L64 Flashcards
(33 cards)
AEIOU mnemonic for indications for renal replacement therapy
Acidosis (metabolic) HyperK refractory to treat Intox - alc + drug intox Overload - diuretics not working Uremia
What is azotemia vs uremia?
Azo = ↑BUN Uremia = accum or uremic toxins, how renal failure presents clinically
Symptoms of uremia: what does the pt come in complaining about
Metallic taste
N/V
Confusion
Pruritis (itching)
Signs of uremia: what do you find on {E
THINK ↑NH4 Asterixis Myoclonic jerk Seizures Pericardial friction rub Uremic frost: NH4 in sweat, covers skin
2 goals of dialysis
Remove 1. solutes (via diffusion) and/or 2. volume (via convection)
What is hemodialysis
Get large venous access - run blood through machine with diffusion membranes
Can do @ hospital or home
What settings make more efficient dialysis?
- Membrane type
- BF rate
- Duration of dialysis treatment
- High flux membrane = bigger pores
- High flow rate = better clearance
- Longer treatment
How is the effectiveness of a dialysis treatment measured?
Det by urea removal
Is dialysis solution usually ↑ or ↓ [electrolytes]?
↓ so create a [ ] gradient for excess in blood to flow out
What are the 3 access options hemodialysis?
AV fistula: connect AV to ↑size vein due to arterial pressure
AV graft: use basilic vein if veins are bad
Dialysis catheter: under skin into jugular vein
Which hemodialysis access option do you prefer?
Fistula - least complications, but takes a while to est
Biggest complication of dialysis catheters
Infection -> bactermia -> metastatic infection
- Coag neg Staph
- SA
- GNs
Common acute complications of dialysis
↓BP // headache
N/V
Muscle cramps
Chest pain
Rare acute complications of dialysis
Allergic rxn to filter
Dialysis disequilibrium syndrome - after 1st treatment, cerebral swelling b/c osmotic shifts after you took out volume too fast
Chronic complications of dialysis - which is most likely to cause mortality
Anemia (no EPO from kidney)
Renal osteodystrophy (↓active vit D)
CV disease = #1 cause mortality
Explain peritoneal dialysis
Peritoneum = filter
Osmotic agent in fluid = glucose (for fluid removal)
+ ↓ [fluid] - stays in abdomen so some period time
Remove and replace consistently
Difference between continuous vs automated peritoneal dialysis
Continuous = long dwell at night Automated = long dwell during day
Pros vs cons peritoneal dialysis
Pros: flexible, might help preserve remaining kidney fxn b/c no drastic vol changes
Cons: fluid 24/7, peritonitis
Why dont you want peritoneal dialysis pts to get constipated?
Transbowel bacteria migration
↑risk peritonitis
What is continuous renal replacement therapy? Which pts?
Slow, continuous dialysis
For unstable ICU pts - has better hemodynamic stability
What is continuous veno-venous hemodialysis?
Hemodialysis but slower
What is continuous veno-venous hemofiltration?
Remove excess fluid
Replace with fluid w/ bicarb to dilute BUN/Cr
What is continuous veno-venous hemo-diafiltration?
Both hemodialysis + fluid removal/replacement
Pros vs cons chronic renal replacement therapy?
Pros: more hemodynamic stability, good clearanceover time
Cons: can’t use for intox or hyperK (too slow), not great for electrolyte disorders, freq clotting
