Peritoneal dialysis prevention

Furthermore, pH determination has been used in other clinical research, both alone and in combination with other measurements. This research includes studies into the relationship between extracellular and intracellular pH in an ischemic heart [6, 7], the pH of airway lining fluid in respiratory disease [8], the study of pH as a marker for pyloric stenosis [9], malnutrition in alkalotic peritoneal dialysis patients [10], pH modulation of heterosexual HIV transmission [11, 12], and wound prevention and treatment [13], In addition, pH changes due to blood acidosis have been used to trigger and pace the ventricular rate of an implanted cardiac pacemaker [14], Research using pH measurements... 

The supportive treatment of aspirin poisoning may include gastric lavage (to prevent the further absorption of salicylate), fluid replenishment (to offset the dehydration and oliguria), alcohol and water sponging (to combat the hyperthermia), the administration of vitamin K (to prevent possible hemorrhage), sodium bicarbonate administration (to combat acidosis) and, in extreme cases, peritoneal dialysis and exchange transfusion. 

Acute poisoning is treated with gastric aspiration and lavage combined with intensive supportive therapy, including thorough assessment of the patient plus measures to prevent respiratory failure. In cases of very severe poisoning, peritoneal dialysis or hemodialysis may be necessary. 

Various techniques to enhance elimination of caffeine have been reported in the literature. Multidose activated charcoal has been advocated to both prevent further absorption of drug and enhance elimination by gut dialysis. Hemodialysis has been reported in the literature for the treatment of caffeine toxicity. The mean plasma protein binding of caffeine (36%), the molecular size (194), and the volume of distribution (0.6-0.81kg ) make hemodialysis a possible modality to enhance elimination. There have also been cases of severe caffeine toxicity treated with peritoneal dialysis, but this modality is less efficient at drug clearance than hemodialysis. 

Acute neonatal hyperammonemia, irrespective of cause, is a medical emergency and requires immediate and rapid lowering of ammonia levels to prevent serious effects on the brain. Useful measures include hemodialysis, exchange transfusion, peritoneal dialysis, and administration of arginine hydrochloride. The general goals of management are to... 

The prevention and treatment of severe metabolic acidosis in patients with kidney disease is also important to prevent the development of renal bone disease, fatigue, decreased exercise tolerance, reduced cardiac contractility, and increased ventricular irritability. Metabolic acidosis also appears to stimulate protein catabolism, which can contribute to a negative nitrogen balance and lower albumin concentrations, as well as cause growth retardation in children. Lower serum bicarbonate levels in peritoneal dialysis patients have also been associated with a higher hospitalization rate and longer hospital stays. Severe acidemia (blood pH <7.1 to 7.2) suppresses myocardial contractility, predisposes patients to cardiac arrhythmias, and may lead to a decrease in total peripheral vascular resistance and blood pressure, reduced hepatic blood flow, and impaired oxygen delivery. ... 

Waite NM, Webster N, Laurel M et al. The efficacy of exit site povidone-iodine ointment in the prevention of early peritoneal dialysis-related infections. Am J Kidney Dis 1997 29 763-768. 

Dialysis dysequilibrium may be prevented by avoiding vigorous hemodialysis in the early treatment of patients with severe uremia, infusing osmotic agents (e.g., manitol) during dialysis, premedication with phenytoin, or by performing the slower and less stressful peritoneal dialysis (B22). 

There is a single case report of the successful treatment of Rhodococcus equi causing peritoneal dialysis-associated peritonitis with oral azithromycin [304, 305]. Both azithromycin and clarithromycin were as effective as amoxycillin, clindamycin, and erythromycin in a viridans group streptococcal experimental endocarditis prophylaxis model in the prevention of endocarditis in this model [306]. In the 1997 recommendations of the American Heart Association either azithromycin or clarithromycin is recommended as one of the alternatives for IE... 

Klinkmann and Vienken, 1995). In the United States, kidney transplantation follows hemodialysis in the number of patients treated, but a limited donor pool prevents dramatic expansion of this option. Peritoneal dialysis trails hemodialysis and transplantation with only 13.5 percent of U.S. ESRD patients supported (USRDS, 2000). The combined cost for ESRD is staggering, with approximately 11 billion expended in the Medicare ESRD program alone in 1998, most of which is applied to hemodialysis treatment (USRDS, 2(KX)). The present section focuses on the use of he-modialyzers as a cardiovascular device addressing kidney failure. 

Fong IW Prevention of haemodialysis and peritoneal dialysis catheter related infection by topical povidone-iodine. Postgrad Med J 1993 69(suppl 3) S15-S17. 

Prevention of cutaneous infecbon around the site of peritoneal dialysis catheter exit site with long-term topical gentamicin was associated with nine cases of rapidly growing nontuberculous mycobacterial infecbons. Six cases... 

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