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Renal oxygen uptake chronic gastritis yahoo answers buy lansoprazole, although also reduced gastritis diet сериалы purchase lansoprazole 15mg otc, has been found to be sufficient to avoid a pathophysiologically meaningful renal hypoxia (Kramer and Deetjen gastritis with hemorrhage lansoprazole 30mg on line, 1960; Lassen et al gastritis remedios discount lansoprazole 15mg on-line. Collectively, these findings delineate a putative mechanism of renal dysfunction: equilibration of filtration pressure and cessation of glomerular filtration in obstructed nephrons. Eventually, some impacted tubules will undergo tubulorrhexis, as documented by elegant microdissection studies by Oliver et al. This event may have the following consequences: a decline in proximal tubular pressure and restoration of glomerular filtration, on the one hand, and elevation of interstitial pressure (as discussed below), on the other. Interstitial pressure this mechanism may provide an additional explanation for cessation of glomerular filtration as a result of reduced perfusion and elevated hydrostatic pressure within the renal capsule (Brun and Munck, 1966). This phenomenon has been attributed to either the reduction in hydraulic conductivity of glomerular endothelial cells, which show reduced number and surface area of fenestrae (Avasthi et al. Within the realm of these hard facts, tightly interrelated and dependent on one another, lies the most plausible explanation of renal dysfunction and oliguria occurring in this syndrome, as schematically depicted in. Proximal tubular pressure Based on morphologic studies demonstrating desquamation of proximal tubular epithelia and cast formation in the distal nephron, investigators performed direct measurements of proximal tubular pressure in experimental animals. Gottschalk and co-workers measured hydrostatic pressure in the proximal tubules in rats with acute renal ischaemia (Arendshorst et al. When agglomeration of desquamated cells and cell debris is prevented by an arginine-glycine-aspartic acid-containing peptide, elevation of the proximal tubular pressure is avoided and renoprotection achieved (Goligorsky and DiBona, 1993). After 10 minutes of ischaemia these investigators detected widespread apical membrane blebbing and desquamation of proximal tubular cells into the tubular lumen resulting in accumulation of intraluminal cellular aggregates and debris. After 30 minutes of ischaemia and reperfusion, many proximal tubules were nearly impacted by a slow-moving cell debris. Inset: intravital videomicroscopy of the rat proximal tubule in control (A), 10 and 20 minutes after cessation of blood flow (B and C), and following reperfusion at elevated perfusion pressure (D)-note that conglomerated desquamated cells are washed-out. Epithelial cell injury Cell stress induces an early elevation of cytosolic calcium concentration and activation of a host of calcium-dependent events, one of which is activation of cysteine proteases, calpains. Substrates for calpain hydrolysis include, among others, plasma membrane and cytoskeletal proteins, especially ankyrin and -fodrin (Inserte et al. Calpain-induced cleavage deranges this anchorage of the sodium pump, the phenomenon occurring early in the course of many insults to the kidney (Molitoris et al. Activation of calpain results in proteolytic cleavage of talin, disassembly of focal adhesions, and collapse of the membrane-anchored cytoskeleton (Beckerle et al. Furthermore, degradation of matrix proteins releases fragments of collagen, osteopontin, and laminin 5 leading, via integrin signalling, to activation of calpain and proteolytic cleavage of other components of focal adhesions, such as focal adhesion kinase and paxillin (Carragher et al. The same proteins serve as targets for inactivation by protein tyrosine phosphatases leading to the disassembly of focal adhesions (Angers-Loustau et al. All these perturbations in focal adhesions, collapse, and remodelling of the cytoskeleton have multiple cellular consequences. The ensuing loss of epithelial cell polarity affects distribution of multiple enzymes and proteins normally segregated to apical or basolateral membranes (Molitoris et al. These include not only sodium pumps, but also integrins, a family of heterodimeric proteins anchoring cells to the extracellular matrix (Gailit et al. Similar processes of desquamation from the basement membrane take place in endothelial cells (see below) and result in the appearance of detached cells in the circulation, on the one hand, and intimal denudation of vessels, on the other. Denuded patches of basement membrane become sites of platelet aggregation, portals for leucocyte infiltration, and foci of vasoconstriction. They are expressed in both cell types and the kidney has the highest expression level for Epac (de Rooij et al. Consequently, when proximal tubular cell cultures are subjected to stress in the presence of a cell-permeable Epac, focal adhesions and adherence junctions remain better preserved after hypoxic stress, than without this treatment (Stokman et al. In vivo application of Epac via the renal artery significantly reduces the loss of epithelial cells and the number of obstructed tubules. Epac pre-treatment of adoptively transferred endothelial progenitor cells improves their engraftment and regenerative potential (Patschan et al. Steinhausen and co-workers were the first to perform high-speed intravital videomicroscopy of ischaemic kidneys following reperfusion (Steinhausen et al. In a series of intravital videomicroscopy imaging studies of renal ischaemia/reperfusion (I/R) in rats, we (Yamamoto et