#Renal Failure
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Please donate if possible, and spread! Dialysis is no joke even in a first world country, I cannot imagine how it is under constant bombardment.
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🌻Happy Invisible Disability week!!!🌻
To everyone with an invisible disability, know that you and your experiences are valid! I value you and your experiences. You deserve love and support when managing your disability. You do not have to prove anything to anyone. You are not defined by your disability. Know that I support you in all your endeavours!
For those of you who don't know what an invisible disability is, it is any long-term impairment, health condition or illness that isn't immediately visible in most everyday circumstances. This can include chronic illnesses like renal failure, diabetes, or even chronic pain. Psychological/neurological disorders like depression, attention deficit disorder, agoraphobia, and functional neurological disorder are also included. Even disorders like chronic fatigue or autism are counted as invisible disabilities.
And there are many more invisible disabilities not mentioned above. I encourage everyone to always be kind, and take the time to listen and support those with invisible disabilities. Just your belief and support means a lot. These disabilities may be invisible, but the people with them are not!
#Invisible disability week#Invisible disability#renal failure#diabetes#chronic pain#depression#attention deficit disorder#agoraphobia#functional neurological disorder#chronic fatigue#autism
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hi, what is your idea on why the bizarre dolls need new blood? I know when they brought a dog back to life (in real life), they had to cycle it's blood with a machine. But then they could stop it after its heart could do the process again. Back to kuroshit now, Maybe due to them being a corpse, their blood stagnates. But I don't see why that's important to a bizarre doll? Then again, we don't know much about the nature of them yet..... Maybe soon with the "brass" getting one!!! That's my idea at least. What's yours?
Why do BD's need fresh blood?
This is something I've answered before. I've discussed it a few times, actually. I'll see if I can find links to older posts about it.
Short answer: Othello says something isn't 100% about the process Undertaker is using, and I suspect it's a matter of kidneys that don't work to clean out their blood. That's probably why the same machines are being used for renal failure patients who were making donations to the Aurora Society. Undertaker is possibly trying to perfect the process for reviving humans... not just reanimating them.
I've previously posted that real Ciel might need a kidney transplant, and that our earl might be needed for that. On top of the possibility that Undertaker might want to transplant our earl's soul into real Ciel's body....
At least some of those posts would also mention Josef Mengele, the "Angel of Death" doctor with the Nazis. He was obsessed with doing medical experiments, particularly on twins, and transplants were one of his specialties.
But please check the tags on this post and look around my blog for previous posts about this.
#black butler#kuroshitsuji#undertaker#bizarre dolls#advanced bizarre dolls#earl phantomhive#our earl#ciel phantomhive#real ciel#bizarre doll ciel#renal patients#renal failure#aurora society#dialysis#blood transfusion#roseate-lagomorph#asks#i answer#answered asks#I'll look for older posts later#but please check tags#please check my blog for older posts on the subject#soul shape#transplant#twin souls#josef mengele#oct 11 2022#tw: nazi
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If a pt with liver failure has varices, you automatically prophylax against SBP with ceftriaxone. It's 1 g IV q24 x7 days.
If pt has renal failurem be cautious regarding K+ repletion--the kidneys remove excess K+ so if your kidneys are failing, then your body has a harder time removing K+. So instead of repleting a K+ of 3.2 with potassium chloride 40 mEq x2, you would give like 50-75% of that so you don't make the pt hyperkalemic.
Anti-pseudomonal: piperacillin-tazobactam, fluoroquinolones (e.g., levofloxacin), aminoglycosides (e.g., gentamicin, amikacin).
Osteomyelitis is usually diagnosed by MRI. But if you see it on a CT scan, that is sufficient.
