List and briefly discuss the considerations in managing a patient with dialysis dependent End Stage Renal Failure (ESRF) admitted to the ICU post-operatively from an uncomplicated Hartmann’s procedure.
B) Respiratory considerations:
C) Cardiovascular considerations:
D) Pharmacokinetics are affected:
E) Electrolyte and acid-base balance will be disturbed:
F) Fluid balance will be disturbed:
Vascular access will also be an issue:
If the patient is on haemodialysis, they will have a fistula, which means a part of their upper limb circulation will be inaccessible for central line placement
If the patient was on peritoneal dialysis, this will no longer be possible after abdominal surgery, in which case they will need a vas cath
The fistula will not be a satisfactory access point for CRRT
G) Nutrition is affected:
H) There may be anaemia due to decreased EPO synthesis.
I) There may be immune dysfunction and increased risk of infection.
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Szamosfalvi, Balazs, and Jerry Yee. "Considerations in the critically ill ESRD patient." Advances in chronic kidney disease 20.1 (2013): 102-109.
Arulkumaran, N., N. M. P. Annear, and M. Singer. "Patients with end-stage renal disease admitted to the intensive care unit: systematic review." British journal of anaesthesia 110.1 (2013): 13-20.
Thompson, Stephanie, and Neesh Pannu. "Renal replacement therapy in the end-stage renal disease patient with critical illness." Blood purification 34.2 (2012): 132-137.