By Alluru S. Reddi
Fluid, Electrolyte and Acid-Base issues: medical overview & Management is a transparent and concise presentation of the basics of fluid, electrolyte and acid-base problems often encountered in medical practice.
Each bankruptcy starts with pertinent simple body structure by way of its medical ailment. situations for every fluid, electrolyte and acid-base disease are mentioned with solutions. moreover, board-type questions with motives are supplied for every medical disease to extend the information for the clinician.
Practical and clinically orientated, this booklet is a convenient reference for working towards physicians, scholars, citizens and fellows.
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Extra info for Fluid, Electrolyte and Acid-Base Disorders: Clinical Evaluation and Management
Diuretic agents. Clinical physiology and pharmacology. San Diego: Academic; 1997. 3, we discussed how NaCl and water are handled by various segments of the nephron. Since Na+ is the major extracellular electrolyte, the total amount of this electrolyte and its accompanying anion (Cl−) determine the extracellular fluid (ECF) volume. Therefore, retention or excretion of Na+ by the kidneys is critical for the regulation of ECF volume. This regulation of NaCl is precise in normal individuals. In a steady state, urinary Na+ approximates dietary Na+, as the kidneys are major excretory organs of Na+ besides gastrointestinal tract and skin.
Physical examination shows ascites and pitting edema in both lower extremities. He is started on several medications, including spironolactone. Question 1 What effect does spironolactone have on serum [K+] and acid–base balance? Answer Spironolactone is a competitive antagonist of aldosterone by antagonizing the mineralocorticoid receptor. By counteracting the effect of aldosterone, spironolactone inhibits K+ secretion in the cortical collecting duct, causing hyperkalemia. Spironolactone also inhibits H+ secretion at the same site, causing metabolic acidosis in cirrhotic patients.
Question 2 Does the patient need blood transfusion (packed RBCs) to raise Hb levels > 10 g/dL? Answer No. The patient needs transfusion of packed RBCs once her Hb drops below 7 g/dL. Question 3 At what stage does the patient need infusion of 5 % albumin? Answer If the blood pressure does not improve with substantial amount of normal saline and the patient has trace edema, infusion of albumin may help to restore blood pressure and tissue perfusion. In a patient with intravascular volume depletion due to diarrhea or other causes, the presence of peripheral edema may imply adequate volume replacement.