Treatments for Proximal Renal Tubular Acidosis
Treatments for Proximal Renal Tubular Acidosis
The list of treatments mentioned in various sources
for Proximal Renal Tubular Acidosis
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
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Discussion of treatments for Proximal Renal Tubular Acidosis:
When possible, identifying and correcting the underlying causes are
important steps in treating the acquired forms of proximal RTA. The
diagnosis is based on the chemical analysis of blood and urine samples.
Children with this disorder would likely receive large doses of oral
alkali, such as sodium bicarbonate or potassium citrate, to treat acidosis
and prevent bone disorders, kidney stones, and growth failure. Correcting
acidosis and low potassium levels restores normal growth patterns,
allowing bone to mature while preventing further renal disease. Vitamin D
supplements may also be needed to help prevent bone problems.
(Source: excerpt from
Renal Tubular Acidosis: NIDDK)
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Anemia:
Treatment
(In a Page: Signs and Symptoms)
-
Severe cases of anemia require immediate intervention if hemodynamic compromise occurs
-
Administer supplemental O2 as needed
-
In cases of ongoing acute blood loss, establish two large-bore IVs; monitor and send for blood type and cross
-
IV fluids as necessary to maintain blood pressure
- Blood transfusion is generally indicated for Hb <8
–Young, healthy patients should only be transfused if symptomatic or have ongoing acute blood losses
–Cardiac patients may require transfusion at Hb <10
–Avoid transfusing beyond Hb >12, as this may increase
blood viscosity and impair O2 delivery
-
Supplement vitamin B12, folate, and iron as necessary
-
Patients with primary marrow disorders require transfusions, further evaluation, and possibly a bone marrow transplant
-
Treat underlying disease according to established protocols
>>>>>>>>
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Fatigue:
Treatment
(In a Page: Signs and Symptoms)
-
Treatment is targeted at specific underlying medical problems, if determined (e.g., thyroid disease, chronic infection, malignancy)
-
Stop or change offending medications
-
Consider trial of antidepressant therapy and/or cognitive behavioral psychiatric therapy
-
Regularly scheduled physical activity
-
Improve sleep hygiene
-
Referral to support groups
-
Discontinue offending medications
-
Chronic fatigue syndrome and fibromyalgia are often treated with supportive care, healthy diet, moderate exercise, and low-dose antidepressants
-
Weight loss for obesity
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Anemia:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Dependent upon etiology; if secondary, treat underlying cause or remove offending drug/agent
-
Iron deficiency
–Iron (6 mg/kg/day elemental iron) for 3 months
–Decrease milk and tannic acid intake
–Increase vitamin C intake (helps iron absorbtion)
–Response to therapy is diagnostic
-
Thalassemias, hemoglobinopathies, and membrane abnormalities: Referral to pediatric hematologist, may require chronic transfusions
-
Folic acid/vitamin B12 deficiency
–Identify cause (pernicious anemia, drugs, malnutrition,
malabsorption, alcoholism, hemolysis, pregnancy)
–Provide repletion
–Treat B12 deficiency early to prevent neurologic
damage
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Fatigue:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Behavioral modifications based on cause
–Increase duration of sleep
–Ensure three calorically adequate meals per day
-
Correction of anemia
–Iron supplementation
–Blood transfusion if hemodynamically unstable
-
Depression
–Psychological counseling and antidepressants
-
Infectious mononucleosis
–Rest if fatigue is severe
–No contact sports with significant splenomegaly
-
Anti-inflammatory drugs for inflammatory causes
-
Chronic fatigue syndrome
–Emotional support
–Psychological treatment if indicated
–Modification of schedule as needed
–Various medications have been attempted, however no
clear consensus, high rate of placebo effect
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Congenital Penile Anomalies:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Routine circumcision should be avoided as the foreskin may ultimately be used in the repair
-
Surgical revision is usually performed for cosmetic and functional reasons
-
Hypospadias and epispadias
–Canalization of the penis improves urinary flow, erectile function, and fertility
–Optimally, a skin flap is created using the foreskin
-
Chordee
–Ventral release and urethroplasty at age 6–12 months
-
Dorsal hood
–May not require treatment, or a modified routine circumcision may restore expected appearance
-
Micropenis
–Androgen stimulation before puberty has been used but is controversial because it may impair penile growth during puberty
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Renal tubular acidosis:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Supportive treatment for patients with RTA requires replacement of those substances being abnormally excreted, especially bicarbonate, and may include sodium bicarbonate tablets or solution to control acidosis. Potassium may be given by mouth for dangerously low potassium levels. Vitamins D and calcium supplements are usually avoided because the tendency toward nephrocalcinosis persists even after bicarbonate therapy. If pyelonephritis occurs, treatment may include antibiotics as well.
