16 research outputs found
O dijalizabilnosti lijekova
Drug dialyzability is determined by complex interaction of many factors, including the characteristics of the drug and the technical aspects of the dialysis system. Numerous aspects of dialysis prescription, including some elaborated in this article, have the potential to influence drug removal by dialysis. Care must be exercised when applying information from published reports of drug dialyzability to the individual patient. In order to provide the best information for individual patients, healthcare professionals should become familiar with the dialysis membranes utilized at their healthcare facility, and interpret literature information in that light. This article includes a table on dialyzability of drugs during conventional and high-permeability dialysis, and during peritoneal dialysis.Dijalizabilnost lijekova je odreÄena složenim meÄudjelovanjem mnogih Äimbenika ukljuÄujuÄi osobine lijeka i tehniÄke osobitosti sustava za dijalizu. Brojni Äimbenici propisivanja dijalize navedeni u ovom Älanku imaju bitan utjecaj na odstranjivanje lijeka. Potrebna je posebna pažnja pri uporabi postojeÄih informacija o dijalizabilnosti lijekova iz objavljenih izvjeÅ”Äa za svakoga bolesnika ponaosob. U cilju pronalaženja najbolje informacije za svakoga pojedinog bolesnika zdravstveni djelatnici trebaju dobro poznavati dijalizne membrane koje rabe i u tom svjetlu objasniti podatke iz literature. Ovaj Älanak sadrži tablicu s podacima o dijalizabilnosti lijekova tijekom konvencionalne, visokopropusne i peritonejske dijalize
ALLERGIC REACTIONS TO POLYSULFONE DIALYSIS MEMBRANES - AN OLD PROBLEM TAKING A NEW DIMENSION?
Umjetna jetra: sadaÅ”njost ili buduÄnost ?
Modern medicine has learned to support many failing organs with machines: dialysis for kidney failure, respirators for breathing, and pacemakers and artificial heart for the heart. However, when the liver becomes too damaged to sustain life, the only medical resource is transplantation. For over 5 years, scientists and physicians have been attempting to develop an artificial liver. This article focuses upon current devices made to provide artificial liver support.Suvremena medicina je sposobna pomoÄu strojeva gotovo u potpunosti nadomjestiti funkciju mnogih oÅ”teÄenja organa: dijalizom bubrežnu funkciju, respiratorima pluÄnu funkciju, a elektrostimulatorima odnosno umjetnim srcem srÄanu funkciju. MeÄutim, kada doÄe do teÅ”kog oÅ”teÄenja jetre, jedino medicinsko rjeÅ”enje je transplantacija. VeÄ viÅ”e od 50 godina znanstvenici i lijeÄnici pokuÅ”avaju naÄiniti umjetnu jetru. Ovaj Älanak usredotoÄen je na prikaz postojeÄih sustava za nadomjeÅ”tanje funkcije jetre
O dijalizabilnosti lijekova
Drug dialyzability is determined by complex interaction of many factors, including the characteristics of the drug and the technical aspects of the dialysis system. Numerous aspects of dialysis prescription, including some elaborated in this article, have the potential to influence drug removal by dialysis. Care must be exercised when applying information from published reports of drug dialyzability to the individual patient. In order to provide the best information for individual patients, healthcare professionals should become familiar with the dialysis membranes utilized at their healthcare facility, and interpret literature information in that light. This article includes a table on dialyzability of drugs during conventional and high-permeability dialysis, and during peritoneal dialysis.Dijalizabilnost lijekova je odreÄena složenim meÄudjelovanjem mnogih Äimbenika ukljuÄujuÄi osobine lijeka i tehniÄke osobitosti sustava za dijalizu. Brojni Äimbenici propisivanja dijalize navedeni u ovom Älanku imaju bitan utjecaj na odstranjivanje lijeka. Potrebna je posebna pažnja pri uporabi postojeÄih informacija o dijalizabilnosti lijekova iz objavljenih izvjeÅ”Äa za svakoga bolesnika ponaosob. U cilju pronalaženja najbolje informacije za svakoga pojedinog bolesnika zdravstveni djelatnici trebaju dobro poznavati dijalizne membrane koje rabe i u tom svjetlu objasniti podatke iz literature. Ovaj Älanak sadrži tablicu s podacima o dijalizabilnosti lijekova tijekom konvencionalne, visokopropusne i peritonejske dijalize
Tromboembolija bubrežne arterije: neprepoznati uzrok akutnog bubrežnog zatajenja