al. This pattern of oscillatory microcirculation is known to affect a host of endothelial and vascular functions. Furthermore, oscillatory shear stress has been implicated in downregulation of antioxidative peroxiredoxins (Mowbray et al. These multiple effects of oscillatory shear stress have a comparable time-course and could be responsible for developing endothelial cell activation and dysfunction in the course of renal I/R, as detailed in. This interaction between two powerful vasoactive compounds provides the system with properties of an intrinsic oscillator, as schematically depicted in. Homodimerization of the enzyme consisting of C-terminal reductase domain and N-terminal oxygenase domain is accomplished via zinc coordination of Cys 99-Cys94 motifs on each monomer. All three endothelins 1-3 have 2 intramolecular disulphide bonds, all are consecutive cleavage products of pre-proendothelins, proendothelins and 38-amino acid peptide big endothelins. Stagnation of blood flow and oscillatory pattern of blood flow, as mentioned above, produce opposite effects, thus predisposing to prevailing vasoconstriction. Similar observations were made in ciclosporin-induced nephrotoxicity (reviewed in Kon and Hunley, 1995). Both vasoactive compounds are produced constitutively by the endothelial cells and release of both can be stimulated by various agonists. Necrotic cells cannot be engulfed by phagocytes and undergo clearance through a much less efficient macropinocytosis process (Krysko et al.

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Anti-platelet therapy in graft thrombosis: results of a prospective gastritis diet гугол cheap 30 mg lansoprazole visa, randomized syarat diet gastritis order lansoprazole 30 mg without a prescription, double-blind study gastritis diet in dogs order lansoprazole without a prescription. Exit of catheter lock solutions from double lumen acute haemodialysis catheters-an in vitro study gastritis diet колеса buy lansoprazole 30 mg mastercard. Clinical management of dialysis catheter-related bacteremia with concurrent exit site infection. Can blood flow surveillance and pre-emptive repair of subclinical stenosis prolong the useful life infectious complications and mortality. Comparative effectiveness of two catheter locking solutions to reduce catheter-related bloodstream infection in hemodialysis patients. Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia. Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas. Failure of arteriovenous fistula maturation: an unintended consequence of exceeding Dialysis Outcome Quality Initiative guidelines for hemodialysis access. Effect of a vascular access nurse coordinator to reduce central venous catheter use in incident hemodialysis patients: a quality improvement report. Treatment of catheter-related bacteremia with an antibiotic lock protocol: effect of bacterial pathogen. A randomized controlled trial of blood flow and stenosis surveillance of hemodialysis grafts. Creation, cannulation, and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Concentration of heparin-locking solution and risk of central venous hemodialysis catheter malfunction. Ultrasound monitoring to detect access stenosis in hemodialysis patients: a systematic review. Salvage of immature forearm fistulas for haemodialysis by interventional radiology. Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. Is percutaneous transluminal angioplasty an effective intervention for arteriovenous graft stenosis Randomized trial of folic acid for prevention of cardiovascular events in end-stage renal disease. Impact of switch of of vascular access type on key clinical and laboratory parameters in chronic hemodialysis patients. Effect of haemodynamic variables on surgically created arteriovenous fistula flow. Stent placement in hemodialysis access: historical lessons, the state of the art and future directions. Bieber and Jonathan Himmelfarb Introduction the development of haemodialysis for the treatment of chronic kidney disease was a remarkable step in medicine that moved what was once a universally fatal organ failure to a condition that is regarded as treatable (Scribner et al. Over the decades since that remarkable advancement, mechanical methods of blood purification to correct the uraemic condition have gained a prominent and often expected role in the care of the patient with end-stage kidney failure. Even so, patients with end-stage kidney disease still experience high rates of morbidity and mortality, at times surpassing other chronic conditions such as cancer (Centers for Disease Control and Prevention, 2007; United States Renal Data System, 2011). The goal of haemodialysis should be not only to maintain life but also to restore the afflicted individual to a state of health, thus rehabilitating them so that they can lead a meaningful, fulfilling life. Currently utilized methods of haemodialysis, while effective at acutely reversing the uraemic condition, often fall short of the goal of rehabilitation. This observation, among others, has led many scientists and physicians to suspect that contemporary dialytic therapy is inadequate and has led to vigorous pursuit of the question: what is the adequate dose of dialysis While extensive effort has been devoted to the pursuit of this question, it has yet to be definitively answered to the satisfaction of the scientific community. The following adequacy chapter will predominantly focus on currently popularized and frequently utilized methods for measurement of dialysis dose with the stipulation that the reader understands that the determination of the adequate dose of dialysis is an evolving field and in clinical