A pt with renal failure and liver failure went into AFib with RVR this morning. Her BPs are low with SBP in the 90s. You don't give metoprolol 5 mg in somone with a low BP. You don't give diltiazem either. Our attending suggested amiodarone (dose for AFib is 150 mg IV x1 over 10 minutes, then 1 mg/min IV x6 hours, then 0.5 mg/min IV x18 hours). We consulted cardiology, who said amiodarone is not a good choice in the setting of hepatic dysfunction; sotalol would complicate management of hypotension. They recommended anticoagulation given her CHADSVasc of 3. Echo is pending and it's worth checking serial troponins. Also check TSH.
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Two basic functions of the kidneys are to cleanse the body of waste products, and to regulate the amount of water and certain chemicals in your blood. If your kidneys fail, unless and until you have a successful kidney transplant, you will need dialysis therapy to clean and filter your blood.
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Navigating Stage 3 Kidney Disease: Understanding, Managing, and Healing
Stage 3 kidney disease marks a critical juncture in the progression of renal impairment, signaling significant changes in kidney function and potential complications. At this stage, proactive management and holistic approaches become essential to slow down the disease's advancement and improve overall kidney health. In this article, we delve into the intricacies of stage 3 kidney disease, exploring its causes, symptoms, and treatment options, including Ayurvedic interventions for chronic renal failure.
Understanding Stage 3 Kidney Disease:
Stage 3 kidney disease, also known as moderate kidney disease, is characterized by a noticeable decrease in kidney function, with a glomerular filtration rate (GFR) ranging from 30 to 59 milliliters per minute. Common causes of stage 3 kidney disease include diabetes, high blood pressure, autoimmune diseases, and certain medications. Symptoms may vary but can include fatigue, swelling, changes in urine output, and electrolyte imbalances.
Managing Stage 3 Kidney Disease:
Managing stage 3 kidney disease involves a multifaceted approach aimed at preserving kidney function, alleviating symptoms, and preventing complications. Conventional treatments may include medication, dietary modifications, blood pressure control, and lifestyle changes. However, complementary and alternative therapies, such as Ayurveda, offer promising avenues for addressing chronic renal failure.
Ayurvedic Treatment for Chronic Renal Failure:
Ayurveda, the ancient Indian system of medicine, offers holistic and natural remedies for managing chronic renal failure. Ayurvedic treatments focus on restoring balance to the body's doshas (vata, pitta, and kapha) and promoting kidney health through herbs, dietary adjustments, lifestyle modifications, and detoxification therapies. Herbs like Punarnava, Gokshura, and Varuna are renowned for their diuretic, anti-inflammatory, and nephroprotective properties, aiding in kidney function and regeneration.
Incorporating Ayurveda into Treatment:
Integrating Ayurvedic principles into the management of stage 3 kidney disease can complement conventional treatments, enhance overall well-being, and potentially slow down the progression of renal impairment. Ayurvedic practitioners tailor treatment plans to individual needs, considering factors such as constitution, stage of the disease, and underlying imbalances. Embracing a holistic approach that encompasses both modern and traditional healing modalities empowers individuals to take control of their health and journey towards kidney wellness.
Conclusion:
Stage 3 kidney disease presents a pivotal moment in the progression of renal dysfunction, where proactive intervention and comprehensive care can make a significant difference in preserving kidney function and improving quality of life. While conventional treatments play a crucial role in managing the disease, exploring complementary therapies like Ayurveda offers additional avenues for holistic healing and kidney support. By embracing an integrative approach to kidney health, individuals with stage 3 kidney disease can optimize their treatment outcomes and embark on a path towards renal wellness and vitality.
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Patients with hypertension on dialysis can take calcium channel blockers. Because they are metabolized by the liver, there is no loss during dialysis.
Source: Georgianos & Agarwal, Clin J Am Soc Nephrol (2016)
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I can't breathe without you
What if I needed help?
What if I took too much?
