This document summarizes renal function in the ICU, including calculation of glomerular filtration rate (GFR) and creatinine clearance, fractional excretion of sodium, hepatorenal syndrome, rhabdomyolysis, and contrast-induced acute renal failure. It also presents several case studies involving evaluation of renal function and diagnosis of conditions such as acute tubular necrosis, SIADH, and normal renal function based on creatinine clearance calculations and urinary indices.
Creatinine clearance may be used as indicator for GFR because:
Creatinine is endogenously produced.
Creatinine is released into body fluid at constant rate.
Its plasma level maintained within narrow limits.
Its plasma level not affected by dietary factors
Creatinine clearance may be used as indicator for GFR because:
Creatinine is endogenously produced.
Creatinine is released into body fluid at constant rate.
Its plasma level maintained within narrow limits.
Its plasma level not affected by dietary factors
this is a series of notes on clinical pathology, useful for undergraduate and post graduate pathology students. Notes have been prepared from standard textbooks and are in a format easy to reproduce in exams.
measurement of GFR and creatinine clearence-- design of dosage for hepatic patients -- therapeutic drug monitoring and clinical pharmacokinetics fifth pharm D notes
Newer drugs approved by US-FDA - Rxvichu!!!RxVichuZ
This is my 22nd ppt............................
It contains HALF of the totl drugs approved by US-FDA for 2014
Consists of 20 drugs...out of 41
Do go through it.....and send ur reviews!
Regards,
Rxvichu-alwz4uh!
:)
Dose Adjustment in Renal Failure ...Practical Approach for Clinical Pharmacists to help them perfectly adjust doses for medications according to best evidence to date
drug induced renal failure, use for only study, not for medicolegal purpose,therre may humam error while writting. my email= ms.manojmandeep@rediffmail.com
this is a series of notes on clinical pathology, useful for undergraduate and post graduate pathology students. Notes have been prepared from standard textbooks and are in a format easy to reproduce in exams.
measurement of GFR and creatinine clearence-- design of dosage for hepatic patients -- therapeutic drug monitoring and clinical pharmacokinetics fifth pharm D notes
Newer drugs approved by US-FDA - Rxvichu!!!RxVichuZ
This is my 22nd ppt............................
It contains HALF of the totl drugs approved by US-FDA for 2014
Consists of 20 drugs...out of 41
Do go through it.....and send ur reviews!
Regards,
Rxvichu-alwz4uh!
:)
Dose Adjustment in Renal Failure ...Practical Approach for Clinical Pharmacists to help them perfectly adjust doses for medications according to best evidence to date
drug induced renal failure, use for only study, not for medicolegal purpose,therre may humam error while writting. my email= ms.manojmandeep@rediffmail.com
Even tho Pi network is not listed on any exchange yet.
Buying/Selling or investing in pi network coins is highly possible through the help of vendors. You can buy from vendors[ buy directly from the pi network miners and resell it]. I will leave the telegram contact of my personal vendor.
@Pi_vendor_247
how can I sell pi coins after successfully completing KYCDOT TECH
Pi coins is not launched yet in any exchange 💱 this means it's not swappable, the current pi displaying on coin market cap is the iou version of pi. And you can learn all about that on my previous post.
RIGHT NOW THE ONLY WAY you can sell pi coins is through verified pi merchants. A pi merchant is someone who buys pi coins and resell them to exchanges and crypto whales. Looking forward to hold massive quantities of pi coins before the mainnet launch.
This is because pi network is not doing any pre-sale or ico offerings, the only way to get my coins is from buying from miners. So a merchant facilitates the transactions between the miners and these exchanges holding pi.
I and my friends has sold more than 6000 pi coins successfully with this method. I will be happy to share the contact of my personal pi merchant. The one i trade with, if you have your own merchant you can trade with them. For those who are new.
Message: @Pi_vendor_247 on telegram.
I wouldn't advise you selling all percentage of the pi coins. Leave at least a before so its a win win during open mainnet. Have a nice day pioneers ♥️
#kyc #mainnet #picoins #pi #sellpi #piwallet
#pinetwork
BYD SWOT Analysis and In-Depth Insights 2024.pptxmikemetalprod
Indepth analysis of the BYD 2024
BYD (Build Your Dreams) is a Chinese automaker and battery manufacturer that has snowballed over the past two decades to become a significant player in electric vehicles and global clean energy technology.
This SWOT analysis examines BYD's strengths, weaknesses, opportunities, and threats as it competes in the fast-changing automotive and energy storage industries.
Founded in 1995 and headquartered in Shenzhen, BYD started as a battery company before expanding into automobiles in the early 2000s.
Initially manufacturing gasoline-powered vehicles, BYD focused on plug-in hybrid and fully electric vehicles, leveraging its expertise in battery technology.
Today, BYD is the world’s largest electric vehicle manufacturer, delivering over 1.2 million electric cars globally. The company also produces electric buses, trucks, forklifts, and rail transit.
On the energy side, BYD is a major supplier of rechargeable batteries for cell phones, laptops, electric vehicles, and energy storage systems.
