ACUTE RENAL FAILURE.pdf

clinpharm

is the sudden, potentially reversible interruption of kidney function, resulting in retention of nitrogenous waste products in body fluids.

Acute renal failure

is administered orally as a tablet or suspension.

Aluminum hydroxide

can be safely given to patients who may have a sulfonamide allergy, which would preclude them from therapy with furosemide or torsemide.

Ethacrynic acid

H Renal biopsy

________ may be performed in selected patients when other test results are inconclusive.

is administered as 10 mL of a 10 % solution (1 g) for 2 to 5 mins.

Calcium gluconate

which has a high potassium content, should not be used because it decreases the effectiveness of the SPS.

Orange juice

is 30 to 50 g in 100 mL of sorbitol as a warm emulsion, administered deep into the sigmoid colon every 6 hrs.

rectal dose

may be given to patients who are unresponsive or allergic to furosemide.

Bumetanide

may also be given to patients unresponsive to or allergic to furosemide.

IV Torsemide

Regular insulin

________ (10 units in 500 mL of 10 % dextrose) is administered intravenously for 60 mins.

causes azotemia and, in 50 % to 60 % of cases, oliguria.

ARF

increases the osmotic pressure of the glomerular filtrate; fluid from interstitial spaces is drawn into blood vessels, expanding plasma volume and maintaining or increasing the urine flow.

Mannitol

is less commonly used to treat ARF because ototoxicity (sometimes irreversible) is associated with its use.

Ethacrynic acid

may be given to reduce fluid volume excess and edema.

Diuretics and dopamine

the leading cause of ARF, may be associated with (1) exposure to nephrotoxic aminoglycosides, anesthetics, pesticides, organic metals, and radiopaque contrast materials.

Acute tubular necrosis

and other nonabsorbable cation- donating laxatives and antacids may decrease the effectiveness of potassium exchange by SPS and may cause systemic alkalosis.

Magnesium hydroxide

may cause increased digitalis toxicity when administered concurrently with digitalis preparations.

Calcium

may be used to treat acute, life- threatening hyperphosphatemia accompanied by acute hypocalcemia.

Dialysis

is a non ionic polymer that binds dietary phosphorus in the GI tract.

Sevelamer (Renagel®)

stems from impaired renal perfusion, which may result from reduced arterial blood volume (e.g., dehydration, hemorrhage, vomiting, diarrhea, other gastrointestinal \[GI\] fluid loss)

Prerenal ARF

be given if the arterial pH is below 7.35. c. Treatment of hyperphosphatemia.

Sodium bicarbonate

Without treatment, may lead to neuromuscular depression and paralysis, impaired cardiac conduction, arrhythmias, respiratory muscle paralysis, cardiac arrest, and ultimately death.

hyperkalemia

may be done with a rubber tube that is taped in place or via a Foley catheter with a balloon inflated distal to the anal sphincter.

Administration

is contraindicated in patients with ventricular fibrillation or renal calculi.

Intravenous (IV) calcium

should be mixed only with water and sorbitol, never with mineral oil.

rectal administration SPS

A rise in urine output or a "diuretic response "may not be seen in

non- oliguric patients.

Administered as an adjunctive treatment for hyperkalemia, ________ reduces potassium levels in the serum and other body fluids.

SPS

inhibit sodium and chloride reabsorption at the loop of Henle, promoting water excretion.

Loop diuretics

offers better bioavailability compared to other loop diuretics; however, it is considerably more expensive.

Torsemide

Signs and symptoms of hyperkalemia, resulting from ___________________ by impaired kidneys, include: (1) neuromuscular depression (e.g., paresthesias, muscle weakness, paralysis) (2) diarrhea and abdominal distention (3) slow or irregular pulse (4) electrocardiographic changes with potential cardiac arrest c. Uremia, caused by excessive nitrogenous waste retention, leads to nausea, vomiting, diarrhea, edema, confusion, fatigue, neuromuscular irritability, and coma.

metabolic acidosis and reduced potassium excretion

reflects Azotemia due to impaired glomerular filtration and concentrating capacity.

Azotemia

typically rises in prerenal ARF due to increased secretion of antidiuretic hormone.

Urine osmolality

may be given by mouth when oral intake is permitted or if the patient has relatively mild hypocalcemia.

