Renal and Hepatic Flashcards
(130 cards)
1
Q
Why is the half life of albumin useful in determining?
A
As the half life is 20-26 days (long), a reduction can indicate long term damage due to extended half life which can’t be decreased immediately
2
Q
What is the prothrombin time?
A
Reference range 10-15 secs
Increase PT when lack of clotting factors
PT depends on factor II,VII and X and will increase if these factors aren’t produced
If hepatocellular damage, liver can’t produce clotting factor as its unresponsive to vit K
If cholestasis increase in PT due to deficiency in bile salts responsible for vit K absorption so responsive to vit K
3
Q
What is the treatment for cholestasis when PT is increased?
A
IV 10mg Vitamin K for 3 days
4
Q
Name drugs and conditions which are Cyp450 inhibitors:
A
Cimetidine, ciprofloxacin, ethromycin, COCs, ketoconazole
CCF, cirrhosis, viral infections
5
Q
Name drugs and conditions which are Cyp450 inducers:
A
Phenytoin, carbamazepine, phenobarbiton, primedonne, rifampicin
Smokers, heavy drinkers
Increase in GGT levels
6
Q
Describe the pharmacodynamics in liver disease:
A
Increase sensitivity to drugs which:
-affect clotting/ bleeding, due to LD decrease clotting factor
-affect CNS, increase risk of hepatic encephalopathy
-diurects
-constipation
6
Q
A
7
Q
How can consitpation cause liver disease complications?
A
Increase risk of hepatic encephalopathy as N waste products in GIT for increased period of time so increased risk of absorption
8
Q
What is the treatment/ management for cirrhosis and end stage liver disease?
A
Low protein diet
Low Na+ and diuretics to minimise water retention
Draining of ascites fluid by paracentesis
Surgery to treat portal hypertension and decrease risk of bleeding
Medicines depending on disease and complications
Transplant
9
Q
What are the lifestyle modifications in liver disease?
A
Lose weight and stop alcohol
10
Q
Describe DTs in acute alcohol withdrawal?
A
DTs develop in 48-96hrs after last drink, results in hallucinations, disorientation, tachycardia, hypertension, hypothermia, agitation and diaphoresis, can be fatal
11
Q
What is the treatment for acute alcohol withdrawal?
A
Symptom control and supportive care
Benzodiazepines
IV fluids
Nutritional supplementation
Frequent clinical assessment
12
Q
Describe the use of benzodiazepines in acute alcohol withdrawal:
A
Control psychomotor agitation and prevent more severity
e.g chlordiazepoxide, oxazepam, decreasing regimen over 9 days
Lowest possible dose given to suppress symptoms without sedation
Seizures- IV lorazepam
Ideally don’t send home with supply as causes respiratory depression and dependence especially with alcohol
13
Q
Describe the treatments for cholestatic pruritis:
A
Cholestryamine- first line:
ion exchange resin, binds to bile salts in the gut stop it being absorbed
Anti-histmaines:
non- sedating to avoid encephalopathy
Calamine lotion/ menthol in aqueous cream
14
Q
What is the treatment for ascites?
A
Diuretics
Bed rest
Na+ and fluid restriction
Paracentesis- physical draining of fluid
Aim for weight loss: 0.5-0.75kg decrease per day (up to 1-1.5kg per day if also peripheral oedema) -therapeutic monitoring
15
Q
What are the diuretic treatments in ascites?
A
1st line= spironolactone as its an aldosterone antagonist
Add on= furosemide (loop) if no weight loss/ peripheral oedema
16
Q
What is the initial treatment for Wernicke-Korsakoff syndrome?
A
IV Pabrinex (IV vit B/C preparations)
Infusion over 30 mins
2 pairs of ampoules TDS for 3-5 days
Need facilities for treating prophylaxis as potential serious allergic reaction
17
Q
What is the additional treatment for Wernicke-Korsakoff syndrome?
A
Oral thiamine for treatment or prophylaxis
100mg TDS (regimen can vary)
Administered at same time as IV and then continue for 3-6 months after abstinence
18
Q
What is the treatment for hepatic encephalopathy?
