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HEMODIALYSIS

Q. 601. Describe the various component of dialysate fliud?


HEMODIALYSIS

hemodialysis complications hemodialysis meaning hemodialysis machine hemodialysis procedure hemodialysis and peritoneal dialysis


Q. 601. Describe the various component of dialysate fliud? 

A. Reference: Dugridas,  hand book of dialysis 1994:

Dzt component:

Conc.:

 

   Sodium:      

 

135-155   meq/L

 

Potassium:

-       0 - 4        meq/L

 

Calcium:

-       1.25 (std)  to 1.75   mmol/L  2.5 (std) to 3.5     meq/L

 

Magnesium:

-       0   -   0.75          mmol/L

0- 1.5               meq/L

 

Chloride:

-       87- 120            meq/L

 

Bicarbonate: (standard)

-       25-40                meq/L

 

Glucose:

-       0 (std) to 20  mg/dl

Q. 602. What are the criteria of amyloid cyst?   ……

hemodialysis complications hemodialysis meaning hemodialysis machine hemodialysis procedure hemodialysis and peritoneal dialysis



                                            A.“Amyloid cyst”:

Œ é10 mm. (one cm) size é shoulder & hip.

 é size by 30 % yearly.

Ž Joint space Normal (dcr. in osteoarthritic cyst.).

 Involve more than two joints.

 Multiple (to D.D. fr. Brown tumor of O.F.C., which’s solitary é hip, jaw,& rib.).

-Brown tumor: A fibrous degeneration, cyst formation, and the presence of fibrous nodules in bone, usually due to HYPERPARATHYROIDISM.

Q.603. How to prevent/ttt. amyloid cyst formation?

 A. Prevention of amyloid cyst ] use a biocompatible “Polysulphone  Dzr.

         - Definitive ttt. ] R.Tx.   👈

Q.604. What is the effect of acidosis on serum K+ level?

A. Every {0.1} P.H. Lower ] 🠞{ 0.7} mmol K+ higher. 

Q.605. Can dialysis patients use Sildenafil (Viagra)?    💘

- Phosphodiasterase inhibitor, Sildenafil (Viagra) cn be used é CrCl <30 mL/ min. é starting dose of 25 mg.

- Viagra  shd NOT be given in three situation:    👌

1)   Nitrate therapy.

2)   Angina pectoris. 

3)   Recent  M.I. (+ve troponin I).

 Q.606. What tumor markers valid in ESRD? What tumor markers  false + ve in ESRD ? What tumor markers false +ve in ESRD?

 

 A. Tumor markers (valid) in ESRD:

1)   a.feto protein.

2)   Total PSA.

3)   C.A. 72

4)   C.A. 125 in non-P.D. ptn.

_ Tumor markers  false +ve in ESRD?

 A.False +ve markers:    

1.    C. A.

2.    G.G.T.

3.    C.A. 125. (in P.D.).

4.    Acidic P.S.A.

5.    C.E.F.

-  AST/ALT   🠞  Normal or low in ESRD.

Q. 607. What are the types of immunoadsorption?

R
 A. Immunoadsorption:      👌

 Protein A coated.

Phenyl alanine coated.

ƒ Anti-human A.B. coated.         

Q.608. What are the indications of plasmapharesis (Pph)?

 A. Indications of Pph: 

 I. Standard Pph:  

1)   Anti-GBM.(Goodpasture's syndrome).

2)   TTP/ HUS.

3)   Mixed cryog. with or without polyneuropathy.

4)   Hyperviscosity syndrome. (waldenstrom).

II. Supportive Pph:

1.    RBGN (crescentic G.N.).

2.    Myeloma kidney.

3.    Post-transfusion purpura.                 

4.    Sickle cell disease. (Cytapharesis).                      

5.    Familial hypercholesterolemia.

III. OTHERS:   

                               i.    Recent FSGS. (post Tx).

                              ii.    A.B.- mediated rejection.

                             iii.    Recent HLA sensitization.

                             iv.    Recurrent N.S.

                              v.    IgA: short term benefit.

                             vi.    Lupus cerebritis.

                            vii.    ANCA- associated Vasculitis.

                          viii.    Thrombocytosis.

                             ix.    i.x. Guian Barre Snd.

                              x.    |M. Gravis.

 

Q.609. In which situations plasmapharesisis is NOT beneficial?  

 A. Pph is NOT beneficial  é:   👌

ΠC.A.N.

 Amyloidosis.

Ž Lupus Nephritis.

Q. 610. Describe the technique of plasmapharesis (Pph)?

 A. Technique of Pph: 

                                I. Filter Membrane- plasma filter, e.g. cryofilter.

                              II. Separator Centrifugal cell separator.

Q. 611. What are the side effects of plasmapharesis (Pph)?

 A. Side effects”of Pph: 

 Infection.

Access clotting.

ƒ Bleeding tendency.

Thrombocytopenia.

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