You're not here to hear my yell
You know you are always my crutch
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First night on night dialysis, 7 hours of doing absolutely nothing whilst pretending to sleep
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My soul-cat, twenty years old, my little gentleman, who went blind last week and immediately started adapting to, now he lies dying in my lap
#cat#renal failure#he's basically been in hospice all year#but there's nowhere left to go against the blood poisoning#we whatsapped the vet and waiting to hear back
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The Kidney Disease Solution
#kidney stone#kidneyhealth#kidney beans#kidney diseases#kidney function test#kidney failure#renal care#renal failure#renal function test#kidney transplant
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look. so many people use the classist card for this, but if you can't afford to feed an animal a diet that's not going to cause serious medical issues that will either kill it or require medical treatment for the rest of the animal's life, then maybe you shouldn't own this animal. "poor people deserve to have animal companions too" yes absolutely i agree, but maybe not at the expense of the animal's health.
#this post was brought to you by people defending feeding cats ferrets hedgehogs and various rodents dry cat food#'oh no why did my hedgie turn yellow :(' because you fed an insectivore food that doesnt contain insects#'oh no why does my ferret have neurological issues' because you fed it dry cat food#'i soaked kibble in water and my cat still had renal failure' because soaking it only solves one problem#I'm not even going to touch mice and hamster breeders that feed their animals cat kibble#szad.txt
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Diuretics use in patients with Acute Renal Failure and Septic Shock by Dr Dale Ventour in Journal of Clinical Case Reports Medical Images and Health Sciences
ABSTRACTS
Loop diuretics should be administered in the ‘de-resuscitative’ of sepsis, this occurs after the initial resuscitative period during sepsis. The dose of diuretic should be monitored and a continuous infusion of furosemide, which is the most prescribed diuretic, should be no greater than 4mg/min.
There needs to be caution with co-administered nephrotoxic agents such as aminoglycosides, other diuretics, NSAIDS as these increase the toxicity profile. Despite the popular use of loop diuretics in critical care, loop diuretic use in sepsis has not been shown to decrease patients’ mortality.
This manuscript aims to discuss the use of diuretics in patients with septic shock exploring the evidence and consensus about the use of this therapy in critically unwell patients.
KEYWORDS: loop diuretics, septic shock, oliguria, ototoxicity, renal failure, critical care.
INTRODUCTION
Loop diuretics can be used in critical care to manipulate urine output in patients with hypoperfusion. Loop diuretics benefit the renal medulla during hypoxia by decreasing the tubular energy requirements(1, 2), which makes it a very attractive addition for patients with septic hypoperfusion. A Meta-analysis by K M Ho et al 2006 did not find in reduction in in-hospital mortality, requirement for dialysis, length of stay or number of patients remaining oliguric(3). A positive diuretic response to furosemide may indicate that the patient is in the ‘de-resuscitative’ phase of sepsis and that renal impairment is less severe. It is also appreciated that patients with non-oliguric renal failure have a lower mortality than patients with oliguric renal failure(4). The timing, duration, and dosing of diuretic therapy, plays a significant role in the morbidity associated with diuretic therapy in sepsis.
Diuretics in critical care; is used as a prophylactic measure that is, to prevent the onset of renal failure; to alleviate renal impairment in patients with established renal compromise or to convert oligo uric to non-oligo uric renal failure. There was no evidence in the meta-analysis by Ho et al 2006 that there was any benefit in the above listed uses of diuretics(3). There was great heterogeneity between groups in this analysis and most patients had existing renal impairment so that extrapolation to critical care patients with sepsis is problematic.
The goal of transitioning a septic patient from oligemic to non-oligemic renal failure is associated with a decreased mortality trend and diuretic therapy might aid patients with regard to normalizing positive fluid balances (5) but this intervention has associated risks and complications.
Diuretic therapy should be initiated not based on urine output but when the patient has transitioned from the early resuscitative phase to the “de-resuscitative” phase of septic shock. The transit point is determined clinically as the patient is no longer fluid responsive as per passive leg raises or with static/dynamic cardiac output monitoring, is less academic and inotropic support has stabilized or decreased.