A
Lactulose
Rifaximin- add on when lactulose not working
Phosphate enemas- when lactulose CI
Avoid precipitating factors
19
Q
Describe the use of lactulose in hepatic encephalopathy:
A
30-50ml TDS
Adjust to aim for 2-3 soft stools a day (therapeutic)
Disaccharide molecule, breaks down to form lactic acetic and formic acid so decreases pH of intestine, from 7 to 5, ionisation of N compounds to decreases absorption, alters intestinal flora (decreases ammonia producing bacteria), speeds up gut transit, less time for N and ammonia to sit in gut and be absorbed into system
20
Q
What are the toxic monitoring parameters of lactose in hepatic encephalopathy?
A
Avoid diarrhoea casing dehydration and hypovolaemia
21
Q
What is the treatment for portal hypertension?
A
Aim to decrease portal BP and resting HR by 25%
Propranolol low dose and increase cautiously as undergoes 1st pass metabolism
Other vasodilators e.g nitrates
22
Q
Describe vasoactive therapy for the treatment of bleeding oesophageal varicies:
A
IV e.g vasopressin, terlipressin, octreotide
Started as soon as haemorrhage is suspected
23
Q
Describe the treatment for prothrombin time:
A
PT is greater than 18seconds
Phytomenadione IV (vit K)- may not work if pt has severe liver disease
Avoid NSAIDs/ warfarin
24
What are the LFT signs of drug induced hepatoxicity?
Many drugs can cause inconsequential rises in LFTs, if up to 2x upper limit then doesn't require medicine
Liver damage has occurred when:
-ALT increased to more than 2x upper limit
-increased conjugated bilirubin more than 2x upper limit
-combined increased ALP and total bilirubin with one more 2x upper limit
25
What is the management for drug induced hepatotoxicity?
Drug withdrawal
Antidote if appropriate
Corticosteroids- evidence controversial, if LFTs still deteriorating 3 weeks after, or if hepatotoxicity remained 6 months after discontinuation
Supportive therapy
Yellow card report- serious report
26
What is the diagnosis for paracetamol toxicity?
Serum paracetamol concentration
27
Name the different treatments for paracetamol overdose:
N acetyl cysteine IV
Methionine oral, both replenish glutathione stores
Activated charcoal of gastric lavage within ONE hour
28
Describe N acetyl cysteine as a treatment for paracetamol overdose:
IV first line
Given during first 8 hours of overodse
Possible effective up to and beyond 24 hours, effectiveness decreases after 12 hours
Dosing depends on plasma paracetamol conc and time after ingestion
A= normal treatment line
B= enhanced risk line, for patients on enzyme inducers, alcoholics, malnourished, HIV
29
What is the Cockcroft and Gault equation:
CrCl (ml/min) = ((140-age) x weight x F*)/ plasma Cr (µmol/L)
F*= 1.23 males
F*= 1.04 females
30
What are the limitations of the Cockcroft and Gault equation?
Assumes average population data
Unsuitable for children and pregnancy
Renal function must be stable (plasma Cr stable)
31
What is the traditionally normal levels of Cr and CrCl?
Cr= 55-125 µmol/L
CrCl= 120 ml/min
32
Name the different stages of renal impairment:
Stage 1(G1)- normal GFR
Stage 2 (G2)- mild impairment
Stage 3A (G3A)- mild to moderate
Stage 3B (G3b)- moderate to severe
Stage 4 (G4)- severe impairment
Stage 5 (G5)- established/ end stage
33
What is the eGFR value for stage 1 renal impairment?
More than 90
34
What is the eGFR value for stage 2 renal impairment?
60-89
35
What is the eGFR value for stage 3A renal impairment?
45-59
36
What is the eGFR value for stage 3B renal impairment?
30-44
37
What is the eGFR value for stage 4 renal impairment?
15-29
38
What is the eGFR value for stage 5 renal impairment?
Less than 15
39
How would you calculate the GFR absolute?
Can use it to individualise someones GFR
= eGFR x (individual BSA/1.73)
40
What is the normal and uraemia range of urea?
More than 15mmol/L= uraemia
Normal 1.7-6.7mmol/L
41
What are the symptoms of uraemia?
N&V
Puritis
42
How would you calculate the albumin: creatinine ratio (ACR):
Divide albumin (mg) by creatinine (g)
43
What is the ACR value showing renal failure in non-diabetics?
More than 70mg/mmol
44
What is the ACR value showing renal failure in diabetics?
More than 2.5mg/mmol in males
More than 3.5mg/mmol in females
Due to increased risk of developing renal disease
45
What is the general classification of CKD?
