tailieunhanh - Access: Acid-Base, Fluids, and Electrolytes - part 9

Điều trị răng miệng natri giải pháp phosphate nên được sử dụng thận trọng ở những người độ tuổi trên 55, những người có nhu động đường tiêu hóa giảm, bệnh nhân giảm GFR, và trong sự hiện diện của sự suy giảm khối lượng rối loạn chức năng thận thường không thể đảo ngược | DISORDERS OF SERUM PHOSPHORUS 385 TABLE 10-13 Continued Treatment Oral sodium phosphate solution should be used with caution in those above age 55 those with decreased gastrointestinal motility patients with decreased GFR and in the presence of volume depletion Renal dysfunction is often irreversible Vitamin D intoxication High dose liposomal amphotericin phosphatidylcholine phosphatidylserine Solvent detergent treated fresh frozen plasma Contained improper amounts of dihydrogen phosphate used as a buffer in the purification process Abbreviations ECF extracellular fluid GFR glomerular filtration rate 386 DISORDERS OF SERUM PHOSPHORUS TABLE 10-14 Signs and Symptoms Signs and symptoms of hyperphosphatemia are primarily the result of hypocalcemia see previous chapter Pathophysiology of hypocalcemia induced by hyperphosphatemia The most common explanation offered for hypocalcemia is that the calcium phosphorus product exceeds a certain level and Ca2 deposits in soft tissues and serum Ca2 concentration falls Calcium phosphorus product of 72 mg dL is commonly believed to result in metastatic calcification Short-term infusions of phosphorus increase bone Ca2 deposition and reduce bone resorption Hypocalcemia can also result from decreased calcitriol concentration from suppression of 1-a-hydroxylase by increased serum phosphorus these effects may be more important than physicochemical precipitation The hypothesis that hypocalcemia results from soft tissue deposition is inconsistent with the observation in experimental animals that serum Ca2 concentration continues to decline for up to 5 days after phosphorus infusions are discontinued and long beyond the time period when serum phosphorus concentration normalizes FIGURE 10-2 An Algorithm for the Approach to the Patient with Hyperphosphatemia. The cause is generally acute kidney injury or chronic kidney disease. Unexplained persistent hyperphosphatemia should raise the suspicion of pseudohyperphosphatemia the most common .