Is

J&y fit

Figure 17 Avoid uxijeaiiiva sail reslilction.

Figure 17 Avoid uxijeaiiiva sail reslilction.

Hyponatremia is commonly seen in ATM. This is usually due to administration of too much tree water, endogenous free water production from tissue catabolisrti and/or the prescription of excessive sali restriction {rig?. 17 & lay

Hyperkalemia is often seen in ATM and may cause cardiac arresi. If, in spite of medical treatment, plasma potassium continues to increase, the only solution is dialysis (Fig, i9)r

Anemia is a constant clinical feature in ATN and usually in two weeks the hematocrit is down in the 20's (Fig 20). This is usually secondary to decreased erythropoietic hemolysis and blood loss.

Figure 20 Hematocrit decreases

There are changes in the metabolism of carbohydrates, lipids and proteins, but clinical manifestations secondary to these disorders are not obvious beeausc of the general condition of the patient.

Changes in the endocrine systcMl occur but J will not discuss them her*- since ihry arc beyond the scope of this book. In patients uitb ATi\ the urine shows (Fig 21): Dccrcistd urea and creatinine Proteinuria Hed blood cells lJccreascd cxcrction ol ("-!", NaJ and K* Casts

Symptoms Due to Organ System Involvement

Gastrointestinal (G, l.)

A dry brown tongue is present in uremic patients regardless of their hydration state (Fig. 22).

Nausea, vomiting and anorexia are usually present (Fig. 23).

G.I. bleeding is frequent in patients with ATN and can be very severe. Hematocrit drops acuiely, melena (Fig. 24) may be present and

induce a further increase in BUN and secondary to plasma protein digestion and destruction of hlood cells in the G.I, tract respectively (Fig. 25} Therefore, in ATN it is very important tu avoid the

Fgjnc 25 With GJ. bleed, plasma HUN iner&aaas due to absorption or n-tnogen 'rem olasrna piotfrrvs dig&stiori whale Iha riamanocrpt dcsriases idmioLstntioa of drugs ihai can cause massive G,l, bleeding, as may be seen with aspirin {Fig. 26). The use oF histamine two rcccprors inhibitors (e.g. cimctidine and ranitidine) for prophylaxis of peptic ulcers secondary to stress, may be very useful,

RSPlfilN

FORBID*

RSPlfilN

FORBID*

Figure 26 Aspirin should Im avoided in patients with AFlF.

Figure 26 Aspirin should Im avoided in patients with AFlF.

Respiratory Systetn

Fluid overload and pulmonary edema are frequent prohJcms for patients with ATN. Jt is very important to keep accurate records of fluid intake and output, as well as daily weights, to avoid "drowning" of the lungs (Fig. 27). Cough, orthopnea and bilateral rules are the usual signs of pulmonary edema

Figure 27 Fluid ove'aad and pulmonary edems.

CardiO fatcukir Sy&etn

There are iwo madn problems thai involve the heart. Increase in left ventricular work secondary ro fluid overload and hypertension, and in-flam mar ion of the pericardium (pericarditis). Congestive heart failure (CIIF) is usually related to fluid overload. As can be seen in Figure 2H, "the k-ft heart gets tired of fighting against the increase in intravascular volume", causing acule pulmonary edema.

Hyperkalemia may cause cardiac arrest as ! mentioned before (Fig.

Figúrese Heart fa 'lure

Figure Hyperkalemia may ta'jst? ujrd ¿'j ari&St.

/ytvrotogfe System The mail' neurological symptoms arc twirchiiijj (Fig 30), myo

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