Decreased GFR and increased ACR
46
Describe excretion of drugs in renal disease:
Less excretion, need to modify doses of drugs which are renally excreted
Lower dose and/or increase dose interval- drug dependent
NO adjustment needed to loading doses
47
Describe the nephrotoxicity of a drug in renal disease:
Ideally not nephrotoxic but in some cases can be essential to use nephrotoxic e.g co-morbidity or long term renoprotective benefit e.g ACEi/ARB
Monitor RF and toxicity
In end stage renal failure- no further renal function damage can occur or decline- so not worried about nephrotoxic drugs but do need to monitor for toxic accumulation levels and side effects from this
48
What should occur in obese or severely underweight patients when calculating CrCl?
Use IBW for obese patients if BMI is over 30
If ABW is smaller than IBW, use ABW
49
What should occur if a patient has got a borderline CrCl?
Need to look at trends of their renal function- if its increasing can possible go for one above
Antibiotics- normally treat with higher dose to treat infection
50
Name types of drugs causing pre-renal failure:
Lactulose overdose
HF
Liver disease
Lisinopril
51
Name types of drugs causing intrinsic renal failure:
Gentamicin
Acute tubular necrosis
Uncontrolled hypertension
52
Name types of drugs causing post-renal failure:
MTX
BPH
Ovarian tumour
53
What are the 3 classifications (reversibility) of renal disease?
AKI (Acute Kidney Injury)- reversible
CKD (Chronic Kidney Disease)- irreversible
ESRF (End Stage Renal Failure)- irreversible
54
Name and describe the 3 potential factors for the diagnosis of AKI:
Serum creatinine rises by ≥26.5µmol/L within 48hrs OR
Serum creatinine rises by ≥1.5 fold from their baseline value, which is known or presumed to have occurred within the last 7 days OR
Urine output is <0.5ml/kg/hr for 6 hrs
55
What are the different stages in AKI?
Stage 1
Stage 2
Stage 3
56
What is the value for stage 1 AKI?
1.5 to 1.9x increase from baseline creatinine
57
What is the value for stage 2 AKI?
2.0 to 2.9x increase from baseline creatinine
58
What is the value for stage 3 AKI?
3.0 or more x increase from baseline creatinine
59
What are the medications that can cause AKI?
Triple whammy:
-ACEi -Diuretics -NSAIDs
Avoid nephrotoxics in those at risk e.g NSAIDs in elderly
Monitor renal function for those taking high risk drugs/ with high risk co-morbidities
Review meds
Educate pt on sick day rules
60
What are the AKI signs and symptoms for volume depletion?
Dehydration signs- initial
Thirst
A lot of fluid loss
Oliguria- loss of fluid
Dry mucosa (clinically dry in mouth/nasal passages)
Reduced skin elasticity
Tachycardia
Hypotension
Decreased JVP
61
What are the AKI signs and symptoms if left untreated?
Volume overload
Increase orthopnoea (SOB lying down) and Paroxysmal Nocturnal Dyspnoea (PND)- pts waking up coughing due to fluid when lying down
Oedema- ankles and lungs
SoA
Pulmonary oedema and crackles
62
Describe the first step in AKI management:
Identify the cause
Urine/ blood tests
Medication history:
-review and hold medication known to exacerbate AKI (ACEi/diuretics)
-adjust doses of other medication to prevent harm (metformin/ DOACs)
Remember, restarting long term medications post AKI is just as important as holding them short term
63
Describe how you would treat volume depletion in the second step of AKI management:
Aggressive, early fluid resuscitation to mimic the nature of fluid loss i.e blood, sodium chloride- to restore perfusion and oxygen delivery
Monitor input and output of fluid
Hypovolaemic- positive fluid balance to hydrate the pt and increase renal perfusion
Dialysis can be used in around 1'/3 of pts to maintain renal function while treating the underlying cause (rapidly rising Cr/urea, severe hyperkalaemia, metabolic acidosis)
64
Name treatments that would be used in the second step in AKI management for fluid overload:
Loop diuretics
Dopamine
65
Describe loop diuretics for fluid overload patients in AKI:
Only if no issue with renal perfusion- caution to avoid dehydration
Diuresis, decrease in tubular cell metabolic demands, increase in renal blood flow
High doses 1-2g IV over 24 hrs- furosemide
4mg/min max rate (if higher, risk of ototoxicity)
66
Describe dopamine for fluid overload patients in AKI:
More common in ICU
Low dose 2mcg/kg/min= renal vasodilation through DA1r increase perfusion and urine output
Higher dosing (more than 5mcg/kg/min) can cause vasoconstriction
67
What are the potassium levels which indicate hyperkalaemia in AKI patients?
