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Chronic Renal Failure - College of Pharmacy-Handout2012

Labs na140 k52 co226 bun 45 cr32 ca85 albumin32

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Labs: Na=140, K=5.2, CO2=26, BUN= 45, Cr=3.2, Ca=8.5, Albumin=3.2, Phos=4.9, Mg=1.8, PTH=70, Hgb=11, Hct=35 PE: Ht=5’5”, Wt=130#
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Patient Case #1 What are AK’s sign and symptoms of CKD? ROS: Mild edema in lower extremities, noted recent weight gain of 10 lbs, along with dry, pale skin . Labs: Na=140, K=5.2 , CO2=26, BUN= 45 , Cr=3.2, Ca=8.5, Albumin=3.2, Phos=4.9 , Mg=1.8, PTH=70, Hgb=11, Hct=35
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Patient Case #1 What is AK’s renal function? Ht=5’5” (IBW= 57 kg), Wt=130# (59 kg), Age = 26 Cockcroft-Gault! (140-age)(IBW)/(72)(SrCr) * 0.85 for females (140-26)(57)/(72)(3.2) * 0.85 = = 24 ml/min
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Measured creatinine clearance versus the modification of diet in renal disease and Cockcroft-Gault equations for the assessment of renal function Amber E. King, Pharm.D. Kishor Gandhi, M.D., M.P.H. Genevieve D’Souza, M.D. Cindy Wordell, Pharm.D. Eugene R. Viscusi, M.D. Treatment of Chronic Renal Failure
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Dialysis and Transplantation Dialysis is primary treatment for ESRD Transplantation is limited by available organs, health of patient, personal preference, age? Dialysis plays important role in both acute and chronic disease Dialysis is life sustaining and serves as bridge to transplantation
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Dialysis Indications Uremia (n/v, anorexia, fatigue, cardiac/pulmonary symptoms) Acid/base disorder (acidosis) Fluid overload Electrolytes (hyperkalemia) Overdose Hemodialysis and Peritoneal Dialysis
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Hemodialysis Consists of three components Blood compartment Dialysis solution Semi-permeable membrane Water and solute transport through a semi-permeable membrane for removal of excess fluid or waste products Solute flow is determined by concentration, molecular weight, filter size, and pressure gradient Replacement of substances can be added to multiple different dialysate solutions
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Hemodialysis Solutes removed by diffusion (down a gradient) and by convection (removal of solutes dissolved in ultrafiltrate) Diffusion: removes relatively low molecular weight solutes Convection: removes some high molecular weight solutes Diffusion and convection can be controlled independently and thus titrated to individual needs of the patient
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Hemodialysis Blood moves from arterial blood thru dialysis machine and back to the venous blood supply Complications include: Clotting Hypotension Chest pain Performed 3 times weekly for 3-4 hours Continuous dialysis or CRRT in acute setting
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Hemodialysis
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Peritoneal Dialysis Same three components as hemodialysis Blood compartment Dialysis solution Semi-permeable membrane Peritoneum serves as the semi-permeable membrane Surgically placed catheter provides access to the peritoneal cavity Dialysate is instilled into cavity and allowed to dwell for a period of time
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Peritoneal Dialysis
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Peritoneal Dialysis Replacement of substances can be added to dialysate During the dwell solutes and fluid diffuse into the dialysate Dialysate is drained and replaced or capped until next treatment Variety of solutions are available to titrate to individual patient needs
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Peritoneal Dialysis
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