A Rare Case of Kidney Failure Due to Diazoxide Toxicity – Discussion.
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This document discusses a case of kidney failure due to diazoxide toxicity. Diazoxide is a medication used to treat hypoglycemia that acts as a potassium channel agonist. It can cause fluid retention, hypotension, and other side effects. The case report describes an infant who developed hepatomegaly, edema, heart failure, pulmonary hypertension, and acute renal failure while being treated with diazoxide for hyperinsulinemia. Kidney function and other symptoms improved after diazoxide was stopped.
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This document discusses recent advances in the medical management of heart failure. It begins by describing the types of heart failure and the historically available treatment options of diuretics and digoxin. It then discusses neurohormonal blockers that have been effective in reducing morbidity and mortality for HFrEF. The document reviews evidence for drugs like hydralazine/isosorbide and goes on to describe several novel drug categories and agents that may further improve heart failure treatment, such as neprilysin inhibitors, soluble guanylate cyclase stimulators, calcium sensitizers, and metabolic modulators.
Diuretics
This document discusses thiazide and potassium-sparing diuretics. It explains that thiazides work by inhibiting sodium and chloride reabsorption in the distal convoluted tubule, causing increased excretion of sodium, chloride, and water. Potassium-sparing diuretics like spironolactone and eplerenone are mineralocorticoid receptor antagonists that inhibit sodium absorption and promote potassium secretion in the collecting duct. The document provides details on the mechanisms and clinical uses of these diuretic drug classes.
Whys & Wherefores in clinical pharmacology (1)
Thiazide and loop diuretics cause hypokalemia by increasing sodium excretion in the distal tubule, which also increases potassium excretion. Spironolactone causes hyperkalemia by blocking sodium channels in the late distal tubule and collecting duct, inhibiting cation reabsorption and facilitating secretion, decreasing potassium and hydrogen excretion. ACE inhibitors can cause hyperkalemia in patients with renal insufficiency or those taking potassium-sparing drugs by interfering with aldosterone, which regulates potassium levels. They are the drug of first choice for hypertension in patients with diabetes or nephropathy because they prevent renal disease progression by blocking angiotensin II effects on the kidney.
Electrolyte dysbalance in chf – prognosis & management
Electrolyte abnormalities such as hyponatremia are common in patients with chronic heart failure (CHF) due to activation of neurohormonal systems that cause sodium and water retention. Hyponatremia in CHF is associated with increased morbidity and mortality. Hypokalemia in CHF also increases the risk of sudden cardiac death. While magnesium abnormalities sometimes occur in CHF, serum magnesium levels themselves do not independently predict mortality. Treatment of electrolyte imbalances in CHF aims to correct abnormalities while avoiding overly rapid changes due to risks of serious adverse events.
Acute kindey injury (definition, pathophysiology and management)
PERIOPERATIVE acute kidney injury. definitions, pathophysiology, management. fluid therapy for Acute kidney injury. effect of anaesthesia on acute kidney injury
Vasopressin agonista and antagonist
This document provides an overview of vasopressin agonists and antagonists. It begins with an introduction to vasopressin and its synthesis, transport, and regulation in the body. It then discusses vasopressin's actions in various organ systems like the kidney, blood vessels, gastrointestinal tract, and liver. The document reviews the pharmacokinetics of vasopressin and lists various vasopressin agonists and antagonists. It describes the use of desmopressin and other vasopressin drugs in treating conditions like diabetes insipidus and SIADH. Finally, it mentions several clinical trials investigating vasopressin antagonists.
Drugs used in Cardiac Failure
This document discusses drugs used to treat cardiac failure. It begins by defining cardiac failure and ejection fraction. The main treatments discussed are:
1. ACE inhibitors to reduce preload and afterload.
2. Diuretics like thiazides and loop diuretics to increase salt and water loss and reduce blood volume.
3. Cardiac glycosides like digoxin which have a positive inotropic effect to increase contractility without increasing oxygen consumption.
