Stages of Dehydration
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Questions and Answers

What is the primary cause of Kussmaul's breathing in patients with chronic renal failure?

  • Hypervolemia
  • Acidosis (correct)
  • Hyperlipidemia
  • Impaired immunity

    • Which of the following is a gastrointestinal manifestation of chronic renal failure?

  • Gastric ulcers
  • Diarrhea
  • Hematemesis (correct)
  • Gastroesophageal reflux

    • What is the primary cause of coronary heart disease in patients with chronic renal failure?

  • Uremic cardiomyopathy
  • Salt and water retention
  • Hyperlipidemia (correct)
  • Hypertension

    • Which of the following is a neurological manifestation of chronic renal failure?

    <p>Asterixis</p> Signup and view all the answers

    What is the primary cause of pleurisy and pleural effusion in patients with chronic renal failure?

    <p>Hypervolemia</p> Signup and view all the answers

    Which of the following is a genital manifestation of chronic renal failure in males?

    <p>All of the above</p> Signup and view all the answers

    What is the primary cause of respiratory acidosis in patients with chronic renal failure?

    <p>Hypoventilation</p> Signup and view all the answers

    Which of the following is a cutaneous manifestation of chronic renal failure?

    <p>Ulcers in the skin</p> Signup and view all the answers

    What is the primary cause of anemia in chronic renal failure?

    <p>Erythropoietin decrease</p> Signup and view all the answers

    What is the recommended duration of efficient dialysis per week?

    <p>12 hours/week</p> Signup and view all the answers

    What is a complication of blood transfusion in chronic renal failure?

    <p>Cardiomyopathy</p> Signup and view all the answers

    What is the goal of antihypertensive treatment in chronic renal failure?

    <p>Never let diastole &lt; 100 mmHg</p> Signup and view all the answers

    What is the primary cause of edema in chronic renal failure?

    <p>A combination of primary renal salt, water retention, and heart failure</p> Signup and view all the answers

    What is a clinical feature of anemia in chronic renal failure?

    <p>All of the above</p> Signup and view all the answers

    What is a complication of aluminum toxicity in patients on dialysis?

    <p>Bone marrow fibrosis</p> Signup and view all the answers

    What is the recommended frequency of efficient dialysis per week?

    <p>3 sittings</p> Signup and view all the answers

    What is the consequence of not receiving sufficient amount of fluid in the patient?

    <p>Dehydration, hypotension, and electrolyte disturbance</p> Signup and view all the answers

    What is a clinical manifestation of hyperkalemia?

    <p>Generalized muscle weakness</p> Signup and view all the answers

    What is the significance of 'urine volume/day + one liter' sign?

    <p>Indicates dehydration and electrolyte disturbance</p> Signup and view all the answers

    What is the main purpose of immune sensitization avoidance before transplantation?

    <p>To increase graft survival chance</p> Signup and view all the answers

    What is the primary goal of treatment in polyuric stage?

    <p>To avoid dehydration with monitoring of C.V.P.</p> Signup and view all the answers

    What is the indication for dialysis in ARF?

    <p>Serum K &gt; 7mEq/ L</p> Signup and view all the answers

    What is the target hemoglobin level for EPREX maintenance dose?

    <p>10-12 gm/dl</p> Signup and view all the answers

    What is the parameter used to differentiate between pre-renal and renal causes of ARF?

    <p>Urine specific gravity</p> Signup and view all the answers

    How is the EPREX dose modified if the target hemoglobin level is not reached?

    <p>The dose is increased by 25U/Kg/week</p> Signup and view all the answers

    What is the prognosis of ARF if detected early and received proper medical treatment?

    <p>Good prognosis with complete recovery</p> Signup and view all the answers

    What is the advantage of EPREX in terms of blood transfusion?

    <p>It reduces the need for blood transfusion</p> Signup and view all the answers

    What is the treatment of hyperphosphatemia in ARF?

    <p>Phosphate binders</p> Signup and view all the answers

    What is a common side effect of EPREX?

    <p>Flu-like syndrome</p> Signup and view all the answers

    What is the main disadvantage of EPREX?

    <p>High cost</p> Signup and view all the answers

    Why is iron supplementation essential with EPREX?

    <p>To increase the effectiveness of EPREX</p> Signup and view all the answers

    What is the administration route of EPREX for rapid correction?

    <p>Intravenous</p> Signup and view all the answers

    What is the main goal of protein restriction in chronic renal failure patients?

    <p>To reduce urea production</p> Signup and view all the answers

    What type of anemia may occur in chronic renal failure patients?

    <p>All types of anemia</p> Signup and view all the answers

    What is the characteristic of broad cell casts in chronic renal failure?

    <p>They are large and broad</p> Signup and view all the answers

    What is the daily caloric intake recommended for chronic renal failure patients?

    <p>35 Kcal/Kg/day</p> Signup and view all the answers

    Why is sodium restriction recommended in chronic renal failure patients?

    <p>Because the body needs only 80mmol/day of sodium</p> Signup and view all the answers

    What is the purpose of skeletal survey in chronic renal failure patients?

    <p>To detect secondary hypertension</p> Signup and view all the answers

    What is the goal of diet control in chronic renal failure patients?

