5 346
订阅者
+524 小时
+117 天
+9830 天
帖子存档
5 348
❇️Coming across the misuse of diuretics in kidney patients, here are some key points:
1. Diuretics are essential for the management of kidney patients.
2. Diuretics are only dangerous when the doctor is Dangerous, because of his ignorance.
3. Diuretics are often life saving!
4. In patients with advanced chronic kidney disease CKD3b to CKD5, thiazide diuretics are useless as they no longer work.
5. In patients with advanced CKD Loop diuretics have to be used.
6. In patients with advanced CKD the dose of loop diuretics has to be increased.
7. If kidney function is halfed, 50%, the dose is doubled =
Lasix 40mg X 2
If the function is quarter the normal, 25%, then the dose is X 4 = Lasix 40mg x 4, etc.
8. Lasix (LA Six) works for Six hours, then the dose has to be given every 6 hours... Not once a day!
9. Potassium supplements are usually NOT needed with diuretics in CKD.
10. Hyponatremia + Oedema = Salt + Water retention...So indication to Increase diuretics!
NOT to give SALT or cut down on Diuretics!
5 348
✳️ Gallbladder Stones:
❇️ Gallstones are hardened deposits of digestive fluid that can form in gallbladder.
❇️ Cholesterol gallstones are formed mainly due to over secretion of cholesterol by liver cells and hypomotility or impaired emptying of the gallbladder.
❇️ Pigmented gallstones, conditions with high heme turnover, bilirubin may be present in bile at higher than normal concentrations. Bilirubin may then crystallize and eventually form stones.
✴️ Symptoms and complications of cholelithiasis result when stones obstruct the cystic duct, bile ducts or both.
✴️ Temporary obstruction of the cystic duct results in biliary pain but is usually short-lived.
❇️ Patients with gallstone disease typically present with symptoms of biliary colic (intermittent episodes of constant, sharp, right upper quadrant abdominal pain often associated with nausea and vomiting), normal physical examination findings, and normal laboratory test results.
✅ It may be accompanied by diaphoresis, nausea, and vomiting.
✳️ Acute cholecystitis occurs when persistent stone dislodged the cystic duct causes the gallbladder to become distended and inflamed.
✴️ The patient may also present with fever, pain in the right upper quadrant and tenderness over the gallbladder.
✅ Ultrasound remains the first line and best imaging modality to diagnose gallstones.
✴️ Gallstones on ultrasound have the appearance of hyperechoic structures within the gallbladder with distal acoustic shadowing.
✴️ Sludge in gallbladder may also be seen, with an appearance of hyperechoic layering within the gallbladder. Sludge, unlike stones, does not cast acoustic shadowing.
❇️ If the following additional signs are noted, suspicion should be raised for acute cholecystitis: thickened anterior gallbladder wall (greater than 3 mm), the presence of pericholecystic fluid or positive sonographic Murphy's sign.
