In this article we will discuss management of the three stages of Acute Tubular necrosis in details .
• General measures:
- Good nursing.
- Daily body weight to assess fluid balance changes.
• ttt Hyperkalemia by Ca gluconate (10 ml of 10% solution) to reduce the risk of arrhythmia. Reduction in serum potassium is achieved by I.V administration of 100 ml of 50% glucose plus 10 units of rapid acting insulin.
Ion exchange resins, e.g polystyrene sulphonate resins (Sorbisterit) orally to prevent subsequent
hyperkalemia.
• Acidosis treated with I.V sodium bicarbonate.
• Fluid balance i.e, daily fluid intake should equal urine output plus losses from fistulae and from vomiting plus an allowance of 500 ml daily for insensible loss.
- Protein restriction to 40 gm/day if it is hoped to avoid dialysis.
- Patients treated by dialysis must receive 70 gm/day protein.
- Hypercatabolic patients will require an even higher nitrogen intake to prevent negative nitrogen balance.
• Control blood pressure.
• Vitamin supplements are usually needed
Treatment of the Oliguric phase
• The aim of management is to keep the patient alive until spontaneous recovery of renal function occurs.• General measures:
- Good nursing.
- Daily body weight to assess fluid balance changes.
• ttt Hyperkalemia by Ca gluconate (10 ml of 10% solution) to reduce the risk of arrhythmia. Reduction in serum potassium is achieved by I.V administration of 100 ml of 50% glucose plus 10 units of rapid acting insulin.
Ion exchange resins, e.g polystyrene sulphonate resins (Sorbisterit) orally to prevent subsequent
hyperkalemia.
• Acidosis treated with I.V sodium bicarbonate.
• Fluid balance i.e, daily fluid intake should equal urine output plus losses from fistulae and from vomiting plus an allowance of 500 ml daily for insensible loss.
• Diet
- Sodium and potassium restriction with rare exception.- Protein restriction to 40 gm/day if it is hoped to avoid dialysis.
- Patients treated by dialysis must receive 70 gm/day protein.
- Hypercatabolic patients will require an even higher nitrogen intake to prevent negative nitrogen balance.
• Control blood pressure.
• Vitamin supplements are usually needed