Treatment for renal calculi secondary to nephrocalcinosis varies and may include supportive therapy until the calculi pass or until surgery for severe obstruction is performed.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Aplastic anemias:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Effective treatment must eliminate any identifiable cause and provide vigorous supportive measures, such as packed RBC, platelet, and experimental histocompatibility locus antigen-matched leukocyte transfusions. Even after elimination of the cause, recovery can take months. Bone marrow transplantation is the treatment of choice for anemia due to severe aplasia and for patients who need constant RBC transfusions. (See Bone marrow transplantation.)
Patients with low leukocyte counts need special measures to prevent infection. The infection itself may require specific antibiotics; however, these aren’t given prophylactically because they tend to encourage resistant strains of organisms. Patients with low Hb levels may need respiratory support with oxygen in addition to blood transfusions.
For older patients, or for those who don’t have a matched bone marrow donor, antithymocyte globulin (ATG) is an alternative treatment. ATG is a horse serum that contains antibodies against human T cells. It may be used in an attempt to suppress the body’s immune system, allowing the bone marrow to resume its blood cell-generating function. Other immunosuppressant agents, such as cyclosporine, may also be used.
Other treatments may include corticosteroids to stimulate erythroid production, marrow-stimulating agents such as androgens (which remain controversial), and colony stimulation factors to encourage growth of specific cellular components.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Folic acid deficiency anemia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment consists primarily of folic acid supplements and elimination of contributing causes. Folic acid supplements may be given orally or parenterally (to patients who are severely ill, have malabsorption, or are unable to take oral medication). Many patients respond favorably to a well-balanced diet. If the patient has combined B12 and folate deficiencies, folic acid replenishment alone may aggravate neurologic dysfunction.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Iron deficiency anemia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
The first priority of treatment is to determine the underlying cause of anemia. Once this is determined, iron replacement therapy can begin. Treatment of choice is an oral preparation of iron or a combination of iron and ascorbic acid (which enhances iron absorption). However, in some cases, iron may have to be administered parenterally — for instance, if the patient is noncompliant to the oral preparation, if he needs more iron than he can take orally, if malabsorption prevents adequate iron absorption, or if a maximum rate of Hb regeneration is desired.
Because total dose I.V. infusion of supplemental iron is painless and requires fewer injections, it’s usually preferred to I.M. administration. Pregnant patients and geriatric patients with severe anemia, for example, should receive a total dose infusion of iron dextran in normal saline solution over 8 hours. To minimize the risk of an allergic reaction to iron, an I.V. test dose of 0.5 ml should be given first. For more patient care information, see Supportive management of patients with anemia, page 1034.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Pernicious anemia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Early parenteral vitamin B12 replacement can reverse pernicious anemia, minimize complications and, possibly, prevent permanent neurologic damage. An initial high dose of parenteral vitamin B12 causes rapid RBC regeneration. Within 2 weeks, Hb levels should rise to normal, and the patient’s condition should markedly improve. Because rapid cell regeneration increases the patient’s iron and folate requirements, concomitant iron and folic acid replacement is necessary to prevent iron deficiency anemia.
After the patient’s condition improves, the vitamin B12 dosage can be decreased to maintenance levels and given monthly. Because such injections must be continued for life, the patient should learn self-administration of vitamin B12.
