abnormal

cirrhosis signs and symptoms

• jaundice

• fatigue

• easily bruising or bleeding

• loss of appetite

• nausea

• weight loss

• swelling in the periphery

• ascites

portal hypertension

• increased pressure within the portal vein, which is the main vein that carries blood from the digestive organs to the liver

varices

• abnormally enlarged and swollen veins that occur when there is increased pressure within the blood vessels

ascites

• accumulation of fluid in the abnormal cavity

kidney function

• regulates fluid volume, acid-base balance, electrolytes

• removal of wastes and urine production

• affects hormones and immune regulation

liver function

• breakdown of toxins, chemicals, medications, hormones

• metabolism of carbs, fats, proteins

• production of clotting factors

• storage of vitamins

• bile secretion