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Pediatric renal tubular acidosis treatment

2017-05-26 09:23

Alkaline drugs:The distal renal tubular row H+ to reduce the retention in the body, caused by metabolic acidosis, proximal renal tubular acidosis, HCO3- reabsorption dysfunction, renal bicarbonate threshold were reduced to below 17 to 20mmol/L (normal is 25 ~ 26mmol/L, the baby is 22mmol/L), even if the plasma HCO3- is normal, because of reduced renal threshold in HCO3-, the filtrate from the urine, caused by acidosis. Application of basic drugs is to correct acidosis, early use of the clinical symptoms were improved or disappeared completely.

Potassium supplementation:Renal tubular acidosis in hyperchloremic acidosis, due to distal renal tubular renal H+ excretion disorder, H+-Na+ exchange reduced, competitive K+-Na+ exchange increased, resulting in excessive excretion of potassium, caused by hypokalemia; proximal renal tubular loss due to the large number of NaHCO3, decreased plasma volume, caused by secondary aldosteronism the result is, NaCl reabsorption, replace the lost NaHCO3 and hyperchloremic acidosis; sodium excretion of potassium absorption caused by hypokalemia is obvious, so the potassium supplement is very important, while there are obvious hypokalemia, should first fill in potassium to correct acid toxicity, so as not to cause low risk way. Citrate acid salt mixture often contain potassium, starting dose of 2 ~ 4mmol/ (kg - D), 3 to 4 times a day orally, with proximal renal acid poisoning maximum dose of 4 ~ 10mmol/ (kg - D) in order to maintain normal blood potassium concentration. In the course of treatment according to the condition and the blood potassium concentration adjustment The amount of potassium chloride. Because of containing chloride ions should be used with caution.

Application of calcium preparations:Chronic acidosis can lead to urinary calcium excretion, from 25 (OH) D to 1.25 (OH) 2D, in addition, some patients with achlorhydria, affect the intestinal absorption of calcium, the calcium is low. Hypocalcemia can cause secondary hyperparathyroidism, increase the phosphorus clearance, bone mineralization and not phosphate calcium citrate reduced blood formation, rickets; in the process of correcting acidosis can occur even hypocalcemia, convulsions. Require calcium supplement. Severe hypocalcemia can be intravenous calcium gluconate in 10%, every time 0.5 ~ 1.0mg/kg or 5 ~ 10mg/ times more dilute slowly after infusion. At the same time, cardiac care, the heart rate less than 60 BPM when the injection is stopped, to prevent the occurrence of cardiac arrest. If necessary, the interval was 6 ~ 8h. The repeated use of general low calcium calcium calcium supplement, according to 15mg/kg.

Vitamin D treatment:Chronic acid poisoning effects of vitamin D and calcium metabolism, especially in the unprovoked renal tubular acidosis and there is an obvious need to rickets of vitamin D. supplementation can promote calcium absorption in the gastrointestinal mucosa and renal tubules, increase the calcium concentration, is conducive to bone mineralization.

Diuretics on I, III cases can reduce renal calcium salt deposition; use a lot of bicarbonate type II severe cases, can not only improve the renal bicarbonate threshold, reduce urinary loss, but also can reduce the amount of basic drugs; help to correct the acidosis and decrease of serum potassium concentration of type IV renal tubular acidosis at the same time, the use of diuretics.

Treatment of type IV renal tubular acidosis

In addition to the principle of correct acidosis, due to its lack of aldosterone or pathological changes in distal renal tubules and collecting ducts of the aldosterone response low, renal tubular reabsorption of NaHCO3 decreased, NaHCO3 increased excretion, urinary excretion of potassium, ammonium acid, row reduced, resulting in H+ and K+ retention in the body, caused by metabolic acidosis and hyperkalemia. So the children taboo of potassium. Type IV type IV renal tubular acidosis is common in Addison disease, congenital adrenal hyperplasia (also called adrenal genital syndrome) and renal dysplasia, supplementing glucocorticoid or mineralocorticoid, commonly used glucocorticoid hydrocortisone dose. 10 ~ 20mg/m2, mineralocorticoid application Fluorohydrocortisone, dose 0.15mg/m2.

Such as renal tubular acidosis and renal function damage must be concentrated, sufficient supply of water, daily about 2 ~ 5l/m2.






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