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How to treat severe complications in acute stage of acute glomerulonephritis in children?

Aug 28, 2017

(1) treatment of acute circulatory congestion:

This disease causes sodium retention and blood volume expansion caused, so the disease treatment should focus on correcting the retention of sodium and water, recovery of blood volume, rather than using enhanced myocardial contractility of digitalis. Bed rest should be strictly limited water, sodium intake as soon as possible. In addition to the application of diuretic antihypertensive diuretic agent when necessary with phenol phentolamine or sodium nitroprusside to reduce ventricular load, the treatment is still failed to control feasible peritoneal dialysis, and rapidly relieve excessive load cycle. With severe hypertension, also can try vasodilators, such as sodium nitroprusside (1-2ug/ kg min). (the same usage of hypertensive encephalopathy) or phentolamine 0.1 ~ 0.2mg/kg adding 5% ~ 10% glucose solution 10 ~ 20ml intravenous injection to reduce cardiac load. Irritability to sedatives such as pethidine (Du Lengding) (1mg/kg) or morphine (0.1 ~ 0.2mg/kg). The subcutaneous injection of cardiac patients The volume is not low, arteriovenous difference of oxygen reduction, ejection fraction is not low, it is generally not a Yongyang. But if the calcium treatment available hemofiltration or peritoneal dialysis hemodialysis or peritoneal dialysis treatment. The effect of the former are effective, fast, can be in 1 ~ 2H in the serum potassium from 7.5 ~ 8mmol/L to within the normal range, and peritoneal dialysis needs 4 ~ 6h to normal. No.1 Hospital of Peking University pediatric nephrology Xiao Huijie

(2) hypertensive encephalopathy:

With hyperolemic water poisoning. The treatment should be strictly limited to water intake limit of salt and diuretic furosemide diuresis. By 2 ~ 3mg/ (kg times), 2 ~ 3 /d. if available sodium nitroprusside infusion. Hypertensive encephalopathy can be 10 ~ 20mg with sodium nitroprusside in 5% glucose 100ml according to the regulation of blood pressure the number of drops from 1 to 8ug/ (kg, min) of the blood pressure stable at a certain level. The expansion of blood vessels available dopamine and phentolamine in the 10mg plus 10% glucose 100ml intravenous drip, 1 times /d, for 7 days. The two drugs can dilate renal arterioles, improve renal blood flow. Most <8ug>4h should not be used, transmission fluid to avoid light the main adverse reactions were nausea, vomiting, headache, muscle spasm, blood pressure is too low. The seizures were available diazepam (diazepam; diazepam, Valium) 0.3mg/ (kg times) or intravenous antihypertensive drugs pided by the effective control of blood pressure, should pay attention to symptomatic treatment can be used to continue to twitch. Who Diazepam 0.3mg/ (kg times), total amount not more than 10mg, intravenous injection, or phenobarbital (phenobarbital) 5 ~ 8mg/ (kg times) intramuscular injection

(3) acute renal failure:

In oliguria stage: the maintenance of water electrolyte and acid-base balance, strengthen the strict control of water diuresis. In: "the measure for the" only of insensible water loss by 400ml/ (M2 d) or 20ml/ (kg, d) in infants, children 15ml/ (kg, d), 10ml (kg / D / children) the amount of water loss and abnormal urine] and the day before.

In the daily urine volume volume = liquid water + insensible water loss - food metabolism and tissue produced by the decomposition. Abnormal loss include vomiting, diarrhea and other gastrointestinal drainage of liquid with 1/4 ~ 1/2 Zhang. Should pay attention to evaluation of the clinical status of patients with water every day, no dehydration or edema.

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