处方和腹膜透析的使用
Frank Reimann1, Melinda Tomlins2
1Manning Base Hospital, Taree, NSW.
Australian prescriber
|December 6, 2023
概括
腹膜透析为末期病患者提供了在家的灵活性. 精心管理液体平衡,药物剂量和预防感染对于成功治疗和保持功能至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内部医学 内部医学
- 脏替代疗法治疗 脏替代疗法
背景情况:
- 腹腔透析 (PD) 是对末期病 (ESKD) 的家庭治疗方法.
- 与血液透析相比,PD提供了灵活性和独立性,尽管溶液和液体清除效率较低.
- 特定于患者的腹运输特征会影响PD的处方和结果.
研究的目的:
- 审查优化腹膜透析治疗的关键考虑因素.
- 突出了PD患者常见挑战的管理策略.
- 强调保存残留功能和预防并发症的重要性.
主要方法:
- 审查与腹膜透析相关的当前文献和临床指南.
- 分析影响PD处方,药物管理和流体管理的因素.
- 讨论并发症和预防措施,包括感染和代谢影响.
主要成果:
- 腹膜运输特征对于定制PD处方至关重要.
- 药物剂量要求遵守病建议,特别考虑腹腔内抗生素.
- 流体过载是一个常见的问题,保持脏残留功能是必不可少的.
- 高葡萄糖透析溶液可能导致不良的代谢效应.
- 与PD相关的并发症,如感染,可能需要转换为血液透析.
- 建议在使用抗生素期间进行抗真菌预防,以预防真菌腹膜炎.
结论:
- 有效的腹膜透析管理需要注意个体患者的需求和潜在的并发症.
- 保持残留功能和预防感染对于PD的长期成功至关重要.
- 患者,医疗保健提供者和透析单位之间的密切合作对于最佳护理至关重要.
相关概念视频
01:27Dialysis
322
Renal failure occurs when the kidneys lose their ability to filter waste products from the blood effectively. It can be classified into two types: acute renal failure (ARF) and chronic renal failure (CRF).
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
322
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
173
Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
173
01:11Renal Failure: Dose Adjustments
95
In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
95
01:22Heart Failure Drugs: Diuretics
396
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
396
01:15Drug Elimination by Renal Route: Tubular Secretion
2.4K
Once the process of glomerular filtration is completed, blood carrying unfiltered drug molecules traverses through efferent arterioles and makes its way into the peritubular capillaries in the proximal tubule. A variety of carriers play a pivotal role in actively secreting drugs from these peritubular capillaries into the tubular fluid. The organic anion transporter transfers acidic drugs, against an electrochemical gradient, from the peritubular capillaries into the renal tubule cells and...
2.4K
01:28Renal Drug Excretion: Tubular Secretion
192
Active tubular secretion is a robust, energy-demanding process that utilizes carrier systems to transport drugs into renal tubules. The active renal secretion systems include the organic anion transporter (OAT) for weak acids and the organic cation transporter (OCT) for weak bases. Structurally similar drugs can compete for the same transporter, potentially leading to drug accumulation and toxicity. However, this principle can be exploited therapeutically. One example is probenecid (Probalan),...
192