If anemia causes extreme fatigue, the patient may require bed rest until Hb levels rise. If Hb levels are dangerously low, he may need blood transfusions. Digoxin, a diuretic, and a low-sodium diet may be necessary for a patient with heart failure. Most important is the replacement of vitamin B12 to control the condition that led to this failure. Antibiotics help combat accompanying infections.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Sickle cell anemia:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment begins before age 4 months with prophylactic penicillin. If the patient's Hb drops suddenly or if his condition deteriorates rapidly, he'll need to be hospitalized for a transfusion of packed RBCs. In a sequestration crisis, treatment may include sedation, administration of analgesics, a blood transfusion, oxygen administration, and large amounts of oral or I.V. fluids.
Daily folic acid supplementation is recommended to prevent megaloblastic crisis. Hydroxyurea, which causes an increase in the synthesis of fetal Hb and a significant reduction in crises, is being used for some patients with sickle cell anemia. Researchers have found it helpful for some patients because it reduces the frequency of painful crises and episodes of acute chest syndrome and decreases the need for blood transfusions.
Newer drugs are being developed to manage sickle cell anemia. Some of these agents try to induce the body to produce more fetal Hb, which helps decrease the amount of sickling. Others work by increasing the binding of oxygen to sickle cells. Currently, bone marrow transplantation offers the only cure for sickle cell anemia. Gene therapy (replacing HbS with normal HbA) may be the ideal treatment, but it's difficult to perform.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Sideroblastic anemias:
Treatment
(Professional Guide to Diseases (Eighth Edition))
Treatment of sideroblastic anemias depends on the underlying cause. The hereditary form usually responds to several weeks of treatment with high doses of pyridoxine (vitamin B6). The acquired secondary form generally subsides after the causative drug or toxin is removed, or the underlying condition is adequately treated. Folic acid supplements may also be beneficial when concomitant megaloblastic nuclear changes in RBC precursors are present. Elderly patients with sideroblastic anemia (usually the primary acquired form) are less likely to improve quickly and are more likely to develop serious complications. Deferoxamine may be used to treat chronic iron overload in selected patients.
Carefully crossmatched transfusions (providing needed Hb) or high doses of androgens are effective palliative measures for some patients with the primary acquired form of sideroblastic anemia. However, this form is essentially refractory to treatment and usually leads to death from acute leukemia or from respiratory or cardiac complications.
Some patients with sideroblastic anemia may benefit from phlebotomy to prevent hemochromatosis (the accumulation of iron in body tissues). Phlebotomy steps up the rate of erythropoiesis and uses up excess iron stores; thus, it reduces serum and total-body iron levels.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Chronic fatigue syndrome:
Treatment
(Professional Guide to Diseases (Eighth Edition))
No treatment is known to cure CFS. Symptomatic treatment may involve the use of medications to treat depression, anxiety, pain, discomfort, and fever. Hidden yeast infections may be present and should be treated. Antiviral drugs such as acyclovir and selected immunomodulating agents, such as I.V. gamma globulin, ampligen, and transfer factor, may be of assistance.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Fatigue:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Regardless of the cause of fatigue, you may need to help the patient alter his lifestyle to achieve a balanced diet, a program of regular exercise, and adequate rest. Counsel him about setting priorities, keeping a reasonable schedule, and developing good sleep habits. Teach stress management techniques as appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Tunnel vision [Gun barrel vision, tubular vision]:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
If tunnel vision is permanent, teach the patient to move his eyes from side to side when he walks to avoid bumping into objects.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Renal tubular acidosis:
Treatment
(Handbook of Diseases)
Supportive treatment of patients with RTA requires replacement of those substances being abnormally excreted, especially bicarbonate. It may include alkaline medications, such as potassium citrate and sodium bicarbonate, to control acidosis, and oral potassium to treat dangerously low potassium levels. If pyelonephritis occurs, treatment may include an antibiotic as well.
CLINICAL TIP: Vitamin D and calcium supplements aren’t usually given because the tendency toward nephrocalcinosis persists even after bicarbonate therapy.
