Early treatment of acute renal tubular necrosis2017-09-19 17:05
Some of the causes of acute tubular necrosis are preventable, mostly reversible, and renal function can be fully restored within weeks or months after timely treatment.
The treatment of oliguria stage: frequent oliguria, acute pulmonary edema, hyperkalemia, upper gastrointestinal bleeding and complicated infection lead to death. Therefore, the focus of treatment is regulating water, electrolyte and acid-base balance, controlling nitrogen retention, providing adequate nutrition, prevention of complications and treatment of primary diseases.
Diet: those who can eat as much as possible use the gastrointestinal tract to supplement nutrition, and give the light liquid or half liquid food as the main. Water, sodium salts, and potassium salts are restricted as appropriate. Early limiting protein (high biological potency protein 0.5g/kg), severe ATN patients often have obvious gastrointestinal symptoms, from the gastrointestinal tract to supplement part of nutrition.
Maintenance of water balance: Patients with oliguria should be strictly calculated 24 hours of water intake and discharge. The following points may be used as a moderate indicator of fluid infusion: subcutaneous dehydration or edema; daily weight loss; if excess 0.5kg or more indicates excessive body fluid; serum sodium levels are normal. If it is low and without salt loss, it suggests fluid retention, and the central venous pressure is between 0.59 and 0.98kPa. If it is higher than 1.17kPa, it indicates excessive body fluid; the blood vessels of chest X are normal. If the lung congestion signs, suggesting fluid retention, heart rate, blood pressure, respiratory rate, if there is no sign of infection, should be suspected of excessive fluid.
Hyperkalemia treatment: the most effective way is hemodialysis or peritoneal dialysis. If there is severe hyperkalemia or high catabolic status, hemodialysis should be appropriate.
Metabolic acidosis: in the absence of high catabolic oliguria, enough calories are added to reduce tissue breakdown in the body, and metabolic acidosis is not serious. But high metabolic metabolic acidosis occurs early, with a severe degree and is sometimes difficult to correct. Severe acidosis may aggravate hyperkalemia and should be treated promptly.