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During hemo-dialysis about 500 ml (range 50-800 ml) of dialysate flows through the dialyer (The plastic casing that contains dialysis membrane and which partitions blood on one side and dialysate on the other).
Water treatment is an essential requisite for safe dialysis.
In a 4 to 5 hrs session about 120 to 150 liters of water thus comes into contact with blood.
A very small impurity in this water thus can get magnified and produce serious consequences in the renal failure patient.
If dialysis water is unfit, it results in recurrent fever, poor health and nutrition of patient, electrolyte abnormalities etc. High aluminium levels can produce brain disorder called dementia and aluminium related bone disease. High chlorine levels can cause severe reactions.
Water treatment is done for ensuring safe dialysis water.
If ground or municipal supply provides hard water it is softened by machine.
Particulate matter is removed by filters consisting of pebbles, sand and other materials first so that large particles are removed, small particles than are removed by microfilters which can remove 5-micron size particles.
Chlorine is removed by adsorption on to carbon particles. It should be present in water before it is treated but removed during water treatment.
Excessive salts are measured as TDS (total dissolved solids) expressed as parts per million or ppm in short.Both cations and anions measured and TDS is equal to about 100 X total ions expressed as milliequivalents. It is usually 0.5 to 1 times the conductivity value.
Bacteria and their products produce harmful substances. These need to be removed and water prevented from letting them grow again by regular maintenance of the pipes and drainage system.
To produce water of sufficiently good quality, various criteria have been laid by different countries. AAMI dialysis criteria is one such criteria. In these acceptable levels of various chemicals and other impurities are mentioned.
Good quality dialysis water reduces morbidity, mortality, and complications in dialysis. It results in better overall health and quality of life for the patient.
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…