≥ 6.5mmol/L K+= muscle weakness, ECG changes, VF, Cardiac arrest
>6mmol/L should be treated urgently in AKI
68
What are the levels and treatment for non AKI patients with hyperkalaemia?
≥6.5 should always be treated
Protect the heart with calcium gluconate 10% IV (antagonises K+ at cardiomyocyte membranes)
Shift K into cells- rapid acting insulin in glucose over 15 mins to stim Na/K transporter
Nebulised salbutamol- lower serum K levels by stimulating take up into cells
69
What is the treatment for moderate K+ 6-6.4mmol/L with no ECG changes?
Insulin glucose infusion
Check pre-treatment blood glucose level
Give 10 IU of actrapid insulin in 50ml of 50% glucose (25g) via large IV access over 15-30 mins
If pre treatment BG less than 7 mmol/L give 10% glucose at 50ml/hr for 5 hrs (25g)
Monitor BG levels
Consider salbutamol 10-20mg nebulised
70
What is the treatment for severe K+ ≥6.5mmol/L with ECG changes?
Emergency help
30ml 10% Ca gluconate IV
Use large IV access and administer over 10 mins
Administer over 30 mins if on digoxin
Do not administer with NaHCO3
Repeat ECG- consider further dose 5-10 mins after if ECG changes present
Then the insulin regimen like moderate K+ level and then salbutamol
71
What is the definition of CKD?
UK Kidney Association (UKKA) defines CKD as a pt with abnormalities of kidney function or structure present for more than 3 months
The definition includes all individuals with markers of kidney damage or those with an eGFR of less than 60ml/min/1.73m2 on at least 2 occasions 90 days apart
72
What are the complications of CKD?
Water and electrolyte balance
Hypertension
Acid/ base balance
Muscle dysfunction
Renal bone disease
Uraemia
Anaemia
73
In the early stages of CKD, how is the kidney unable to regulate water/ electrolytes?
Polyuria/ nocturia
Osmotic effect of urea (>40mmol/L)
Loss of ability to concentrate urine
74
What are the main complications in CKD when the kidney is unable to regulate water/ electrolytes?
Hyperkalaemia- kidneys inability to excrete, risk of CA, VF
Acidosis- inability to remove H+ ions= decrease in bicarbonate ions
75
What is the first line treatment in CKD when the kidneys can't regulate water?
Fluid restriction- turn off the tap
Not yet on dialysis and still pass urine, restriction at a min of 1L/day
If patients on haemodialysis and not passing urine, restriction may be a lot less, around 500ml/ day
Na+ restriction- dietary measures
Monitor daily weights at home and BP
76
What is the second line treatment in CKD when kidneys can't regulate water?
If fluid restriction doesn't work, move onto diuretics- take the plug out
Diuretics- loop diuretics first line (furosemide up to 2g daily), bumetanide better absorbed if a lot of fluid accumulation in the abdomen
Metolazone (atypical thiazide)- cautious addition as very strong diuretic, closely monitor, stop when dialysis start- most pts
77
What is the target level of potassium in pre-dialysis patients?
4.0-6.0mmol/L
78
What is the first line treatment in patients with hyperkalaemia in CKD?
Calcium resonium (potassium binder)- binds to K+ in the GIT
Releases Ca2+ in exchange and constipation SE- prescribed lactulose alongside it
79
What is the second line treatment in pts with hyperkalaemia in CKD?
Sodium zirconium cyclosilicate and Patiromer calcium approved by NICE for acute and chronic hyperkalaemia meeting certain criteria
80
What is the treatment for acidosis in CKD?
Sodium bicarbonate PO 500mg TDS
Can be uptitrated
81
What is the level in CKD that a patient has uraemia?
More than 15mmol/L
82
What is the main treatment for uraemia in CKD?
Effective treatment requires dialysis
83
What are the symptoms of uraemia in CKD?
Anorexia
N&V
Constipation
Foul taste
Pruritis
Skin discolouration
84
What are off label use medications for uraemia in CKD?
Anti-histamines
SSRIs
Gabapentinoids
85
What is a NICE approved treatment for prutitis in uraemia in CKD?
Jan 2024
Difelikefalin in HD pts
86
What are the symptoms of muscle dysfunction in CKD?