Why does this matter?
There are associated side effects when initiating diuretic therapy in critically unwell patients such as ototoxicity, hypernatremia, hypotension and worsening renal function.
OTOTOXICITY
There is changes in the endolymph ionic concentration and fluid composition secondary to the inhibition of the Na-K-2Cl transporter within the stria vascularis of the inner ear(6). Aminoglycoside antibiotics potentiate furosemide ototoxicity, but noise trauma apparently does not. Methods of avoiding ototoxicity are suggested including slow continuous infusion rather than bolus injection, use of divided oral dose regimens, and the measurement of blood levels to avoid exceeding 50 mcg/ml of furosemide(6).
In heart failure patients as outlined by Salvador et al 2005(7), continuous infusions of furosemide resulted in a lower incidence of ototoxicity and fewer side effects. Continuous infusions resulted more than 30% increase in sodium excretion than bolus administration.
The ototoxicity induced by furosemide can be reversible although permanent deafness has been reported. The complication is related to both the peak serum drug concentration and the accumulated dose from continuous infusion and is aggravated with the concurrent use of aminoglycosides or Non-Steroid Anti-Inflammatory Drugs. The maximum recommended infusion dose is 4 mg/min (8).
HYPERNATREMIA
Hypernatremia as outlined by Hai-bin Ni et al 2016(9) was associated with increased mortality whether or not it was associated with diuretic use, this is a common side-effect with liberal diuretic use within the Intensive Care.
Hypernatremia as an independent predictor of mortality regardless of aetiology, speciality and across patients with different ages and co-morbidities (10-14). Risk factors include advancing age, co-existent renal impairment, associated use of nephrotoxic drugs. The phenomenon is poorly understood but correction is based on balancing renal water loss with overcorrection with isotonic solutions versus hypotonic water correction.
It necessities the use of Nasogastric water, naturetics, 5% Dextrose administration, low sodium enteral feeds and re-constituting drugs with 5% Dextrose rather than saline to correct this electrolyte imbalance. These interventions further complicates the management of the critically unwell patient, prevention is of tantamount importance.
WORSENING RENAL FUNCTION
Numerous studies have indicated that there is no benefit in the use of diuretic therapy to improve outcomes in patients with established acute renal failure in Intensive Care (15, 16). Maeder et al 2012, indicated a trend toward worsening renal function in elderly patients with chronic renal failure within a medical Intensive Care(17). His definition of chronic renal failure was >0.5 mg/dl increase in baseline creatinine over the 6 months follow up, again the findings not only supported renal failure as an independent predictor of mortality, but it was also aggravated by escalating the loop diuretic dose [17].
HOW DO WE ADMINISTER LOOP DIURETICS?
Meta-analyses support the administration of loop diuretics as continuous infusions versus boluses as there is better diuresis at a lower cumulative dose(18), this will inevitably lead to fewer side effects and more efficient fluid balance.
It has been suggested that the infusion dose be limited to 4mg/min to minimize the side effect profile as the loop diuretic has a ceiling effect around this dose [9]. It is also proposed by this author that the diuretic be administered in the ‘de-resuscitative’ phase of sepsis to manage the patient’s overall fluid balance.
The use of diuretics should be for the shortest time possible as there are considerations for electrolyte abnormalities and ototoxicity with a clear focus on serum sodium to gauge the amount of free water loss. While I am not against the administration of loop diuretics in septic patients with acute renal failure the timing of administration of the drug class with the “de-resuscitative phase of sepsis” is vitally important.
DISCUSSION
There is a paucity of evidence supporting the use of loop diuretics in septic critically unwell patients with acute renal failure leading to improved mortality(19, 20). These studies have highlighted increased risk of complications such as electrolyte disturbance without reducing the need for continuous renal replacement therapy or the duration of renal replacement.