Seminar: Gender Board Diversity through Ownership NetworksGRAPE
Seminar on gender diversity spillovers through ownership networks at FAME|GRAPE. Presenting novel research. Studies in economics and management using econometrics methods.
how to swap pi coins to foreign currency withdrawable.DOT TECH
As of my last update, Pi is still in the testing phase and is not tradable on any exchanges.
However, Pi Network has announced plans to launch its Testnet and Mainnet in the future, which may include listing Pi on exchanges.
The current method for selling pi coins involves exchanging them with a pi vendor who purchases pi coins for investment reasons.
If you want to sell your pi coins, reach out to a pi vendor and sell them to anyone looking to sell pi coins from any country around the globe.
Below is the contact information for my personal pi vendor.
Telegram: @Pi_vendor_247
The secret way to sell pi coins effortlessly.DOT TECH
Well as we all know pi isn't launched yet. But you can still sell your pi coins effortlessly because some whales in China are interested in holding massive pi coins. And they are willing to pay good money for it. If you are interested in selling I will leave a contact for you. Just telegram this number below. I sold about 3000 pi coins to him and he paid me immediately.
Telegram: @Pi_vendor_247
The Evolution of Non-Banking Financial Companies (NBFCs) in India: Challenges...beulahfernandes8
Role in Financial System
NBFCs are critical in bridging the financial inclusion gap.
They provide specialized financial services that cater to segments often neglected by traditional banks.
Economic Impact
NBFCs contribute significantly to India's GDP.
They support sectors like micro, small, and medium enterprises (MSMEs), housing finance, and personal loans.
The European Unemployment Puzzle: implications from population agingGRAPE
We study the link between the evolving age structure of the working population and unemployment. We build a large new Keynesian OLG model with a realistic age structure, labor market frictions, sticky prices, and aggregate shocks. Once calibrated to the European economy, we quantify the extent to which demographic changes over the last three decades have contributed to the decline of the unemployment rate. Our findings yield important implications for the future evolution of unemployment given the anticipated further aging of the working population in Europe. We also quantify the implications for optimal monetary policy: lowering inflation volatility becomes less costly in terms of GDP and unemployment volatility, which hints that optimal monetary policy may be more hawkish in an aging society. Finally, our results also propose a partial reversal of the European-US unemployment puzzle due to the fact that the share of young workers is expected to remain robust in the US.
Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
how can i use my minded pi coins I need some funds.DOT TECH
If you are interested in selling your pi coins, i have a verified pi merchant, who buys pi coins and resell them to exchanges looking forward to hold till mainnet launch.
Because the core team has announced that pi network will not be doing any pre-sale. The only way exchanges like huobi, bitmart and hotbit can get pi is by buying from miners.
Now a merchant stands in between these exchanges and the miners. As a link to make transactions smooth. Because right now in the enclosed mainnet you can't sell pi coins your self. You need the help of a merchant,
i will leave the telegram contact of my personal pi merchant below. 👇 I and my friends has traded more than 3000pi coins with him successfully.
@Pi_vendor_247
What price will pi network be listed on exchangesDOT TECH
The rate at which pi will be listed is practically unknown. But due to speculations surrounding it the predicted rate is tends to be from 30$ — 50$.
So if you are interested in selling your pi network coins at a high rate tho. Or you can't wait till the mainnet launch in 2026. You can easily trade your pi coins with a merchant.
A merchant is someone who buys pi coins from miners and resell them to Investors looking forward to hold massive quantities till mainnet launch.
I will leave the telegram contact of my personal pi vendor to trade with.
@Pi_vendor_247
If you are looking for a pi coin investor. Then look no further because I have the right one he is a pi vendor (he buy and resell to whales in China). I met him on a crypto conference and ever since I and my friends have sold more than 10k pi coins to him And he bought all and still want more. I will drop his telegram handle below just send him a message.