Calcium carbonate, chloride, gluconate, or lactate

The ________ helps determine the etiology of ARF.

RFI

IV sodium bicarbonate restores

________ bicarbonate that the renal tubules can not reabsorb from the glomerular filtrate and increases arterial pH.

results from obstruction of urine flow anywhere along the urinary tract including: a. Ureteral obstruction, as from calculi, uric acid crystals, or thrombi b. Bladder obstruction, as from calculi, thrombi, tumors, or infection c. Urethral obstruction, as from strictures, tumors, or prostatic hypertrophy d. Extrinsic obstruction, as from hematoma, inflammatory bowel disease, or accidental surgical ligation C. Pathophysiology.

Postrenal ARF

occurs due to the accumulation of organic acids (metabolic acidosis)

Hyperkalemia

binds excess phosphate in the intestine, thereby reducing phosphate concentration.

Aluminum

and creatinine levels can help classify ARF.

Measurement of urine sodium

provides an index of renal excretory function and body chemistry status.

Blood chemistry

may be given at intervals of 2 to 3 hrs.

third dose A second or

may cause or worsen pulmonary edema and circulatory overload.

IV mannitol

is available in solutions ranging from 5 % to 25 %.

Mannitol

may be given as an emergency measure for severe hyperkalemia or metabolic acidosis.

Sodium bicarbonate

can cause calcium resorption and bone demineralization d. Treatment of hypocalcemia.

Aluminum hydroxide

may double from day- to- day in the initial recovery period.

Urine output

For the treatment of ________ or the prevention of ARF, the usual initial dose is 12.5 to 25.0 g, administered intravenously; the maximum daily dosage is 100 g, administered intravenously.

oliguric ARF

are more potent and faster acting than thiazide diuretics.

Loop diuretics

reduces the serum phosphorus concentration by chelation.

________ reduces the serum phosphorus concentration by chelation.

is distributed throughout the intestines and excreted in the feces.

SPS

Postrenal ARF results from obstruction of urine flow anywhere along the urinary tract including

a. Ureteral obstruction, as from calculi, uric acid crystals, or thrombi b. Bladder obstruction, as from calculi, thrombi, tumors, or infection c. Urethral obstruction, as from strictures, tumors, or prostatic hypertrophy d. Extrinsic obstruction, as from hematoma, inflammatory bowel disease, or accidental surgical ligation C. Pathophysiology

This phase begins when urine output rises above 500 mL/day

typically after several days of oliguria

(1) neuromuscular depression (e.g., paresthesias, muscle weakness, paralysis) (2) diarrhea and abdominal distention (3) slow or irregular pulse (4) electrocardiographic changes with potential cardiac arrest c. Uremia, caused by excessive nitrogenous waste retention, leads to nausea, vomiting, diarrhea, edema, confusion, fatigue, neuromuscular irritability, and coma

Signs and symptoms of hyperkalemia, resulting from metabolic acidosis and reduced potassium excretion by impaired kidneys, include

d. Metabolic acidosis, a common complication of ARF, is evidenced by

(1) deterioration of mental status, obtundation, coma, and lethargy

(3) Manifestations of hypocalcemia include

(a) neuromuscular irritability, cramps, spasms, and tetany

(1) flat jugular venous pulses when the patient lies supine

g. Intravascular volume depletion, suggesting prerenal failure, may cause

h. Other findings suggesting prerenal failure include

(1) an abdominal bruit, possibly indicating renal artery stenosis

i. Postrenal failure caused by obstructed urinary flow may manifest itself in

(1) a suprapubic or flank mass

Findings typical of ARF include

(1) increased blood urea nitrogen (BUN)

(a) urinary tract calculi

(2) Kidney, ureter, or bladder radiography may reveal

(3) Radionuclide scan may reveal

(a) bilateral differences in renal perfusion, suggesting serious renal disease

age) and insensible losses (i.e., skin, respiratory tract) of 500 to 1000 mL/day should be included in fluid balance calculations

Sensible losses (i.e., urine, stool, tube drain

donating laxatives and antacids may decrease the effectiveness of potassium exchange by SPS and may cause systemic alkalosis

Magnesium hydroxide and other nonabsorbable cation

The exact concentration of the solution is determined by

the patients fluid requirements