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Treatment of Acute Tubular necrosis

In this article we will discuss management of  the three stages of Acute Tubular necrosis in details .

 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

Treatment of the Polyuric phase 

• Fluid, replacement is sometimes required with Na and K supplements.
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Tamer Mobarak

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