Ototoxicity remains an underreported complication as there can be other contributing factors for altered hearing after the critical care episode. This complication will contribute to a patient’s post critical care morbidity affecting patient and patient’s family quality of life.
The is wide variation with the timing, dose, and indication for diuretic therapy in critical care. Bolus administration, low-dose continuous infusions (20) or high dose titrated to urine output or daily fluid balance are all methods used to administer diuretics. Liborio et al in his observational study of over 14,000 patients found no decreased mortality in critically ill patients with over 60% of these patient experiencing sepsis with a dose of furosemide up to 80 mg/day(21)
CONCLUSION
The indication and use of diuretics in septic patients with oliguric acute renal failure is varied and confounded by timing and effective dosage. However, there are significant complications associate with the use of diuretics in the critical care population and need serious considerations prior initiation of this therapy as there is no mortality benefit in septic patients with acute kidney injury.
Acknowledgement: No acknowledgement
For more information: https://jmedcasereportsimages.org/about-us/
For more submission : https://jmedcasereportsimages.org/
#loop diuretics#septic shock#oliguria#ototoxicity#renal failure#critical care#NSAIDS#hypoperfusion#heterogeneity#hypotonic water#Dr Dale Ventour#jcrmhs
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1. Assessment prior to Kidney Transplantation:
a. Evaluating Kidney Function: It is crucial to assess the severity of renal dysfunction in order to determine the timing and necessity of the transplantation procedure.
b. Managing Comorbidities: Before surgery, it is important to identify and address any additional medical conditions such as cardiovascular disease, diabetes, and infections.
c. Screening for Cancer: Detecting and treating malignancies before the transplantation procedure is essential to prevent complications and ensure successful outcomes.
d. Psychological Assessment: Evaluating the mental and emotional well-being of transplant candidates aids in identifying potential issues that may arise.
2. Donor Evaluation:
a. Assessment of Living Donors: A comprehensive evaluation of potential living donors includes medical, surgical, and psychological assessments to ensure suitability and minimize risks.
b. Selection of Deceased Donors: The compatibility between the donor and recipient is determined through human leukocyte antigen (HLA) matching, which is crucial for a successful transplantation.
3. Surgical Approaches:
a. Traditional Nephrectomy: The conventional method involves making a large abdominal incision to remove the kidney from the donor.
b. Laparoscopic Nephrectomy: Minimally invasive laparoscopic techniques have become popular due to their lower morbidity and faster recovery time for living donors.
c. Robot-assisted Nephrectomy: Robotic surgery offers improved precision and dexterity, making it an emerging option for donor nephrectomy.
d. Implantation Techniques: Various methods for vascular anastomosis and ureteral reimplantation are employed during the kidney transplantation procedure.
You can contact some of the best nephrologists in Mumbai to know more about the preparation, procedure, after-care, and approximate cost of kidney transplant in Mumbai before undergoing the procedure.
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We're having to put Suzie to sleep this afternoon. She had a kidney infection on Monday, which she's been on antibiotics for, but also went from mid-Stage 3 (IRIS) to late Stage 4 in about three months. We haven't actually had a checkup to see what her creatinine looks like, but if we treat the cat instead of the numbers, I don't think she's really enjoying life anymore.
She's drinking OK on her own, but the only thing she'll eat without a syringe is turkey rolls (as in the meat you generally serve at an English Christmas dinner). That's not remotely sustainable, because a) salt and b) lack of basically anything that makes food complete for cats. I start a new full-time job on Monday, so the syringe is no longer an option and a feeding tube would get expensive fast.
She's had a pretty good life so far, certainly an improvement on the hoarding situation she came from, and having had five days to watch her progress (or lack thereof), I don't think I have any regrets.
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Two basic functions of the kidneys are to cleanse the body of waste products, and to regulate the amount of water and certain chemicals in your blood. If your kidneys fail, unless and until you have a successful kidney transplant, you will need dialysis therapy to clean and filter your blood.
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