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Acute Renal Failure.

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Presentation on theme: "Acute Renal Failure."— Presentation transcript:

1 Acute Renal Failure

2 CASE 1 Mr. B. is a patient in the intensive care unit with ARF whose arms are observed to flex in intermittent involuntary tonic contractions. Urea and electrolyte results revealed the following (normal value) Sodium mmol/L ( ) Potassium mmol/L ( ) Calcium mmol/L ( ) Phosphate mmol/L ( ) Urea mmol/L ( ) Creatinine μmol/L (50-120) Question: What is the cause of this condition and how should it be treated?

3 CASE 2 Mr D has been admitted to an intensive care unit with ARF which developed following a routine cholecystectomy . his electrolyte picture shows the following Sodium mmol/L ( ) Potassium mmol/L (3.5-5) Urea mmol/L (3-6.5) Bicarbonate 19 mmol/L (22-31) Creatinine μmol/L (50-120) pH ( )

4 CASE 2 the patient was connected to an ECG monitor and the resultant trace indicated absent p-wave and a broad QRS complex. Question: Explain the biochemistry and ECG abnormalities and indicate what therapeutic measures must be implemented.

5 Answer of case 1 Convulsion is due to electrolyte disturbance
Treatment: Correction of electrolytes (ca- gluconate , phosphate binder) Anticonvulsant and hemodialysis

6 Answer of case 2 Hyperkalemia is one of the principal problems encountered in patients with renal failure. The increased levels of k arise from failure of the excretory pathway &also from intracellular release of k. attention should also be paid to pharmacological or pharmaceutical processes that might lead to k elevation “k-supplement, ACE I “. The acidosis noted in this patient, which is common in ARF, also aggravates hyperkalemia by promoting leakage of k from cells. Serum k level greater than 7 m mol\L indicates that emergency ttt is required as the patient risk-life-threatening ventricular arrhythmia &asystolic cardiac arrest if EEG changes are present as in this case emergency ttt should be initiated when serum k rise above 6.5 m mol\L .

7 Answer of case 2 The emergency ttt should include the following:
1-Stabilization of the myocardium by I.V administration of ml ca.gluconate 10% over 5-10 min the effect is temporary but the dose can be repeated. 2-I.V adm. Of units of soluble insulin with 50 ml of 50% glucose to stimulate cellular k uptake the dose may be repeated. The blood glucose should be monitored for at least 6 hr to avoid hyperglycemia.

8 Answer of case 2 3-I.V salbutamol 0.5 mg in 100ml 5%dextrose over 15 min has been used to stimulate the cellular sod-k-atpase pump & thus drive k into cells. This may cause disturbing muscle tremors at the doses required to reduce serum k levels. 4-Acidosis may be corrected with I.V dose ml of NaHCO3 8.4% correction of acidosis stimulates cellular k –uptake. Hypertonic HCO3 soln(8.4%)can cause volume expansion & should be used with extreme caution.

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