Cramps and restlessness legs especially at night
87
What is the non-pharmacological treatment of muscle dysfunction in CKD?
Lifestyle measures- as drugs that are used have debatable efficacy or can be addictive
e.g check caffeine levels
Check iron levels
88
What is the drug treatment of muscle dysfunction in CKD?
Quinine 300mg ON (cramps)- efficacy debated and trail recommended, should be reviewed within 2-4 weeks
Ropinirole 250mcg ON (restless legs) -dopamine agonist
89
What can be a negative outcome of HTN in CKD?
Proteinuria
Sustained HTN can lead to protein in the urine
>2g in 24 hr= glomerular disease
>5g in 24 hrs= severe disease (nephrotic syndrome)
90
State and describe the blood pressure targets for patents with CKD:
Targets decided on protein level
Proteinuria low (ACR<70 or PCR<100) BP <140/90
Proteinuria high (ACR>70 or PCR>100) BP <130/80
91
What are the patient characteristics where you should follow the normal NICE HTN guidelines?
Pts have CKD, HTN and ACR of 30mg/mmol or less
92
What are the patient characteristics where you should not follow the normal NICE HTN guidelines?
CKD, HTN and ACR of more than 30mg/mmol
Or have diabetes and ACR is 3mg/mmol or more
93
What is the treatment for HTN for CKD patients when not following the normal NICE guidelines?
ACEi/ARB started and optimised
ACEi/ARB may also be offered to CKD patients who do not have existing HTN or diabetes if ACR is more than 70mg/mmol or more
94
What are the monitoring requirements for ACEi/ARBs?
Monitor K+ prior to treatment and 1-2 wks after initiation/dose change
-potassium binder may be required if hyperkalaemia on repeat sample
Monitor creatinine, 1-2 wks after initiation/ dose change
-in ESRF don't need to worry about creatinine
95
What is the CI of ACEi/ARBs and why?
In renal artery stenosis
Atherosclerosis in renal arteries supplying blood to kidney= decreased GFR
RAS system constricts the efferent arteriole to maintain pressure and perfusion
RAS blockers (ACEi/ARBs) block this compensatory mechanism, causing further renal impairment
96
Describe CCBs in CKD for hypertension:
Ankle oedema SE, particularly in nifedipine
97
Describe diuretics in CKD for hypertension:
Not usually for HTN, mainly oedema
-thiazide diuretics (except metolazone) ineffective CrCl <25ml/min
-K+ sparing diuretics increase hyperkalaemia risk egg spironlactone
98
Describe B blockers in CKD for hypertension:
Cardioselective e.g metoprolol (cleared by liver), low dose and titrate
Can also be seen on bisoprolol and atenolol
99
Describe a blockers in CKD for hypertension:
Doxazosin, cleared via liver
100
Describe vasodilators in CKD for hypertension:
E.g hydrazalazine
SEs of reflection tachycardia (use with B blockers), fluid retention (use with diuretics) and minoxidil causes excess hair growth
101
Describe the use of SGLT2i in CKD:
Dapagliflozin is the only licensed one in CKD
Add on to optimised standard including highest tolerated ACEi or ARB unless CI
eGFR 25-75ml/min/1.73m2 at the start of treatment WITH T2D or urine ACR of at least 22.66mg/mmol
102
What're the warnings/ counselling points for SGLT2i?
Sick day rules
MHRA warning- DKA that can be euglycemic (normal BG) so need to monitor ketones
MHRA warning- Fournier's gangrene- genital necrosis infection as urinating glucose rich for bacteria, keep area clean/dry and report signs of genital infection
103
What are the main causes of renal bone disease (RBD)?
Particularly in CKD stages 4 and 5
-hyperphosphatemia
-low vit D
-hypocalcaemia
104
What is the treatment of hyperphosphatemia in RBD?
Diet- decrease phosphate intake
Phosphate binders e.g Calcium acetate (1st line), Sevlamer (2nd line), lanthanum
Bind with phosphate in the gut (take with/before meal and dose according to meal size)
105
What are the problems with phosphate binders in RBD?
Need to check adherence before changing
They are large tablets which many need to taken at once
Come with GI SEs
106
What are the treatments of hypocalcaemia and low vit D?
Vit D3 analogue e.g Calcitriol (activated)
Alfacalcidol (activated in liver)
Can't give Cholecalciferol as needs to be activated by the kidney
107
What are the treatments for hyperparathyroidism?