4. Other drugs discussed include beta-blockers, aldosterone antagonists, organic nitrates, calcium sensitizers, and inotropic drugs for acute heart failure. The document provides details on the mechanisms and uses of these
DIURETICS
Diuretics work by interfering with electrolyte reabsorption in the kidney to promote excretion of sodium and water. They are classified based on where in the nephron they act: carbonic anhydrase inhibitors act in the proximal convoluted tubule; loop diuretics act on the ascending loop of Henle; thiazide diuretics act in the distal convoluted tubule; and aldosterone inhibitors act on the collecting tubule. Common diuretics include acetazolamide, furosemide, hydrochlorothiazide, and spironolactone. They are used to treat conditions like hypertension, heart failure, and edema. Adverse effects can include electrolyte imbalances like hyp
Acute kidney injury
Acute Kidney Injury (AKI) is a common complication, affecting 5-7% of hospital admissions and 30% of intensive care unit patients. The top causes of AKI in India are diarrheal diseases, sepsis, malaria, drug toxicity, and hospital-acquired injuries. Biomarkers like cystatin C and kidney injury molecule 1 can help detect AKI earlier than creatinine. Treatment involves fluid resuscitation, eliminating nephrotoxins, and renal replacement therapy for complications like electrolyte imbalances or uremia. Outcomes depend on the underlying cause, with pre-renal and post-renal AKI having a better prognosis than intrinsic renal injury.
Hyponatremia in Liver disease
Hyponatremia is very common in patients with cirrhosis. Treatment is indicated for neurological symptoms or sodium levels below 120 mEq/L. Management involves fluid restriction and correcting hypokalemia. Hypertonic saline may be used for severe hyponatremia below 110 mEq/L or before liver transplant to prevent rapid correction. While vasopressin receptor antagonists show promise, none are currently approved for use in liver disease patients.
Acute Kidney Failure in children.pptx
This document discusses acute kidney injury (AKI) in children. It defines AKI and describes the staging system used to classify it. The causes of AKI are divided into pre-renal, renal, and post-renal. The major causes in each category are outlined. Clinical evaluation involves obtaining history, physical exam, and initial lab tests. Imaging and renal biopsy may also be used for diagnosis. Management focuses on fluid balance, electrolyte control, treating the underlying cause, and providing nutrition. Dialysis is indicated for severe fluid overload, hyperkalemia, acidosis, or neurological symptoms.
Drugs used in chf ii
The document discusses drugs used to treat heart failure, including aldosterone antagonists like spironolactone and eplerenone. It notes that aldosterone contributes to disease progression and antagonists can provide benefits, though are contraindicated in renal insufficiency due to risk of hyperkalemia. Sympathomimetic drugs like dobutamine and dopamine are discussed as having positive inotropic effects to combat pump failure. Phosphodiesterase inhibitors like inamrinone and milrinone are described as increasing myocardial cAMP and having inotropic and vasodilating effects. The mechanisms and pharmacological actions of cardiac glycoside digoxin are explained in detail.
CONTRAST INDUCED NEPHROPATHY(CI-AKI)
CIN ,third most common cause of AKI.
asymptomatic.
prevention is the one to be emphasised in case of CI-AKI.
ACE inhibitors
1. Angiotensin converting enzyme inhibitors (ACEIs) block the conversion of angiotensin I to angiotensin II, inhibiting the renin-angiotensin system.
2. ACEIs are used to treat hypertension, congestive heart failure, myocardial infarction, diabetic nephropathy, and scleroderma renal crisis.
3. Common adverse effects of ACEIs include hypotension, cough, and hyperkalemia. ACEIs are contraindicated in pregnancy and bilateral renal artery stenosis due to risks of hypotension, renal failure, and fetal complications.
Cardiorenal syndrome
download link : https://www.dropbox.com/s/a8ug16pfkvv1bzp/Cardiorenal%20syndrome.ppt?m
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Adenosine
Adenosine has several clinical uses including treating supraventricular tachycardia and ventricular tachycardia. It works by slowing conduction in the atrioventricular node. Its effects are short-lasting due to rapid uptake and breakdown. It can cause side effects like flushing but these are brief. Adenosine is also being studied for uses in pain management when administered intrathecally and shows potential for treating neuropathic pain.
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A Rare Case of Kidney Failure Due to Diazoxide Toxicity – Discussion.
- 1. A Rare Case of Kidney Failure Due to Diazoxide Toxicity – Discussion. MSSM Nephrology Clinical Conference Raj Kiran Medapalli, MD, MPH. Fellow, Division of Nephrology Mount Sinai School of Medicine
- 3. The K ATP channel couples glucose metabolism to insulin secretion. Glucose enters the cell via GLUT2 transporter, and via glycolytic and mitochondrial metabolism leads to an increase in ATP and a fall in MgADP which results in K ATP channel closure, membrane depolarization, opening of calcium gated channels, calcium influx and exocytosis of insulin granules. Frances M. Ashcroft. ATP-sensitive potassium channelopathies: focus on insulin secretion. J Clin Invest. 2005 Aug;115(8):2047-58.
- 12. Case reports of Diazoxide Toxicity