Professional Documents
Culture Documents
Management in Renal
Failure
By :
dr. Yudi Hadinata
Consultant :
dr. Wiwi Jaya Sp.An
NEPHRON
NEPHRON
Renal Functions
Acid Base
Acid Base
Homeostasis
Homeostasis
Excretion of
Excretion
wastes of
wastes
Osmolality
Osmolality
Regulation
Regulation
Hormone
Hormone
Secretion
Secretion
Blood pressure
Blood
pressure
regulation
regulation
(Morgan, 2006)
Definition
Acute Renal Failure :
Diagnosis
Anamnesis
Physical exam
Anamnesis
Physical exam
Laboratory
findings
Laboratory
findings
Pulmonary
Cardiovascular
Neurological
Gastrointestinal
Hematologic
Endocrine
hyperparathyroidism
Metabolic
Renal
(Hines, 2008)
RENAL
FAILURE
Diagnosis
Creatinine level
(Morgan, 2006)
(Morgan, 2006)
Fluid Overload
Fluid
Overload
Hyperkalemia
Hyperkalemia
Severe
Acidosis
Severe Acidosis
Encephalopathy
Encephalopathy
Pericarditis
Pericarditis
Coagulopathy
Coagulopathy
Refractory
GIT
Refractory
symptomGIT
symptom
Drug
Toxicity
Drug Toxicity
(Morgan, 2006)
Preoperative Evaluation
Progressing
Progressing
Renal
Renal
Diseas
Diseas
e
e
Stable
Stable
Diminishing
Diminishing
Hemodialy
sis
Hemodialy
sis
Clinical Evaluation
Respiratory
Clinical
Evaluation
Hemodynamic
Respiratory
Urine Production
Hemodynamic
Urine Production
Laboratory Result
Hb,
Electrolyte, BT/CT,
PT/APTT
Laboratory
Result
Hb, Electrolyte, BT/CT, PT/APTT
Ureum/Creat
inine
Ureum/Creat
inine
Input
Input
Outpu
Outpu
t
t
Dietary
Dietary
intake
intake
Urine
Urine
IV fluid
IV fluid
Insensible
Insensible
water
loss
water loss
Blood
Blood
products
products
Bleeding
Bleeding
Renal excretion
Partially renal
excretion
Induction drug
Barbiturates
Muscle relaxant
Gallamine, metocurine
Pancuronium,
vecuronium
Neostigmin,
Edrophonium
Cardiovascular drugs
Digoxin, Inotropes
Atropine,
Glycopyrollate,
milrinone,
ydralazine
Antimicrobials
Aminoglycosides, vancomycin,
cephalosporin, penicillin
Sulfonamides
Cholinesterase
inhibitor
Drugs
Warning
Dose
Intravenous
Propofol
adjustment
1-2 mg/KgBW
Etomidate
adjustment
0.20.4mg/KgBW
Thiopenthal
adjustment
2-3mg/KgBW
Ketamine
!Hypertension
Isofluran
safe
Desfluran
safe
Sevofluran
Toxic (Compound A)
Halotan
Toxic (Fluoride)
Enfluran
Toxic (Fluoride)
N20
Lidocain
depends
Benzodiazepin
Accumulation
Inhalation
Other drugs
1-1.5 mg/KgBW
(Morgan, 2006; Hines, 2008)
Type of Drugs
Drugs
Warning
Dose
Opioid Analgetics
Fentanyl
Hepatic clearance
2 - 150 ug/Kg
Remifentanyl
Hepatic clearance
1 uq/Kg
Sulfentanyl
Hepatic clearance
0.25-30 ug/Kg
Alfentanyl
Hepatic clearance
8-100 ug/Kg
Morphine
Metabolic Accumulation
0.1 - 1 mg/Kg
Meperidine
Metabolic Accumulation
2.5-5mg / Kg
Muscle Relaxant
Muscle
relaxant
Renal excretion
Dose (Mg/KgBW)
(%)
Mivacurium
< 10
0.15
Atracurium
10
0.4
Rocuronium
10
0.6
Vecuronium
15
0.1
Doxacurium
30
Pipecuronium
38
Pancuronium
40
Metocurine
43
Tubocurarine
45
Gallamine
90
Succinylcholin
Conclusion
Preoperative
Preoperative
evaluation
evaluation
Safe Drugs
Safe Drugs
Good
Good
Outcome
Outcome
Monitoring
Monitoring
Post operative
Post
operative
Management
Management
THANK YOU
Hyperkalemia
Signs :
Treatment :
Dialysis