CKD

When is dialysis indicated?

A
Acidosis
E
Electrolyt
es

I
O
Uremia

pH <7.2
manifestations: Cheyne-Stokes breathing, drowsiness, pCo2
Hyperkalemia
Manifestations: hyperreflexia
Cardiac: absent P waves, Peaked T waves,
Urinary:
cell K+ increases Resting membrane potential
Hypocalcemia
Manifestations: ST segment Prolongation
Shrinkage of cortex: glomerulus, loop of Henle except: DM,
Polycystic kidney disease
Non-pitting edema
Encephalopathy: seizures
Cardiac: Pericarditis: Becks Triad: Hypotension, Muffled heart
sounds, JVD

Pneumothorax:
-

If Caused by COPD:
Pleural effusion by M. tuberculosis- is a hypersensitivity reaction, most of the
time cannot have (+) presence of bacillus, better to have ADA.
If with T- tube: on x-ray: Sentinel eye sign (fenestrations of tube)
Pleurodesis oxytetracycline, talc, induce fibrosis adhesion of parietal and
visceral then turn to 4 sides for 30 mins
Gold standard imaging for COPD: CT scan structural damage
Gold standard imaging for pleural effusion: UTZ can visualize loculations better
Imaging for COPD: hyperaerated lungs, pushed diaphragm

Pneumonia
-

Pseudomonas : ttt -lactams + aminoglycoside

Renal Insufficiency: Linezolid ; 15 % more efficacious
Atypicals : resistant to all lactams, must be ttt with macrolide,
fluoroquinolone, tetracycline
Procalcitonin, : indicated for treatment failure or entertaining another focus of
infection