Acute renal artery thromboembolism is a critical condition and significant but commonly misdiagnosed and possibly reversible cause of kidney ischemic disease. This disorder is commonly overlooked, and an early and proper diagnosis can lead to proper therapy with greater chance for recovery of renal function and avoidance of unnecessary invasive diagnostic and therapeutic procedures. When encountering a patient suffering from acute renal failure and atypical lower back or abdominal pain, especially one who has high risk factors, we recommend diagnostic screening based on serum lactate dehydrogenase determination with other diagnostic procedures and therapeutic algorithm for renal artery thromboembolism.Akutna tromboembolija bubrežne arterije je kritiÄno stanje za bolesnika. ZnaÄajan je, ali Äesto pogreÅ”no dijagnosticiran te potencijalno reverzibilan uzrok ishemijske bolesti bubrega. Ova se bolest Äesto previÄa, a rana i ispravna dijagnoza vode ka ispravnom lijeÄenju uz dobre izglede za oporavak bubrežne funkcije i izbjegavanje nepotrebnih, agresivnih dijagnostiÄkih i terapijskih postupaka. Kada se susretnemo s bolesnikom koji ima akutno bubrežno zatajenje i atipiÄnu bol u križima ili trbuhu, poglavito u onih s visokim Äimbenicima rizika, preporuÄamo provoÄenje dijagnostiÄkog postupka koji se temelji na odreÄivanju serumske razine laktat dehidrogenaze u kombinaciji s ostalim dijagnostiÄkim metodama i postupnikom za lijeÄenje tromboembolije bubrežne arterije
Perioperacijsko zbrinjavanje bolesnika s kroniÄnim bubrežnim zatajenjem
Any surgical procedure, ranging from general operation (the most common procedures is surgical creation of arteriovenous fistula and catheter for peritoneal dialysis placement) to open heart surgery, may be performed in patients with chronic renal failure treated conservatively or with dialysis without a significant increase in the perioperative mortality and morbidity in comparison to patients without renal disease. This is possibly only with good perioperative management of these patients and multidisciplinary collaboration of nephrologist, anesthesiologist, cardiologist, surgeon, primary care physician and nursing staff to recommend strategies for reducing cardiac and renal risk for the planned surgical procedures.Svaki kirurÅ”ki postupak, od relativno jednostavnih (u ovih bolesnika najÄeÅ”Äi su operacijsko stvaranje arteriovenske fistule i postavljanje katetera za peritonejsku dijalizu) do operacije na otvorenom srcu, može se u bolesnika s kroniÄnim bubrežnim zatajenjem koji se lijeÄe konzervativno ili dijalizom uÄiniti bez znaÄajnog porasta pobola i smrtnosti u odnosu na bolesnike bez bubrežne bolesti. Kako bi se mogli provesti planirani kirurÅ”ki zahvati uz smanjenje srÄanog i bubrežnog rizika za ove bolesnike neophodna je multidisciplinska suradnja nefrologa, anesteziologa, kardiologa, kirurga, lijeÄnika opÄe medicine i sestrinskog tima za njegu bolesnika
Perioperacijsko zbrinjavanje bolesnika s kroniÄnim bubrežnim zatajenjem
Any surgical procedure, ranging from general operation (the most common procedures is surgical creation of arteriovenous fistula and catheter for peritoneal dialysis placement) to open heart surgery, may be performed in patients with chronic renal failure treated conservatively or with dialysis without a significant increase in the perioperative mortality and morbidity in comparison to patients without renal disease. This is possibly only with good perioperative management of these patients and multidisciplinary collaboration of nephrologist, anesthesiologist, cardiologist, surgeon, primary care physician and nursing staff to recommend strategies for reducing cardiac and renal risk for the planned surgical procedures.Svaki kirurÅ”ki postupak, od relativno jednostavnih (u ovih bolesnika najÄeÅ”Äi su operacijsko stvaranje arteriovenske fistule i postavljanje katetera za peritonejsku dijalizu) do operacije na otvorenom srcu, može se u bolesnika s kroniÄnim bubrežnim zatajenjem koji se lijeÄe konzervativno ili dijalizom uÄiniti bez znaÄajnog porasta pobola i smrtnosti u odnosu na bolesnike bez bubrežne bolesti. Kako bi se mogli provesti planirani kirurÅ”ki zahvati uz smanjenje srÄanog i bubrežnog rizika za ove bolesnike neophodna je multidisciplinska suradnja nefrologa, anesteziologa, kardiologa, kirurga, lijeÄnika opÄe medicine i sestrinskog tima za njegu bolesnika
METFORMIN-INDUCED LACTIC ACIDOSIS: ARE WE UP TO THE CHALLENGE OF A GROWING PROBLEM?
