Indications for dialysis in AKI- Potassium >6
- pH <7.2 or bicarb <10
- Pulmonary oedema without diuresis
- Uraemic pericarditis
- Uraemic encephalitis
Four functions of the kidney - Excretion
- Regulation
- Metabolism
- Endocrine
Infections in pregnancy - Chicken pox
- Risk to mother (pneumonia) and to baby (fetal varicella syndrome)
- Specialist advice may recommend oral aciclovir 800 mg x 5 daily for 5-7 days if >20 weeks
- No role for varicella immunoglobulin once infection has been contracted
- If in late pregnancy => Premature delivery => Neonatal chickenpox
- Treat with immunoglobulin and aciclovir
- Rubella
- Risk of congenital rubella syndrome
- Infection in the first 8-10 weeks of pregnancy results in damage in up to 90% of surviving infants
- The risk of damage reduces to 10-20% if the infection is in the first 11-16 weeks of pregnancy
- Fetal damage is rare over 16 weeks of gestation
- No treatment
- Offer TOP if positive IgM in the first 16 weeks of pregnancy
- Measles
- Risk to mother (measles pneumonia)
- Prophylactic vaccination if unimmunised (vaccine stimulated immune response faster than organism)
- Parvovirus B19
- Risk to foetus
- 30% chance of transfer to baby; 5-10% chance of fetal loss
- Especially in first trimester
- Test for parvovirus B19 (and rubella) IgM and IgG as soon as possible after contact with, or symptoms of, a rash illness
- Refer to specialist centre (Fetal blood sampling / intrauterine transfusion of erythrocytes / early delivery)
Notes - Angiotensin II is a potent vasoconstrictor as well as stimulating aldosterone release
- Consequence of high phosphate in CKD
- Pyrophosphate arthropathy
- Calcinosis cutis
- Phosphate => calcium deposition as CaPi
- When the calcium-phosphate product exceeds 70 mg2/dL2
- KEEP GIVING calcium gluconate until ECG normalises
- Amiodarone is a P450 inhibitor
- Many interactions, e.g. with statins => rhabdo
- nsAid affect Afferent, acEi affects Efferent
- ACEi => Efferent vasodilatation => Reduced hypertensive renal damage
- But in renal artery disease the kidneys rely on efferent vasoconstriction to maintain renal blood flow
- Dietary protein => Acidosis
- Parvovirus B19 = Slapped cheek = Erythema infectiosum
- Measles is the most infectious disease known to man
- Any face-to-face contact / 15 minutes in the same room
- Children under 12 months do not respond to MMR vaccination
- Maternal antibodies neutralise it
- May give some protection in an epidemic, but ignore a pre-12 month dose otherwise
- Meningitis PEP is with CIPROFLOXACIN
- Single dose 500 mg
- NOT rifampicin
- For overnight stay / kissing contacts
- Protective Neisseria strains are killed by ciprofloxacin PEP => Only give to those that are indicated
- Leigionella
- No known cases of human-human transmission
- Only grows if water is between 20 and 45 degrees
- "Doesn't know if it's Tuesday or wheelbarrows"
|
|
