Transcript
Page 1: Acute peritoneal dialysis prescription

Acute peritoneal dialysis PrescriptionYousaf khanLecturer Renal diaysisIPMS-KMU

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Introduction Provide nephrologist with non vascular alternative dialysis Use intensive care setting, actually less efficient that conventional

dialysis Its continuous nature comparable with dx Management of actual renal failure with toxic or metabolic, electrolyte,

volume problem in critical ill patient Use in children it low cost make attractive

Advantage: simple than other mode of dx Does not require highly trained person or expensive complex equipment Perform usually manually but can be done by cycle Avoid vascular problem like hemorrhage, air embolism and thrombosis

ets Does not require anticoagulation Hemodynamicaly instability, lacked blood hemodialyzer reaction

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Disadvantage: PD is less efficient than hemodialysis in the treatment of

acute problem like pulomary edema, poisonings or drug overdose, acidosis and hyperkalemia ets

Protein losses can be substantial in PD and could complicate the care of already malnourished, critically ill patients.

Morbidity 30% and mortality 5%

Indication: Acute renal failure Hemodynamically unstable patients Patient in whom vascular access is problematic

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Contraindication: Recent surgery requiring abdominal drains Fungal peritonitis Severe hypercatabolic states and abdominal wall

cellulitis Peritoneal fibrosis hernia Big poly cystic kidney

Peritoneal catheter: Initial insertion of a Tenckhoff catheter

Use of Automated cyclers: Traditionally been done using manual exchanges APD with considerable saving time

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Prescribing acute peritoneal dialysis:A: Session length: In the setting of acute renal failure, continous removal of fluids and

solutes is required in a patient who often is catabolic, oliguric and in need of ongoing nutritional and therapeutic support.

24 hr at a time, reassessing and altering the prescription as indicated.

B: Exchange volume: Depend size of peritoneal cavity Average size adult can usually tolerate 2L exchange Some nephrologist prefer to start with smaller volume 1-1.5L for the

first few exchange.

C: Exchange time: Combine time required for inflow, dwell and drain Most commonly use 1hr, although 2hr exchange time also are

commonly. Inflow 10 mint, dwell time 30 mint and outflow 20 -30 mint

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Acute peritoneal dialysis order

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Prescribing acute peritoneal dialysis:D: Choosing the dialysis solution dextrose concentration:

E: Dialysis solution additives: Potassium, Heparin (1000 units/2L) and Insulin

(administration may be required for diabetic patient)

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Prescribing acute peritoneal dialysis:F: Monitoring fluid balance

G: Monitoring Clearance:

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Complication A number of problems may arise during the course of acute

peritoneal dialysisAbdominal distention: Incomplete drainage may lead to progressive intraperitoneal

accumulation of dialysate with attendant discomfort, distention, and even respiratory compromise.

Peritonitis: Peritonitis may complicate acute peritoneal dialysis in up to

12% of cases. This is occurs most often within the first 48hr Infection from gram positive dominant

Hypotension: Rapid removal of large amounts of fluid can lead to

hypovolemia with consequent hypotension, arrhythmia and even death.

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ComplicationHyperglycemia: In the daibetic or prediabetic patient, the high dextrose

solutions used for peritoneal dialysis can result I hyperglycemia.

Hypernatremia

Hypoalbuminemia: With the frequent exchanges utilized in acute peritoneal

dialysis, protein loss via the dialysate can be as high as 10 – 20g per day and up to twice this amount if peritonitis.

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Thank You


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