    <p>To control protein, carbohydrate, fat, and calorie intake</p> Signup and view all the answers

    What is the recommended daily fluid intake for chronic renal failure patients?

    <p>2-3 L/day</p> Signup and view all the answers

    Study Notes

    Acute Renal Failure (ARF)

    • In the oliguric stage, if the patient does not receive sufficient fluid, dehydration, hypotension, and electrolyte disturbance become manifested.
    • Clinical manifestations of ARF include: • Generalized muscle weakness • Hypotonia • Weak or loss of deep reflex • Arrhythmia • Acute renal failure
    • Prognosis of ARF is good with complete recovery if detected early and received proper medical treatment, but can progress to Chronic Renal Failure (CRF) or even death from complications.

    Recovery Stage of ARF

    • In this stage, urine volume returns to normal gradually with normal specific gravity.
    • Kidney functions and serum electrolyte return to normal values.
    • Complete recovery from previous clinical manifestations and restoration of wellbeing occur.

    Investigations of ARF

    • Urine analysis may be helpful to differentiate between pre-renal and renal causes of ARF.
    • Parameters include urine specific gravity, proteinuria, and casts (broad cell casts are characteristic to CRF).

    Treatment of ARF

    • Treatment of hyperkalemia: • Cardiac monitoring • Insulin and glucose infusion • Sodium polystyrene sulfonate • Calcium gluconate
    • Treatment of acidosis: • Sodium bicarbonate I.V.
    • Treatment of hyperphosphatemia: • Phosphate binders
    • Dialysis is indicated in: • Uraemic coma not responding to medical treatment • Serum K > 7mEq/L • Serum bicarbonate < 12mEq/L • Arterial pH < 7.15 • Prolonged oliguric stage with daily rapid rise of blood urea and serum creatinine

    Chronic Renal Failure (CRF)

    Clinical Picture of CRF

    • Clinical manifestations of CRF include: • Respiratory manifestations:
      • Rapid deep breathing (Kussmaul's breathing)
      • Pulmonary edema
      • Pleurisy and pleural effusion • GIT manifestations:
      • Dry mouth
      • Unpleasant taste
      • Uremic (ammoniacal) odor
      • Anorexia
      • Nausea
      • Vomiting • Cardiovascular manifestations:
      • Hypertension
      • Cardiac arrhythmia
      • Uremic cardiomyopathy
      • Coronary heart disease • Urinary manifestations:
      • Water disorders • Genital manifestations:
        • Male: Impotence, infertility
        • Female: Amenorrhea, infertility • Skin manifestations:
      • Uremic frost • Ocular manifestations:
      • Uremic retinopathy • Metabolic manifestations:
      • Hypoglycemia due to decrease renal clearance of insulin
      • Impaired glucose tolerance due to insulin resistance • Dialysis complications • Skeletal manifestations:
        • Osteodystrophy

    Investigations of CRF

    • GFR assessed by creatinine clearance
    • Biochemical changes: • Increase serum creatinine and blood urea • Increase alkaline phosphate
    • Blood picture: Anemia may occur
    • Skeletal survey for 2ry hypertension
    • Plain x-ray and abdominal U/S to detect complications

    Treatment of CRF

    • TTT of the cause
    • Rest and adequate sleep
    • Diet control: • Protein restriction to 0.5 gm/Kg/day • Carbohydrates to supply enough caloric requirements • Fat restriction to correct hyperlipidemia • Caloric intake: 35 Kcal/Kg/day • Salt restriction • Sufficient fluid intake: 2-3 L/day • K-rich diet
    • Correct electrolyte imbalance: • Na deficient: 1-2 gm/day • K restriction in hyperkalemia • Ca supplementation • Decrease P04 supplement
    • Symptomatic treatment: • Hypertension • Anemia • Heart failure • Osteodystrophy

    Anemia in Chronic Renal Failure

    Etiology of Anemia in CRF

    • All types of anemia can occur
    • Erythropoietin decrease
    • Bone marrow depression by toxins
    • Hemolytic anemia due to toxins
    • Fe decrease due to anorexia
    • Blood loss
    • Bone marrow fibrosis due to aluminum toxicity in patients on dialysis
    • Dilutional anemia

    Clinical Picture of Anemia in CRF

    • Pallor
    • Fatigue
    • Intolerance to cold
    • Anorexia
    • Dyspnea on exertion
    • Palpitation
    • Angina pectoris
    • Depression
    • Cognitive deterioration
    • Drowsiness
    • Sleep disturbance
    • Sexual dysfunction
    • Blurred vision

    Management of Anemia in CRF

    • Efficient dialysis
    • Iron and folate supplementation
    • Blood transfusion (rarely)
    • EPREX (Recombinant Human Erythropoietin): • Indications: Absolute or relative deficiency of erythropoietin • Regimen: Initial dose varies from 50-150 U/Kg/week • Maintenance dose: Target hemoglobin level is 10-12 gm/dl • Iron supplementation is essential with EPREX • Advantages: No need for blood transfusion, improvement of quality of life, cardiovascular performance, and sexual potency • Side effects: Flu-like syndrome, high cost, elevation of blood pressure, and rare thrombosis

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    Description

    Identify the signs and symptoms of dehydration, including hyperkalemia and acute renal failure, and understand the recovery stage.

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