SACCM 180: Extracorporeal Therapies for Blood Purification Flashcards
what product is used for regional citrate anticoagulation?
acid citrate dextrose solution A (ACD-A)
What two electrolyte disturbances are common in extracorporeal therapy?
hypocalcemia (from citrate)
hypophosphatemia - due to diffusion from low or no phosphate in dialysate solutions
What are the clinical signs of hypocalcemia?
What are the clinical signs of hypophosphatemia?
- wide-spread cellular dysfunction
- hemolysis
- secondary infections from immunosuppression
- hemorrhage from thrombocytopenia and pathia
- arrhythmias from myocardial dysfunction
- skeletal muscle signs: weakness, tremors, muscle pain, rhabdomyolysis
- neurologic signs: ataxia, seizures, coma
- gastrointestinal: anorexia, nausea, functional ileus, vomiting, diarrhea
How does hemodialysis remove toxins and what toxin properties make it suitable for hemodialysis as removal strategy?
- by diffusion
- small molecular weight (<500-1000 Da)
- water-soluble (i.e., not highly protein-bound, i.e., < 80%)
How does hemofiltration remove toxins and what toxin properties make it suitable for hemofiltration as removal strategy?
- via convection - solvent drag
- molecular size 1000-10,000 Da and low protein binding (<80%)
How does hemoperfusion remove toxins and what toxin properties make it suitable for hemoperfusion as removal strategy?
- via perfusion of blood across a charcoal or absorbent polymer cartridge
- molecular size > 10,000
- higher protein-binding (80-95%)
What is the name of the force binding toxins in hemoperfusion?
Van der Waals forces
What is combined with hemoperfusion and why?
always combined with hemodialysis
the absorbent may indiscriminently bind other substances (e.g., glucose, calcium, white blood cells, platelets)
after passing absorbent –> flows accross a dialyzer and is exposed to dialyzate to amerliorate some of those losses
what toxin properties make it suitable for TPE as removal strategy?
Proteinn binding >95% or very large molecules (>50,000 Da)
