Are there any principles in the treatment of renal failure i2017-01-24 11:31
Are there any principles in the treatment of renal failure in children? What do we notice during the treatment?
The treatment of chronic and chronic decay in children should be monitored in pediatric clinical (physical examination and blood pressure) and laboratory tests including hemoglobin. Electrolyte (hyponatremia. Hyperkalemia. Acid poisoning. Blood urea nitrogen and creatinine determination. Calcium and phosphorus levels and alkaline phosphatase activity. Regular examination of parathyroid hormone levels and bone X-ray films for early detection of bone dystrophy. Chest X-ray and echocardiography may be helpful in understanding cardiac function. Nutritional status can be regularly checked serum albumin. Zinc. Transformation of iron. Folic acid and iron levels to monitor.
1. The diet of chronic renal failure when the glomerular filtration is below 50%. Children's growth rate decreased. The main reason is insufficient intake of calories. Although not understanding the renal function. What is the appropriate amount of calories. But as far as possible to make caloric intake is equivalent to or higher than the age group of the child. Can be used to increase the calorie intake of carbohydrates, such as sugar. Jam。 Bee bee. Such as glucose polymer and fatty chain in three glycerol fat. But the patient can tolerate.
When urea nitrogen was higher than 30mmol/L (80mg/dl), the patient could be sick. Vomiting and anorexia. These can be limited by the restriction of protein intake. Because of the need to use a certain amount of protein in growth in renal failure. Protein 1.5g/ (D, kg). And should be given the high quality protein contain large amounts of essential amino acids (such as egg coat was su Huan?. Milk. Followed by meat. Fish. Chicken and poultry. The milk is too high phosphorus. Should not be used more. Need to use glucose. Peanut oil a kind of food to supplement the heat.
Loss due to inadequate intake or dialysis. Children with renal insufficiency. There may be water soluble vitamin deficiency. Must be added to the general. If there are trace elements of iron. Zinc and other lack of supply should also be. Fat soluble vitamins such as A. E. K is not necessary to add.
2. Treatment of pediatric renal insufficiency with water and electrolytes. Rare to be limited to the amount of. Because of the brain and thirst center regulation. Dialysis should be used unless end-stage renal failure is developed. The vast majority of children with renal insufficiency when using a proper diet to maintain normal sodium balance. Some patients with renal dysfunction due to anatomical abnormalities. When a large amount of sodium is lost in urine. The diet should be supplemented with sodium; the patient has hypertension. Edema or congestive heart failure should limit sodium. Sometimes combined with furosemide. 1 ~ 4mg/ (kg, 24h).
Because there is too much potassium in the diet. Severe acidosis or aldosterone deficiency (near glomerular destruction). Even with moderate renal insufficiency may also occur in high blood way. But in the vast majority of renal insufficiency in children can maintain his balance. If further deterioration of renal function. Dialysis treatment is required. Hyperkalemia in the first trial of potassium in diet intake control plus oral alkaline substances or Kayexalate (sodium polystyrene sulfonate. Kayexalate) treatment.
Almost all children with renal failure acidosis. Generally do not need to deal with. In addition to 100 serum bicarbonate below 20mmol/L. You need to be corrected with sodium bicarbonate.
3. Renal bone dystrophy with high blood phosphorus. Hypocalcemia. Parathyroid hormone levels and serum alkaline phosphatase activity increased. Often complicated with renal bone dystrophy. Generally, glomerular filtration rate is below 30%. Serum phosphorus levels were increased. Serum calcium decreased. Secondary four - like side gland. Hyperphosphatemia can be controlled by low phosphorus diet. Can also be used to promote oral antacids or calcium phosphorus discharged from the intestinal tract. Children also need to pay attention to the problem of aluminum poisoning. The level of serum aluminum should be regularly monitored.
Severe renal insufficiency may be associated with Vit.D deficiency. Vit.D for persistent hypocalcemia. X-ray showed increased serum alkaline phosphatase activity and rickets.
4. In most patients, hemoglobin was stable from 60 to 90g/L (6 ~ 9g/dl). No need for a blood transfusion. If hemoglobin is less than 60g/L then carefully enter the red blood cell 10ml/kg (small amount can reduce the risk of blood circulation overload). ).
5. Hypertension on hypertensive emergency sublingual nifedipine or two diazoxide diazoxide injection by intravenous 5mg/kg (i.e.. Maximal 300mg. Injection in 10 seconds. Severe hypertension blood circulatory overload can give furosemide (2 ~ 4mg/kg. Speed is 4mg/min. Renal function insufficiency. To be careful with the use of sodium nitroprusside. Toxic accumulation of acid salt.
Continuous high blood pressure can be combined with restricted intake (2 ~ 3g/d). Furosemide 1 ~ 4mg/ (kg - D). Propranolol (1 ~ 4mg/ (kg * d)) and hydrazine (~ 5mg/kg). Minoxidil (minoxidil) and captopril (captopril).
In a word, we should strive for early diagnosis. Removal of cause. If found too late. Although the removal of the cause. The damage of kidney tissue has been difficult to restore. Such as disease because of urinary tract obstruction. Corresponding surgical treatment should be done. But children are often in poor renal function. Can't tolerate too much surgery. Can be done first kidney ostomy or suprapubic bladder ostomy. Drainage by drainage. If there is persistent or intermittent pyuria. Infection should be actively controlled. And track review. Patients with end-stage renal disease or difficult to recover renal failure. In recent years, the application of chronic hemodialysis. Long term intermittent hemodialysis. Enable many patients to continue to live or to return to normal life. Current long-term regular dialysis. General dialysis 3 to 2 times a week. Can be carried out at night to sleep. Children receiving chronic dialysis therapy. The development of secondary sexual characteristics. No significant effect on weight gain. Only slightly affected height. In recent years。 The implementation of chronic dialysis in foreign countries has been