Objectives This chapter will: 1. Define renal tubular acidosis. 2. Review the types of this disorder. 3. Describe the relevant renal acid-base physiology and pathophysiology. 4. Present clinical methods of diagnosis and differential diagnosis. 5. Discuss treatment. Definition Renal tubular…
Objectives This chapter will: 1. Review the major factors that modulate physiologic lactate production and utilization. 2. Discuss the mechanisms that modulate lactate during critical illness. 3. Review acid-base aspects of lactic acidosis. 4. Review causes of lactic acidosis that…
Objectives This chapter will: 1. Provide a brief review of the quantitative (physiochemical) approach. 2. Describe the effects of acidosis in human physiology. 3. Describe the source of body acids during health and major critical care syndromes through the lens…
Objectives This chapter will: 1. Review in depth and criticize some of the foundations for current acid-base discourse. 2. Describe a model based on the strong requirement for charge balance in any fluid. To facilitate this, the notion of strong…
Objectives This chapter will: 1. Give a brief overview of blood gas measurement. 2. Define anion gap and strong ion gap and explain why these terms are used. 3. Explain the similarities and differences between anion gap and strong ion…
Objectives This chapter will: 1. Review the structure, mechanism of action, and biologic effects of aldosterone antagonists, amiloride, and triamterene (the potassium-sparing diuretics). 2. Contrast the properties of the potassium-sparing diuretics with other diuretic drugs. 3. Discuss the renal and…
Objectives This chapter will: 1. Explain vaptan characteristics. 2. Review the diagnosis and management of hyponatremia. 3. Review vaptans for use in treatment of hyponatremia, especially with heart failure, cirrhosis, and syndromes of inappropriate antidiuretic hormone secretion. Kidneys play an…
Objectives This chapter will: 1. Explain the mechanism of action of loop and thiazide diuretics. 2. Discuss pharmacokinetics and pharmacodynamics of loop and thiazide diuretics. 3. Discuss resistance to loop and thiazide diuretics. 4. Discuss the available evidence to guide…
Objectives This chapter will: 1. Review the transfusion indications for red blood cells, platelets, plasma, and cryoprecipitate in critically ill patients. 2. Outline the principles of massive transfusion. 3. Discuss common transfusion reactions and their management. Over the last two…
Objectives This chapter will: 1. Describe the physiologic rationale for fluid resuscitation in the intensive care unit. 2. Discuss choice of fluid, volume, and end points for intravenous fluid resuscitation. Administering intravenous (IV) fluid is one of the most common…