Renal Flashcards
(9 cards)
Antibiotics for dialysis-associated peritonitis
IP cefazolin 15mg/kg
IP gentamicin 0.6mg/kg max 50mg
Added to single dialysate bag daily
REPLACE cef with IP vanc 30mg/kg max 2g if MRSA suspected
Added to bag every 3-7 days
Indications for urgent dialysis in event of missed sessions
- Refractory hyperkalaemia
- Uraemic encephalopathy
- Volume overload
- Refractory acidosis
- Uraemic pericarditis
Treatment of HyperK - drugs, MOA and estimated time of onset
Salbutamol - Acts on b-receptors to stimulate K+ retuptake - minutes
Insulin - Facilitates increased uptake of K+ into cells - 15-60mins
NaHCO3 - Alkalosis shifts K directly into cells through action of H+-K+ channels - minutes
Calcium - Stabilises cardiac membrane, protecting against hyperkalaemic effects - seconds-minutes
Urea:creatinine ratio interpretation
> 100:1 - pre-renal
40-100:1 - normal or post-renal
<40:1 - intrinsic renal damage
Differential for high urea:creatinine ratio
Drivers Can use GPS
Dehydration/prerenal failure
Corticosteroids
GI haemorrhage
Protein-rich diet
Severe catabolic state
Differential for low urea:creatinine ratio
I am a SIMPLE SR
Severe liver dysfunction
Intrinsic renal damage
Malnutrition
Pregnancy
Low protein diet
SIADH
Rhabdomyolysis
Peritoneal-dialysis associated peritonitis: specific history and exam findings
- Abdo pain gradual onset and constant
- Cloudy dialysate bags
- Generalised ternderness with signs of peritonism; absence of focal peritonitis
Diagnostic criteria for peritoneal dialysis-associated peritonitis
- Cloudy dialysate and 2 or more of:
- Abdo pain
- Fever
- Nausea
- Vomiting
- Diarrohea - PD fluid with WCC >100 or which >=50% are PMNs (neutrophils)
- Positive gram stain or culture
Peritoneal dialysis-associated peritonitis: common organisms
Staph epi
Staph aureus
Enterobacteria
Pseudomonas
Fungi (uncommon)