Treatment of renal calculi secondary to nephrocalcinosis varies and may include supportive therapy until the calculi pass or until surgery for severe obstruction is performed.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Aplastic and hypoplastic anemias:
Treatment
(Handbook of Diseases)
Identifiable causes must be eliminated and vigorous supportive measures must be provided, such as transfusions of packed RBCs and platelets. Human leukocyte antigen–matched leukocytes or antithymocyte globulin, used alone or in combination with cyclosporine, has especially impaired outcomes for children and severely neutropenic patients. Experimental trials of androgen therapy are in process. Even after elimination of the cause, recovery can take months. Bone marrow transplantation is the treatment of choice for patients with anemia resulting from severe aplasia and for patients who need constant RBC transfusions.
Preventing infection
Patients with low leukocyte counts need special measures to prevent infection. The infection itself may require specific antibiotics; however, they aren’t given prophylactically because they tend to encourage resistant strains of organisms. Patients with low hemoglobin (Hb) levels may need respiratory support with oxygen, in addition to blood transfusions.
Other treatments
Other appropriate treatments include a corticosteroid to stimulate erythroid production (tends to be successful in children but not adults); a marrow-stimulating agent, such as an androgen (which is controversial); an antilymphocyte globulin (which is experimental); an immunosuppressant (if the patient doesn’t respond to other therapy); and a colony-stimulating factor to encourage growth of specific cellular components.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chronic fatigue and immune dysfunction syndrome:
Treatment
(Handbook of Diseases)
Treatment is aimed at the cause, if one can be found. Supportive therapy includes an anti-inflammatory, an antihistamine, and rest.
Treatment of symptoms may include a tricyclic antidepressant (doxepin), a histamine2-blocker (cimetidine), and an anxiolytic (alprazolam). In some patients, avoidance of environmental irritants and certain foods may help to relieve symptoms.
Experimental treatments include the antiviral acyclovir and selected immunomodulators, such as I.V. gamma globulin, ampligen, and transfer factor.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Folic acid deficiency anemia:
Treatment
(Handbook of Diseases)
Folic acid supplements and the elimination of contributing causes are the primary treatments. Supplements may be given orally (usually 1 to 5 mg/day) or parenterally (to patients who are severely ill, have malabsorption, or are unable to take oral medication).
Clinical tip The clinical features of anemia usually disappear within 1 to 2 weeks after administration of folate.
Many patients also respond favorably to a well-balanced diet.
If the patient has combined vitamin B12 and folate deficiencies, folic acid replenishment alone may aggravate neurologic dysfunction.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Iron deficiency anemia:
Treatment
(Handbook of Diseases)
The first priority of treatment is to determine the underlying cause of anemia. When this is determined, iron replacement therapy can begin. The treatment of choice is an oral preparation of iron or a combination of iron and ascorbic acid (which enhances iron absorption). In some cases, iron may have to be administered parenterally — for example, if the patient is noncompliant to the oral preparation, if she needs more iron than she can take orally, if malabsorption prevents adequate iron absorption, or if a maximum rate of Hb regeneration is desired. (See Injecting iron solutions.)
Because a total-dose I.V. infusion of supplemental iron is painless and requires fewer injections, it’s usually preferred over I.M. administration. Pregnant patients and elderly patients with severe anemia, for example, should receive a total-dose infusion of iron dextran in normal saline solution over 8 hours. To minimize the risk of an allergic reaction to iron, an I.V. test dose of 0.5 ml should be given first.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Pernicious anemia:
Treatment
(Handbook of Diseases)
Early parenteral vitamin B12 replacement can reverse pernicious anemia, minimize complications, and possibly prevent permanent neurologic damage.
Vitamin B12 replacement
An initial high dose of parenteral vitamin B12 causes rapid RBC regeneration. Within 2 weeks, the Hb level should rise to normal, and the patient’s condition should markedly improve. Because rapid cell regeneration increases the patient’s iron and folate requirements, concomitant iron and folic acid replacement is necessary to prevent iron deficiency anemia.
After the patient’s condition improves, the vitamin B12 dosage can be decreased to maintenance levels and given monthly. Because such injections must be continued for life, patients should learn how to do the injections themselves.