Effective management of Ca and phosphate
Cinacalcet- lowers PTH levels by increasing sensitivity of Ca receptors (calcimimetic)
Paricalcitiol- IV vit D analogue (expensive, not seen often)
Parathyroidectomy- last resort
108
What are the targets for PTH in RBD?
> 2x and <4x upper limit of normal
109
What are the targets for phosphate in RBD?
1.1-1.5mmol/L
1.1-1.7 mmol/L if on dialysis
110
What is the corrected Ca levels in RBD?
2.2-2.6 mmol/L
111
What is renal anaemia in CKD?
Common in CKD stage 3 onwards
Erythropoietin (low levels)
Low levels of iron also
112
Describe what low erythropoietin levels in CKD can cause:
Decrease in RBC proliferation in bone marrow leading to anaemia
113
What is the first line treatment for low erythropoietin in CKD?
Recombinant human erythropoietin by injection (IV/SC) AKA Epoinjections
-epoetin alfa (Eprex), Darbepoetin (Aranesp), Epoetin beta (NeoRecrmon)
114
What are the SEs of the first line treatment for low erythropoietin in CKD?
HTN
Pre red cell aplasia (Eprex only)
115
What is the second line treatment for low erythropoietin in CKD?
HIF stabilisers
Roxadustat
Involved in gene expression in erythropoiesis to increase Hb production and improve iron response
Hb target: 100-120g/L
116
What treatment in renal aneamia needs to be sorted first and why?
Erythropoietin produces RBCs which need iron, so iron stores need to increase before Epo injection
117
What is the target ferritin range in CKD?
200-500mcg/L
Max 800mcg/L and min more than 100mcg/L
118
What is the treatment for iron anaemia in CKD?
PO iron may be sufficient for pre-dialysis patients
Most patients will need IV replacements e.g Ferinject, Venter is serum ferritin under 200mcg/L
119
What is one major thing to avoid in iron anaemic patients in CKD?
Avoid blood transfusions- particularly if they are a candidate for renal transplantation in the future as there is an increased chance of rejection
120
What are the vitamins complications of CKD?
All water soluble vitamins tend to get removed
Need replacement
Renavit- contains water soluble vitamins along with dietary advice
Particularly need on dialysis as removes water soluble vitamins
121
Describe the use of the Hep B vaccination in CKD:
5 yearly booster for all CKD patients with blood manipulation, particularly HD (monitored yearly for Abs)
Doses are doubled at 3x 40mcg dose
122
When do we initiate dialysis?
In ESRF average eGFR 7ml/min
-becomes unmanageable by other interventions
Joint decision between MDT and patient, pt choice as may not be suitable e.g elderly as too frail
Patient needs to understand that it wont be curative and life lengthening
123
What are the monitor requirements when a patient is on dialysis?
Need to assess weight before and after dialysis- assessing fluid removal as too much fluid removal can cause dizziness/ hypertension
Fluid accumulation between sessions, no more than 1.5kg gain and each pt has tailored 'dry weight' - weight gain causes risk of pulmonary oedema and acute hospital admission for cardiac failure
124
What is the time scale for dialysis and why?
Work up to 3-5 hours to prevent disequilibrium syndrome: headaches, N&V, convulsions due to large urea removal
Usually 4 hrs 3x a week
125
What is the signs and treatment for PD peritonitis?
Cloudy bag- should normally be clear
Give IV vancomycin- via port via catheter (+ve)
PO ciprofloxacin (-ve)
Targets both gram -ve and gram +ve
126
What is the dietary requirements when on dialysis?
Healthy diet- low fat and salt, high fibre
Low potassium- in chocolate, potatoes, caffeine
Low phosphate
High protein diet in CAPD- can lose protein through CAPD fluid
127
What is the fluid restriction requirements in HD?
More strict
Urine output + 500ml a day
128
What is the fluid restriction requirements in PD?
Urine output + 750ml a day
Includes anything that is a liquid at room temperature e.g ice cream
129
What are the medication considerations when a patient is on dialysis?
Fluid management- stop diuretics unless residual function to pass urine
Acid/ base balance- stop sodium bicarbonate
HTN- monitor pre/post dialysis like to decrease after dialysis but still needed
Renal bone disease- remain on treatment
Erethypoetin- risk of blood loss increases in dialysis so still required and usually given with IV iron on dialysis