Metforminom uzrokovana laktacidoza je rijetka, životno ugrožavajuÄa komplikacija koja se javlja u bolesnika s oÅ”teÄenjem bubrežne funkcije. Nastaje kao posljedica nakupljanja metformina zbog nemoguÄnosti izluÄivanja putem bubrega te neravnoteže izmeÄu stvaranja i razgradnje laktata Å”to ima za posljedicu teÅ”ku metaboliÄku acidozu. Brojne studije su pokazale malu incidenciju ove nuspojave u odnosu na veliki broj bolesnika koji uzima metformin i u odnosu na njegove brojne pozitivne terapijske uÄinke. Uz pridržavanje strogih uputa o doziranju metformina u bolesnika s oÅ”teÄenom bubrežnom funkcijom, lijek se pokazao sigurnim, meÄutim akutna naruÅ”avanja zdravstvenog stanja uz brzo pogorÅ”anje bubrežne funkcije mogu dovesti do ove teÅ”ke nuspojave Äak i u bolesnika koji su do tada imali urednu bubrežnu funkciju. Temeljem vlastitih kliniÄkih iskustava u lijeÄenju ove teÅ”ke nuspojave zakljuÄujemo da svaku teÅ”ku laktacidozu u bolesnika sa Å”eÄernom boleÅ”Äu tipa 2 uz oÅ”teÄenje bubrežne funkcije, koji u redovnoj terapiju uzima metformin, treba shvatiti kao metforminom uzrokovanu laktacidozu i pristupiti svim raspoloživim mjerama intenzivnog lijeÄenja. KljuÄnu ulogu u lijeÄenju ima hemodijaliza u svojim razliÄitim oblicima (intermitentna ili kontinuirana) pri Äemu je važan ispravan odabir otopina bez laktata. Zbog visoke smrtnosti metforminom uzrokovana laktacidoza ostaje i dalje veliki terapijski problem, a lijeÄnicima
obiteljske medicine i dijabetolozima izazov u provoÄenju mjera prevencije.Metformin-induced lactic acidosis is an uncommon, life-threatening complication occurring in patients with impaired kidney function. It develops as a result of metformin accumulation due to the inability of renal excretion and the imbalance of lactate metabolism, resulting in severe metabolic acidosis. Various studies have shown a small incidence of this complication as opposed to the large number of patients taking metformin. Provided the strict dosage measures are implemented, metformin has been shown to be a safe drug. However, any acute illness resulting in rapid kidney function deterioration can lead to this severe complication, even in patients with normal initial renal function. Based on our clinical experience in treating this severe side effect, we conclude that any severe lactic acidosis in patients with type 2 diabetes treated with metformin, with impaired renal function should be understood as metformin-induced lactic acidosis, and all available intensive care measures should be taken. Hemodialysis in its different forms (intermittent or continuous) plays a key role in the treatment, whereby it is important to appropriately select solutions that should not contain lactate. Due to the high mortality, metformin-induced lactic acidosis remains a major therapeutic problem, as well as a challenge in implementing preventive measures by family physicians and diabetologists
METFORMIN-INDUCED LACTIC ACIDOSIS: ARE WE UP TO THE CHALLENGE OF A GROWING PROBLEM?