Other measures
If anemia causes extreme fatigue, the patient may require bed rest until his Hb level rises. If his Hb level is dangerously low, blood transfusions, digoxin, a diuretic, and a low-sodium diet for heart failure may be needed. Most important is the replacement of vitamin B12 to control the condition that led to this failure. Antibiotics help combat accompanying infections.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Sickle cell anemia:
Treatment
(Handbook of Diseases)
Prophylactic antibiotics are given in certain treatments and at follow-up, even when the patient isn’t in crisis. If the patient’s Hb drops suddenly or if his condition deteriorates rapidly, a transfusion of packed RBCs is needed. Supplementation with folic acid is required because of rapid RBC turnover.
In a sequestration crisis, treatment may include sedation, administration of analgesics, blood transfusion, oxygen administration, and large amounts of oral and I.V. fluids. A good antisickling agent isn’t available yet; the most commonly used drug, sodium cyanate, has many adverse effects.
Partial exchange transfusions may be done in crisis situations. Bone marrow transplants are also successful in treatment.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Sideroblastic anemias:
Treatment
(Handbook of Diseases)
The underlying cause determines the type of treatment.
Hereditary form
Hereditary sideroblastic anemia usually responds to several weeks of treatment with high doses of pyridoxine (vitamin B6).
Primary acquired form
Elderly patients with sideroblastic anemia — most commonly the primary acquired form — are less likely to improve quickly and are more likely to develop serious complications. Deferoxamine may be used to treat chronic iron overload in selected patients.
Carefully cross-matched transfusions (providing needed Hb) or high doses of androgens are effective palliative measures for some patients with the primary acquired form of sideroblastic anemia. However, this form is essentially refractory to treatment and usually leads to death from acute leukemia or from respiratory or cardiac complications.
CLINICAL TIP: Some patients with sideroblastic anemia may benefit from phlebotomy to prevent hemochromatosis. Phlebotomy steps up the rate of erythropoiesis and uses up excess iron stores; thus, it reduces serum and total-body iron levels.
Secondary acquired form
The secondary acquired form generally subsides after the causative drug or toxin is removed or the underlying condition is adequately treated. Folic acid supplements may also be beneficial when concomitant megaloblastic nuclear changes in RBC precursors are present.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Fatigue:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Regardless of the cause of fatigue, you may need to help the patient alter his lifestyle to achieve a balanced diet, a program of regular exercise, and adequate rest. Counsel him about setting priorities, keeping a reasonable schedule, and developing good sleep habits. Teach stress management techniques as appropriate.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Fatigue:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Help the patient determine which daily activities he may need help with and how he should pace himself to ensure sufficient rest.
▪ Take measures to reduce pain and nausea.
▪ If fatigue results from a psychogenic cause, refer him for psychological counseling.
Patient teaching
▪ Educate the patient about lifestyle modifications, including diet and exercise.
▪ Stress the importance of pacing activities and planning rest periods.
▪ Discuss stress management techniques.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Tunnel vision [Gun barrel vision, tubular vision]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To protect the patient from injury, remove all potentially dangerous objects and orient him to his surroundings.
▪ Prepare the patient for diagnostic procedures, such as tonometry, perimeter examination, and visual field testing.
Patient teaching
▪ Explain the underlying disorder and treatment plan.
▪ Because vision impairment is frightening, reassure the patient, and clearly explain diagnostic procedures.
▪ Teach the patient how to compensate for tunnel vision to avoid bumping into objects.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Renal Tubular Acidosis:
Renal Tubular Acidosis - TREATMENT
(The 5-Minute Pediatric Consult)
- Alkali administration is the primary therapy for children with RTA.
- Sodium/potassium citrate (Polycitra 2 mEq HCOSodium citrate (Bicitra 1 mEq HCOOlder children can take sodium bicarbonate tablets (7.7 mEq HCOPatients with type I RTA usually require 1–4 mEq/kg alkali therapy per day in 3–4 divided doses.
- Patients with type II RTA require considerably more alkali therapy (5–20 mEq/kg/d in 4–6 divided doses).
- The dosage of alkali in children with type IV RTA ranges from 1–5 mEq/kg/d, which is usually sufficient to correct the hyperkalemia.
» READ BOOK EXCERPT ONLINE »
Source: The 5-Minute Pediatric Consult, 2008
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