l********y
发帖数: 2295 | 1 NEPH: ESRD pts
- watch lytes closely; careful with things like laxatives (fleets enemas),
etc. Hi phos load, Na load; same with kayexalate
- if hyperkalemic: check EKG and see pt; if no peaked T's, likely can wait
to get HD; but give insulin, Ca gluconate, etc. If worried, give kayexalate
- if septic and oliguric: carefulw ith IVF; small boluses, ~500cc at a time
(like CHF pts); avoid fluid overload and causing pulm edema
- Phos: danger is elevated Ca x Phos product (serum Ca x serum Phos); > 55... 阅读全帖 |
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b*****l
发帖数: 8603 | 2 2007年的，不知道你们说的是不是这个。祝好。
medical ethics more than hundred cases
Sep 24th, 2007, 12:17pm
1. A 25- year old mother refused immunization for her 2-month old son. The
social worker spoke to the mother. (Important for Board examination)
Next step in management: immunization should be given for the benefit of the
child.
2. A 30-year old mother refused surgery for suspected appendicitis for her 6
-year old daughter. The social worker spoke to the mother. (Important for
Board examination)
Next step in ma... 阅读全帖 |
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h*****i
发帖数: 40 | 3 为什么potassium高时， 给病人glucose 和insulin， 而不是kayexalate， 这个药不
是antipotassium吗， 总是confuse这个问题。 请高手指点一下，什么时候用glucose
和insulin， 什么时候给kayexalate。
先谢谢！ |
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s*******y
发帖数: 1739 | 4 glucose 和insulin可以使K 进入细胞内,从而降低血K,kayexalate 是通过Na-K通道,我
的理解是两个办法都可,如果病人NPO或没有TUBING FEEDING的话,就不能用kayexalate,
因为它是肠道吸收 |
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T*R
发帖数: 36302 | 5 是啊。一般病人如果没有口服禁忌，都是先上kayexalate。
D50+insulin+葡萄糖醛酸钙一般是比较紧急的情况。 |
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T*R
发帖数: 36302 | 6 透析过程本身就交换了钾。钾在透析后就平衡了。
排尿是针对不做透析的情况。
尿排不出，那么肠道就是第二选择。
美国这边是给口服Kayexalate。就是你说的那种树脂。
聚苯乙烯磺酸钠粉 |
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h****8
发帖数: 278 | 7 A 57-year-old man is brought to the emergency department 30 minutes after he
was found on the floor of his house; he has left hip pain and shortness of
breath. He has renal failure but has missed his last two dialysis treatments
. His renal failure was caused by inadvertent ingestion of ethylene glycol.
His renal function did not improve, and he is currently on the
transplantation list. Medications include amlodipine and doxazosin. On
arrival, his temperature is 37.5 C (99.5 F), blood pressure i... 阅读全帖 |
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r*r
发帖数: 67 | 8 Insulin and glucose combination works much faster and more efficient than
Kayexalate, remember BIGK, Sodium Bicarb, insulin/glucose, and Kay( we dont
use much in ICU )
glucose |
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N******m
发帖数: 17 | 9 Kayexalate permanent removes potassium, since potassium is removed with BM.
However, insulin plus glucose just shifts potassium from blood stream into
cells.The potassium still in the system. |
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a********n
发帖数: 438 | 10 2。electrolyes
在CARDIAC FLOOR, 我们有standing order for potassium and magnesium
replacement. 保持 K> 4/4.5, MAG> 2。当然，如果病人有renal insufficiency , MD
会自己写医嘱。 低钾低镁有可能引发各种arrhythmias, 如果病人run NON-SUSTAIN
VT, 先看清楚是不是artifact, 量血压，问问病人当时在干什么，再数EKG STRIP有多
少BEATS，打电话给医生前，最好查查病人最近的POTASSIUM和MAGNESIUM是多少，因为
医生第一句话就会问。
还有hyperkalemia 也很常见。处理的方法 IVD50 PLUS 10U REGULAR INSULIN,
KAYEXALATE 30G PO, IV ca gluconate 1amp if EKG changes, 最后可能上DIALYSIS。 |
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