1. CKD answers

2. Chronic Renal Failure- Management
Drug therapy
Which drugs are used to treat the patient in ESRD in the following areas? Please provide specific examples.
Fluid overload & edema? LOOP, K+ sparing, thiazide) Lasix, bumex, demadex, Zaroxylyn , HCTZ
Blood pressure? Ca+ channel blockers, beta blockers, ARB, ace inhibitors
Nausea and vomiting?
Gastric acid secretions? H2 blockers, PPIs Zantac, protonix, Carafate
Constipation? senekot
Anemia? Erythropoetin
Itching /Pruritis?
Hyperphosphatemia? Calcium carbonate (calcium phosphate binder), SEVELAMAR

3. Signs of Hyperkalemia peaked T waves -- K level go around 6 meq/L.
prolongation of PR interval --K level going around or above 7 meq/L.
Absent P wave with widened QRS complex -- is a very dangerous sign. It means that atrial activity is lost and stage is set for ventricular tachycardia/fibrillation. It is usually seen at level around 8-9 meq/L.
Ventricular tachycardia/fibrillation is the price you pay of ignoring above changes on monitor.

4. Chronic Renal Failure- Emergency Management of Hyperkalemia
1.Ca+ chloride or Ca+ gluconate (restoring normal gradient between threshold potential and resting membrane potential)
2.Kaexalate- resin orally or rectally takes hours
3.GIK intravenous injection of units of regular insulin along with 50 ml of 50% dextrose (lasts a few hours while doing more permanent measures)
4. Na+ HCO3 therapy (e.g. 1 ampule (50 mEq) infused over 5 min) shiftings potassium into the cell.

5. Management of Hyperkalemia
5. Ventolin- (15 mg albuterol via nebulizer)
- Albuterol works to lower potassium concentrations by stimulating the release of insulin. This release of insulin shifts the potassium into the cells thus lowering the potassium level.
- Albuterol also stimulates the Na/k+ pump causing potassium to be shifted into the cells.