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Skip to 0 minutes and 14 seconds So now we can go further about the management of complication As we mentioned there are a lot of important functional for kidney Therefore we have lots of complication into management for this group of a patient. The most important issue is about through the electrolyte imbalance metabolic acidosis, anemia and the renal osteodystrophy. Let’s look at metabolic acidosis. As reabsorption of bicarbonate decreased and also there are less ammonia production the patient may have a metabolic acidosis And metabolic acidosis they actually progressed the other complications including hyperkalemia and bone, osteoporosis bone atrophy and decreased cardiac contractility decreased albumin synthesis of arrhythmia.

Skip to 1 minute and 20 seconds And management go for metabolic acidosis as 20 and the treatment usually required sodium bicarb and the oral dosing is usually enough for a patient in chronic kidney disease. and there is another calculation for a dose in a slice that you can use to calculate dose and potassium citrate is also another option but when we use potassium citrate we need to understand those issues about the increase of aluminum absorption and aluminum has actually worsen bone metabolism and will be some consideration for this group of a patient. In a case as a very high and increased and very abruptly level of metabolic acid acidosis those patients may require dialysis.

Complications of ESRD : Metabolic acidosis

In this step, Prof. Chen illustrates the complications of ESRD, especially on metabolic acidosis.

With decreasing reabsorption of bicarbonate and less ammonia production, patients may have metabolic acidosis, which progresses other complications, including hyperkalemia, osteoporosis, bone atrophy, and decreased albumin synthesis.

For the management of metabolic acidosis, the goal is to let bicarbonate become near 20 mmol/L.

When we use potassium citrate as a treatment, we need to understand those issues on the increase of aluminum absorption.

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Pharmacokinetics: Drug Dosing in Renal Disease

Taipei Medical University