* 46-year-old Aboriginal * type 2 diabetes mellitus * Eight weeks ago she had an arteriovenous fistula * past week she has experienced anorexia, nausea, vomiting, problems with concentration and pruritus * Complains of swelling in her feet and hands * Has gained 4.5 kg in the past 2 weeks Can somebody please help? Ta
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1 :
Get her to the hospital, quick. She's having signs of kidney failure already... anorexia, vomiting and pruritus as well as weight gain... which is probably because of edema (thus the swelling in her hands and feet)... what was the AV for? was that a Scribner shunt? That's probably for hemodialysis which she also probably needs right now!
2 :
Take ECG and consult a cardiologist.
3 :
What are the symptoms of CKD? Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you: -feel more tired and have less energy -have trouble concentrating -have a poor appetite -have trouble sleeping -have muscle cramping at night -have swollen feet and ankles -have puffiness around your eyes, especially in the morning -have dry, itchy skin -need to urinate more often, especially at night Symptoms of uremia include anorexia, nausea, vomiting, malaise, asterixis, muscle weakness, platelet dysfunction, pericarditis, mental status changes, seizures and, possibly, coma. These symptoms result from the accumulation of several toxins in addition to urea; thus, no strict correlation exists between clinical presentation and plasma blood urea nitrogen (BUN)and creatinine levels. Acute uremia or uremia resulting from progressive disease is an indication for immediate dialysis. Patients with kidney failure should be evaluated for kidney transplantation. The person in question is at high risk for chronic kidney disease due to her DM type 2 and because she belongs to the population group. with a high risk for DM and hypertension. Look at the criteria list below: Anyone can get chronic kidney disease at any age. However, some people are more likely than others to develop kidney disease. You may have an increased risk for kidney disease if you: have diabetes have high blood pressure have a family history of chronic kidney disease are older belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians Type-2 diabetes is the main factor attributed to more African American women experiencing kidney failure. Usually brought on by obesity, diabetes is the number one risk factor for chronic kidney disease. High blood pressure is the second most common risk factor for kidney disease. Making women aware of the risks of chronic kidney disease and the measures to prevent CKD will hopefully reverse this upward trend. What can kidney patients do to help themselves? Take an active role in learning about kidney disease and treatment. Follow the prescribed diet and fluid limits. Take all medications properly and tell the doctor of any side effects. Ask for an exercise program to help muscle tone, strength, and endurance. Your doctor and dietitian can suggest a weight gain or loss program, if needed. Lead a healthy lifestyle. Be aware of other things that could affect your sexual functioning, such as drinking too much alcohol and smoking. Side effects of certain medicines and complications from uremia can cause fatigue, menstrual irregularities and decreased sexual desire. Uremia Despite optimal treatment, kidney function may continue to deteriorate. Ultimately, patients may develop uremia and kidney failure. Symptoms of uremia include anorexia, nausea, vomiting, malaise, asterixis, muscle weakness, platelet dysfunction, pericarditis, mental status changes, seizures and, possibly, coma. These symptoms result from the accumulation of several toxins in addition to urea; thus, no strict correlation exists between clinical presentation and plasma blood urea nitrogen and creatinine levels. Acute uremia or uremia resulting from progressive disease is an indication for immediate dialysis. Patients with kidney failure should be evaluated for kidney transplantation. Her classical symptoms including anorexia, nausea , vomitng, decreased cognition-are that of an acute uremic state. That's why an A-V fistula or shunt is placed most likely on her arm as an access for immediate hemodialysis treatment to remove excess fluid and waste products such as creatinine and BUN from her body. Her decreased cognition or concentration is due to anemia. Anemia can also lead to fatigue. Anemia can be treated with erythropoietin ( a type of protein hormone produced by specialized cells in the kidneys) However, sometimes the actual dialysis treatment is the cause of fatigue. Use of steroids may cause weight gain, acne, and unwanted hair growth or loss. Swelling or pedal edema of the hands and feet could contribute to the weight gain. In addition, the edema is due fluid overload and salt retention. Puffiness around the eyes and swelling of the hands and feet is one of the six warning signs of kidney disease. She might not be adhering to her strict prescribed diet of salt and water restriction. Nausea and vomiting and edema is due to electrolyte and acid-base imbalance; hyperkalemia( high potassium), hyperphosphatemia ( high phosphorus)and metabolic acidosis. Pruritus is common due to uremia and the build-up of nitrogenous waste products.and diabetic hyperglycemia. The kidneys are failing and are not capable of adequately getting rid of body waste products such creatinine and BUN. . Leg cramps on her calves are due to hyperkalemia and hyperphosphatemia. She might experience these also during the tx due to the sudden removal of waste products. by the dialysis machine.( artificial kidney) The chemical changes that occur in her body with kidney disease affect hormones, circulation, nerve function and energy level. These changes would account for her decreased appetite. Her anorexia might also be due to depression. Some women become anxious about changes in their appearance, such as weight loss, or in the case of some PD patients, weight gain from the sugar in the dialysate. The catheter in the abdomen or fistula in the arm may also create anxiety either because a woman believes it is unattractive or is afraid it could be damaged Patients with chronic kidney disease are at risk for malnutrition and hypoalbuminemia. Both of these conditions are associated with poor outcomes in patients who are beginning dialysis Hope this helped. This involved a lot of research on pathophysiology.
4 :
It is the swelling that accounts for the weight gain. Fluid that is retained comes from fluid that you take in - what goes in must come out. With kidney failure, it is sometimes difficult to eliminate all the fluid that you take in, and so it remains in the body as swelling (also called oedema). This can be treated often with diuretics, but when there is insufficient kidney function to allow these drugs to work, dialysis is the only other route. Since you have already had your fistula created, it sounds likely that you will start dialysis quite soon, if you haven't already. When you are on dialysis the doctors and nurses adjust the machine to take off any excess fluid. Your nephrologist can explain it you in more detail. You should note that a person can retain a huge amount of fluid as oedema - in some people 10 or 15 litres of fluid, which works out to be two and a half gallons or more - which in turn will add 10 to 15 kg (up to thirty or more pounds) in weight!
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