Metforminom uzrokovana laktacidoza je rijetka, životno ugrožavajuÄa komplikacija koja se javlja u bolesnika s oÅ”teÄenjem bubrežne funkcije. Nastaje kao posljedica nakupljanja metformina zbog nemoguÄnosti izluÄivanja putem bubrega te neravnoteže izmeÄu stvaranja i razgradnje laktata Å”to ima za posljedicu teÅ”ku metaboliÄku acidozu. Brojne studije su pokazale malu incidenciju ove nuspojave u odnosu na veliki broj bolesnika koji uzima metformin i u odnosu na njegove brojne pozitivne terapijske uÄinke. Uz pridržavanje strogih uputa o doziranju metformina u bolesnika s oÅ”teÄenom bubrežnom funkcijom, lijek se pokazao sigurnim, meÄutim akutna naruÅ”avanja zdravstvenog stanja uz brzo pogorÅ”anje bubrežne funkcije mogu dovesti do ove teÅ”ke nuspojave Äak i u bolesnika koji su do tada imali urednu bubrežnu funkciju. Temeljem vlastitih kliniÄkih iskustava u lijeÄenju ove teÅ”ke nuspojave zakljuÄujemo da svaku teÅ”ku laktacidozu u bolesnika sa Å”eÄernom boleÅ”Äu tipa 2 uz oÅ”teÄenje bubrežne funkcije, koji u redovnoj terapiju uzima metformin, treba shvatiti kao metforminom uzrokovanu laktacidozu i pristupiti svim raspoloživim mjerama intenzivnog lijeÄenja. KljuÄnu ulogu u lijeÄenju ima hemodijaliza u svojim razliÄitim oblicima (intermitentna ili kontinuirana) pri Äemu je važan ispravan odabir otopina bez laktata. Zbog visoke smrtnosti metforminom uzrokovana laktacidoza ostaje i dalje veliki terapijski problem, a lijeÄnicima
obiteljske medicine i dijabetolozima izazov u provoÄenju mjera prevencije.Metformin-induced lactic acidosis is an uncommon, life-threatening complication occurring in patients with impaired kidney function. It develops as a result of metformin accumulation due to the inability of renal excretion and the imbalance of lactate metabolism, resulting in severe metabolic acidosis. Various studies have shown a small incidence of this complication as opposed to the large number of patients taking metformin. Provided the strict dosage measures are implemented, metformin has been shown to be a safe drug. However, any acute illness resulting in rapid kidney function deterioration can lead to this severe complication, even in patients with normal initial renal function. Based on our clinical experience in treating this severe side effect, we conclude that any severe lactic acidosis in patients with type 2 diabetes treated with metformin, with impaired renal function should be understood as metformin-induced lactic acidosis, and all available intensive care measures should be taken. Hemodialysis in its different forms (intermittent or continuous) plays a key role in the treatment, whereby it is important to appropriately select solutions that should not contain lactate. Due to the high mortality, metformin-induced lactic acidosis remains a major therapeutic problem, as well as a challenge in implementing preventive measures by family physicians and diabetologists
Obostrani endogeni endoftalmitis uzrokovan bakterijom pseudomonas aeruginosa u imunokompetentnog bolesnika s nozokomijalnom urosepsom nakon abdominalnog kirurŔkog zahvata
Endogenous endophthalmitis is a vision-threatening condition that results from hematogenous spread of infection to the eye, originating from a distant primary focus. It is considered as a rare entity that predominantly occurs in immune-compromised patients. We present a case of a critically ill immune-competent patient who underwent abdominal surgery later followed by nosocomial urosepsis complicated with bilateral Pseudomonas aeruginosa endogenous endophthalmitis that resulted in blindness. This case is clinically important because of the absence of predisposing factors for this kind of eye infection.Endogeni endoftalmitis je akutna komplikacija hematogenog rasapa infekcije iz udaljenog žariÅ”ta u oÄi, Å”to u najveÄem broju sluÄajeva rezultira sljepilom. Bolest je rijetka, a najÄeÅ”Äe se javlja u imuno kompromitiranih bolesnika. Prikazujemo imuno kompetentnog bolesnika kod kojega se nakon hitne operacije inkarcerirane ingvinalne hernije razvila nozokomijalna urosepsa komplicirana obostranim endogenim endoftalmitisom uzrokovanim bakterijom Pseudomonas aeruginosa, koji je rezultirao sljepilom. BuduÄi da se radi o bolesniku bez prethodno opisanih predisponirajuÄih Äimbenika za razvoj ove teÅ”ke bolesti, smatramo ovaj prikaz kliniÄki važnim za rano prepoznavanje i Å”to ranije agresivno lijeÄenje ove teÅ”ke bolesti