@Pi_vendor_247
1. RENAL FUNCTION IN THE ICU S. ESFANDIARI MD, SURGICAL INTENSIVE CARE UNIT
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3. Case Study 86 year Male 40 Kg had been admitted to ICU for G.I. Bleeding last 12 hr. BUN = 65 Creat 1.6 Urine Output = 30 cc/h BP = 140/90 C.I. 3.4L/min PCWP = 28 Medication Lasix 40 mg. Q/ d + Renal dose Dopa Urine Creat ( 2H)= 105 mg/L Urine Na = 60 Urine OS= 400 GFR=? < 15 > =35 = 19 =125 =60 DIAG A= ATN B=PUMP FAILURE C= NORMAL RENAL FUNC D= INSU DATA FOR DIAG
4. RENAL CLEARANCE/GFR Practical issues regarding creatinine, clearance in SICU A. Estimate Creatinine Clearance CL Cr = (140 - age) x lean BW in Kg 72 x S Cr Female = Estimate Value x .85
5. Case Study Calculate G.F.R V.S Measured Creatinine Clearance Estimate GFR 140 - 86 x 40 = 19 72 x 1.6
6. Case Study GFR = Cr C 2h = 105 x .5 = 32 1.6 GFR = 32 is normal for this patient age, Diagnosis = normal kidney function; High BUN is due to GI bleeding
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10. RENAL CLEARANCE/GFR (cont) 24 Creatinine Clearance or 2 Hours = CL Cr = Ucr x UV(cc/min) S cr needs volume of urine (cc/min) urine concentration of creatinine ( lab reports total amount of creatinine per vol of urine) serum concentration of creatinine
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13. Case Study 4 (cont) Ccr = 140 - Age x B.W. = 140 - 43 x 105 = 110 72 x Pcr 72 x 1.4 Female correction = Ccr x .85 = 110 x .85 = 94
14. Case Study 4 ESTIMATED VS MEASURED CREATININE CLEARANCE 43 year old female; weight 105 kg; evaluated for possible renal disease. Plasma creatinine 1.4/DL Urine creatinine 62/DL Urine volume 24 hours 1080 cc Consider zosyn dose
15. case 4 C cr measured 24 hour urinary creatinine clearance Ccr = Ucr x Uv min = 62x .75 = 33 Pcr 1.4
16. Interpretation= GFR Dialysis <10 >6 End stage Aggressive hydration 40-60 2-6 Severe hypovolemia Diuretics/dialysis 10-20 2-4 ATN None,protection strategy 20-30 2-4 C.Renal insufficiency None 30-80 1-2 Age >60 None 80-120 1-2 Normal TX GFR Serum Cr condition
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20. Case Study 2 (cont) FENa = UNa x Pcr x 100 = 65 x 1. 8 x 100 = 6% PNa x Ucr 130 x 15 2h urinary creatinine clearance Ccr = Ucr x UV (min) = 15 x 4 = 33 Pcr 1.8
29. Case Study 5 70 year old woman 80 kg in very good health admitted in ICU after surgical removal of her spleen. She has been hypotensive and on pressors in PACU for a period of 6 hours prior to ICU admission: BP 110/70 BUN = 20 Creat 1.6/L urine output 30cc/h CVP = 12 Lasix drip, 2 mg/h + Dopa renal dose Urine Na = 65 Urine osm = 320 Urine Creatinine 48 mg/L SN a=135 DIAGNOSIS A= ATN B= SIADH C= HYPOVOLEMIA D=INSU DATA FOR DIAGNOSIS
30. Case Study 5 (cont) Estimated Creatinine Clearance from Cock Croft - Gault Ccr = (140-age) x BW = 140 - 30 x 80 = 76 72 x PCr 72 x 1.6 Correction for Female .85 = 65
31. Case 5 Urinary Cr clearance 2 h Ccr= Ucr x UV (min) = 48 x .5 = 15 Pcr 1.6
39. Mechanism of Rhabdomyolosis Release of myoglobin, which is 25% of HG size rapidly filtering by glomerlus, precipitate as an acid ferrihematin in proximal tubes, hypovolemia, urine pH<6 low urine output enhancing the process
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49. Case Study 7 (cont) FENA UNa - 111 Sr cr - 2 SNa - 160 Ucr - 15 x 100 = 9%
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51. Case Study 45 year old male with Cirrhosis and large acites admitted in I.C.U.for hypotension and low urine out put Patient urinary output 20 cc/h C.I. 5L/min PCWP = 20 BP = 130/70 P Na= 130 U Na = 5 meq/l Urine osmo = 580 Pcr 2.6 BUN = 60 meq/l Urine Cr = 92
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55. Case 3 DX= HRS LOW GFR =11 LOW FENA=.1 H/O LIVER DISEASE
68. Free Water Clearance In a patient with prerenal oliguria, the urine flow may be 0.5 ml/min, serum osmolarity 300 mOsm/liter, and urine osmolarity 600 mOsm/liter: Cl OSM = (600)(0.5) = 1.0 ml/min (300) Cl H2O = urine flow (ml/min) _ Cl OSM = 0.5 - 1.0 = -0.5 ml/min
69. Free Water Clearance Cl H2O = Urine Volume/min - Cl OSM Example: Serum OSM = 300 MSO Urine OSM = 600 MSO Urine Value 120 cc/h Cl OSM = Uosm x UV = 600 x 2 = 4 S OSM 300 Cl H2O = UV = Cl OSM = 2- 4 = - 2
70. Tests to Evaluate Tubular Dysfunction Osmolar Clearance CL OSM = Uosm x Uv SERUM OSO Refers to total number of osmotically active solute particles instead of single substance: If CL OSM in equal with urine volume means no solute, would be cleared by kidney.
71. Free Water Clearance Cl OSM = (0.5)(200) = 0.36 ml/min (280) Cl H2O = 0.5 - 0.36 = 0.14 ml/min . IF FREE WATER Cr POSITIVE MEANS LACK OF CONCENTRATION CAPABILTY
73. Free Water Clearance Free-water clearance (Cl H2O ) is defined as urine volume per minute minus osmolar clearance and is normally negative. Isosthenuria (urine osmolarity the same as plasma) is one of the earliest and most consistent functional characteristics of ATN As urine osmolality falls, osmolar clearance also falls and free-water clearance becomes less negative. If urine osmolality falls below that of serum, free-water clearance becomes positive, a fall in osmolar clearance may occur, even before a fall in Cl cr or serum Cr . in some patients as ATN is developing.