tailieunhanh - Chapter 046. Sodium and Water (Part 18)

Algorithm depicting clinical approach to hyperkalemia. NSAID, nonsteroidal anti-inflammatory drug; ACE, angiotensin-converting enzyme; RTA, renal tubular acidosis; TTKG, transtubular K+ concentration gradient. The appropriate renal response to hyperkalemia is to excrete at least 200 mmol of K+ daily. In most cases, diminished renal K+ loss is due to impaired K+ secretion, which can be assessed by measuring the transtubular K + concentration gradient (TTKG). | Chapter 046. Sodium and Water Part 18 Algorithm depicting clinical approach to hyperkalemia. NSAID nonsteroidal anti-inflammatory drug ACE angiotensin-converting enzyme RTA renal tubular acidosis TTKG transtubular K concentration gradient. The appropriate renal response to hyperkalemia is to excrete at least 200 mmol of K daily. In most cases diminished renal K loss is due to impaired K secretion which can be assessed by measuring the transtubular K concentration gradient TTKG . A TTKG 10 implies a decreased driving force for K secretion due to either hypoaldosteronism or resistance to the renal effects of mineralocorticoid. This can be determined by evaluating the kaliuretic response to administration of mineralocorticoid . 9a-fludrocortisone . Primary adrenal insufficiency can be differentiated from hyporeninemic hypoaldosteronism by examining the renin-aldosterone axis. Renin and aldosterone levels should be measured in the supine and upright positions following 3 days of Na restriction Na intake 10 mmol d in combination with a loop diuretic to induce mild volume contraction. Aldosterone-resistant hyperkalemia can result from the various causes of impaired distal Na reabsorption or from a Cl- shunt. The former leads to salt wasting ECF volume contraction and high renin and aldosterone levels. In contrast enhanced distal Cl- reabsorption is associated with volume expansion and suppressed renin and aldosterone secretion. As mentioned above hypoaldosteronism seldom causes severe hyperkalemia in the absence of increased dietary K intake renal insufficiency transcellular K shifts or antikaliuretic drugs. Hyperkalemia Treatment The approach to therapy depends on the degree of hyperkalemia as determined by the plasma K concentration associated muscular weakness and changes on the electrocardiogram. Potentially fatal hyperkalemia rarely occurs unless the plasma K concentration exceeds mmol L and is usually associated with profound weakness and absent P waves QRS

• Y học thường thức
• Sodium and Water
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu học ngành y
• Harrisons Internal Medicine
• Modeling of hydrodynamic processes
• Large leak of water into sodium
• The fast reactor coolant circuit
• Mesh characteristic method
• Sodium water reaction
• Interparticle potential of 10 nanometer titanium nanoparticles in liquid sodium
• 10 nanometer titanium nanoparticles in liquid sodium
• Sodiume water reaction
• Van der Waals forces
• bệnhbệnh học và điều trị
• Sodium and Water học và điều trị
• Changing of soil stability in irrigation with reclaimed water
• Soil stability in irrigation with reclaimed water
• Irrigation with reclaimed water
• Sodium Adsorption Ratio
• Scanning Electron Microscopy
• Groundwater quality assessment
• Water quality index
• Soluble Sodium percentage
• Nemerows Pollution Index
• NEA and the IAEA
• Sodium cooled fast reactors
• Pressurized water reactors
• Occupational Exposure program
• Nuclear power plants
• RSC water
• Soil dehydrogenase enzyme
• Nutrient content
• Different residual sodium carbonate waters
• Soil nutrient availability
• Sodium selenite
• Selenium enriched yeast
• Carcass characteristics
• Meat quality
• Water holding capacity(WHC)
• Extract reserve volume
• Thiobarbituric acid