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Blood flows on one side of membrane while dialysate flows on the other side. To ensure effective dialysis a high blood flow is required for taking blood from the body to the dialysis machine. The blood flow required is about 5ml/kg body weight /min. Usually 250 ml to as much as 500-600 ml if tolerated.
The way to achieve this is through creation of dialysis access. This may be temporary or permanent.
A temporary access is made in those patients who will require dialysis for a few days to few weeks as in acute kidney injury ( also called earlier as ARF or acute renal failure), while awaiting creation of a permanent access.
Temporary access is obtained by inserting a tube in neck veins (Int Jugular Vein) usually on right but sometimes on left side. It is uncommon nowadays to use subclavian (behind collar bone ) or upper thigh veins. The advantage of this is that it is ready to use immediately however it often gets infected and may cause clot formation in the vein in which it is placed. It should be used for less than 2 weeks and never handled by patient. Sudden dislodgement may cause bleeding. In case long term dialysis is required and AV fistula( read further on to know about AVF) is not yet ready a permanent dialysis catheter which is useful for a few months is a far better though costly choice.
The method of choice is creation of arterio-venous fistula (AVF). It is usually made in the wrist but if blood vessels are small or thrombosed it is at times made in arm near elbow. This requires surgery usuaally under local aneasthesia. The failure rates are higher if done by inexperienced surgeons (1 in 2 to 1 in 4 AVFs may fail.)
It takes 2 to 3 months to mature and hence should be made much before the need of dialysis arises. It should be checked to see that it is working. If there is stoppage of flow early treatment may make it work again but if delayed another AVF creation is required.
If injured rapid bleeding may occur. So protect these from injuries. Do not allow these to be used for drugs and samples other than in dialysis room by dialysis personnel.
A good AVF is a life line for patients. Get it made early & keep it functional !!
For patients suffering from type II /adult onset diabetes :In type II diabetes, diagnosis is often late (after the disease has already been present for some time). In early days T2DM (short for the adult type of diabetes) are often without symptoms. Hence the delay in diagnosis. This means complications will be seen early after diagnosis. Foot Care :
Foot disease in diabetes may lead to difficulty in walking, pain and may lead to infections. If neglected amputation may be required.
Inspect feet with a mirror before going to sleep every night.
Use well fitting shoewear.
Do not walk bare feet even in the house.
Socks should be clean and correct size.
In case of deformities of feet, special shoes can be worn. Eye Care :
It is nowadays the commonest cause of blindness throughout the world. Continue Reading ~ Second Medical Opinion / Advice
Nephrotic Syndrome Kidneys receive approximately 1 liter of blood every minute. Of this, about 100 ml gets filtered in the kidney. This contains, small molecules and few large molecules. This is due to the intricate cellular structure that prevents proteins from getting filtered into the urinary space. A derangement of this filter results in passage of heavy amounts of proteins in urine. This condition is called HeavyProteinuria or Nephrotic syndrome or Nephrosis. Definition:
In the urine, the protein excretion is > 3.5 gm/day or in children, it is >50mg/kg of body weight. In most cases, the serum albumin is <3gm/dl (normal>4), and passage of lipids in the urine. The lipids in the blood increase and swelling of face and feet also occur. Causes of Nephrotic Syndrome:
In children, most cases are due to Minimal Change Disease, FSGS, MPGN etc. In adults, most cases are due to primary illness while upto 30% may be due to secondary illness. Clinical Features:
Apart from Edema, ther…
Asthma or Bronchial Asthma is a common disease. About 75 % cases start in childhood before 10 years of age. A large no of patients stop having symptoms at the time of puberty and some may again have the disease in the later years. It is uncommon after 50 years of age. It can be troublesome, disabling and if not treated properly may be dangerous.
The disease results from heightened reactivity of the airways in response to irritants, allergens, fumes and at times exercise. It is typically intermittent and a person feels well when there is no ongoing attack of asthma. Symptoms:
Symptoms of asthma are shortness of breath, difficulty in breathing, cough and whistling sounds during breathing. These symptoms may also be seen in a no of heart, lung or infective conditions. Hence the diagnosis is usually made by experienced doctors after a few episodes have occurred!
The important markers of the disease are rapid reversibility of the signs and symptoms with appropriate treatment or spontaneousl…