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Related Concept Videos

Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy01:26

Extracorporeal Removal of Drugs: Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy (CRRT) is an essential intervention for patients experiencing severe kidney dysfunction. This therapy offers a continuous mechanism for removing fluids and toxins from the bloodstream, leveraging the patient’s blood pressure to facilitate filtration through a specialized filter. This method contrasts with intermittent dialysis, providing a gentler and more consistent removal of waste products and excess fluid, which is particularly beneficial in critically...
Continuous Renal Replacement Therapy01:30

Continuous Renal Replacement Therapy

Continuous Renal Replacement Therapy, also known as CRRT, is a procedural treatment for acute kidney injury (AKI) that gradually removes uremic toxins and fluids while maintaining acid-base balance and stabilizing electrolytes. It is particularly useful for hemodynamically unstable patients. Unlike intermittent hemodialysis, which is faster, CRRT provides a gentler approach over 24 hours, closely mimicking the function of natural kidneys. However, CRRT is not ideal for patients with...
Renal Regulation of Acid-Base Balance01:29

Renal Regulation of Acid-Base Balance

Metabolic reactions in the body produce nonvolatile acids, such as sulfuric acid, which generate an acid load of approximately 1 mEq of H+ per kilogram of body weight daily. Excreting H+ in the urine is essential to balance this acid load.
In the kidneys, cells within the proximal convoluted tubules (PCT) and the collecting ducts secrete hydrogen ions (H+) into the tubular fluid. Specifically, in the PCT, Na+/H+ antiporters secrete H+ while reabsorbing Na+.
However, the intercalated cells in...
Respiratory Regulation of Acid-Base Balance01:18

Respiratory Regulation of Acid-Base Balance

Respiratory compensation is a vital physiological process that stabilizes blood plasma pH by regulating the partial pressure of carbon dioxide (PCO2), a key determinant of pH levels. Most carbon dioxide in the blood dissolves and converts into carbonic acid (H2CO3). It dissociates into hydrogen ions (H+) and bicarbonate ions (HCO3⁻). There is also an inverse relationship between PCO2​​ and pH.
When carbon dioxide levels increase in the blood, more H+ and HCO3⁻ are produced, leading to a...
Renal Drug Excretion: Effect of Urine pH, Flow Rate, and Drug pKa01:22

Renal Drug Excretion: Effect of Urine pH, Flow Rate, and Drug pKa

The pH of urine, the drug's pKa, and the urine flow rate are vital parameters for drug reabsorption and excretion. Urinary pH varies between 4.6 and 8.0 and is influenced by diet, drug intake, and the patient's pathophysiology. It affects a drug's ionization state and reabsorption. For instance, carbohydrate-rich food produces alkaline urine promoting drug excretion, while proteins and certain medications like ascorbic acid lead to acidic urine enhancing reabsorption.
The pKa of a drug,...
Acute Kidney Injury V: Interprofessional Care01:20

Acute Kidney Injury V: Interprofessional Care

Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...

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Related Experiment Video

Updated: May 9, 2026

A Recovery Cardiopulmonary Bypass Model Without Transfusion or Inotropic Agents in Rats
09:54

A Recovery Cardiopulmonary Bypass Model Without Transfusion or Inotropic Agents in Rats

Published on: March 23, 2018

Low-flow CO₂ removal integrated into a renal-replacement circuit can reduce acidosis and decrease vasopressor

Christian Forster, Jens Schriewer, Stefan John

    Critical Care (London, England)
    |July 26, 2013
    PubMed
    Summary
    This summary is machine-generated.

    Integrating a hollow-fiber gas exchanger into renal replacement circuits safely reduced carbon dioxide and improved acidosis in critically ill patients with ARDS and kidney failure. This approach also enhanced hemodynamic stability, reducing the need for vasopressors.

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    06:57

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    Published on: July 9, 2020

    Area of Science:

    • Critical Care Medicine
    • Nephrology
    • Pulmonology

    Background:

    • Patients with Acute Respiratory Distress Syndrome (ARDS) and multiorgan failure, including renal failure, often experience combined respiratory and metabolic acidosis.
    • Lung-protective ventilation strategies can exacerbate acidosis in these patients.

    Purpose of the Study:

    • To assess the effectiveness of a hollow-fiber gas exchanger integrated into a renal-replacement circuit for CO₂ removal.
    • To evaluate the impact on acidosis and hemodynamics in critically ill patients.

    Main Methods:

    • An observational study involving ten ventilated patients with ARDS and Acute Kidney Injury (AKI).
    • A hollow-fiber gas exchanger was added to the renal-replacement circuit for low-flow CO₂ removal.
    • Evaluated safety, CO₂ removal capacity, pH changes, ventilator settings, and hemodynamics.

    Main Results:

    • Low-flow CO₂ elimination was safe and well-tolerated.
    • Mean reduction in partial pressure of carbon dioxide (pCO₂) of 17.3 mm Hg (-28.1%) observed after 4 hours, with a corresponding increase in pH.
    • Hemodynamic improvement noted in unstable patients, with a 65% average reduction in vasopressors in catecholamine-dependent patients within 24 hours.

    Conclusions:

    • Integration of a hollow-fiber gas exchanger into a renal circuit is a viable therapeutic option for mild to moderate ARDS with respiratory acidosis.
    • This approach requires no additional catheters beyond those for renal replacement, minimizing patient trauma.
    • Considered an attractive tool, provided severe oxygenation defects do not necessitate Extracorporeal Membrane Oxygenation (ECMO) therapy.