practice should require more diligence than simple surveillance of urea clearance. The adequacy of volume management, which is arguably of equal importance to the adequacy of uraemic retention solute clearance, is covered in other chapters within this text. It was recognized that dialysance of various molecules differed depending upon the size and charge of the molecule. With increasing surface area of membrane as well as with increasing blood flow, the dialysance of all molecules was increased despite their specific characteristics. Also recognized was the rate of excretion in the artificial kidney, which is proportional to the difference between the blood and bath concentration. At this time in history, haemodialysis was still a therapy that was only utilized at specialized medical centres and large variation existed between centres as to the type of dialysis apparatus and dialysis membrane utilized. In 1964, there was an attempt to quantify the performance characteristics of different dialysers (Michaels, 1966). In this work it was suggested that the overall efficiency of a membrane device is dependent upon two independent parameters, the ratio of flow rates (of blood and dialysate) and the rate constant (K) for solute transport between fluids. K would be dependent upon the characteristics of the membrane such as surface area, membrane thickness, pore size, and local fluid velocity. Recognizing these relationships led to the development of mathematical and graphical models allowing the estimation of the expected clearances at differing flow rates using a constant (KoA) for a particular dialyser at different blood and dialysate flows. Today the mass transfer permeability area coefficient or KoA is provided on dialyser specification sheets and predominantly has utility in comparing performance characteristics between dialysers and in calculations performed with urea kinetic modelling. In the early 1960s, the development of the arteriovenous shunt and advancing dialysis technology made the treatment of chronic renal failure a more realistic possibility (Scribner et al. Early determinations of the dose of dialysis were largely speculative, based on clinical observation and bound by logistical and financial constraints.

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Effect of smooth muscle relaxant drugs on proximal human ureteric activity in vivo: a pilot study gastritis diet shopping list buy generic lansoprazole 30mg online. Modified supine versus prone position in percutaneous nephrolithotomy for renal stones treatable with a single percutaneous access: a prospective randomized trial gastritis tums buy lansoprazole 30mg fast delivery. An assessment of the clinical efficacy of intranasal desmopressin spray in the treatment of renal colic gastritis diet recipes lansoprazole 30 mg for sale. Repeated radiological radiation exposure in patients undergoing surgery for urinary tract stone disease in Victoria gastritis and coffee cheap lansoprazole 15 mg without a prescription, Australia. Time to stone passage for observed ureteral calculi: a guide for patient education. Effect of terazosin on lower urinary tract symptoms and pain due to double-J stent: a double-blind placebo-controlled randomized clinical trial. Shock wave lithotripsy at 60 or 120 shocks per minute: a randomized, double-blind trial. Extracorporeal shock wave lithotripsy success based on body mass index and Hounsfield units. Shock wave lithotripsy success determined by skin-to-stone distance on computed tomography. A protocol of early spiral computed tomography for the detection of stones in patients with renal colic has reduced the time to diagnosis and overall management costs. Skin to stone distance is an independent predictor of stone-free status following shockwave lithotripsy. American Urological Association Education and Research, Inc; European Association of Urology. Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. The necessity of prophylactic antibiotics during extracorporeal shock wave lithotripsy. Prospective study of the long-term effects of shock wave lithotripsy on renal function and blood pressure. Computerized tomography magnified bone windows are superior to standard soft tissue windows for accurate measurement of stone size: an in vitro and clinical study. Spiral computerized tomography in the evaluation of acute flank pain: a replacement for excretory urography. Extracorporeal shock wave lithotripsy in impacted upper ureteral stones: a prospective randomized comparison between stented and non-stented techniques. Role of computed tomography with no contrast medium enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi. Imaging-based assessment of the mineral composition of urinary stones: an in vitro study of the combination of Hounsfield unit measurement in noncontrast helical computerized tomography and the twinkling artifact in color Doppler ultrasound. Adjunctive tamsulosin improves stone free rate after ureteroscopic lithotripsy of large renal and ureteric calculi: a prospective randomized study. Computerized tomography attenuation value of renal calculus: can it predict successful fragmentation of the calculus by extracorporeal shock wave lithotripsy Alternative or additional diagnoses on unenhanced helical computed tomography for suspected renal colic: experience with 1000 consecutive examinations. Outcomes of long-term follow-up of patients with conservative management of asymptomatic renal calculi. Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of follow up. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy Efficacy of flexible ureterorenoscopy with holmium laser in the management of stone-bearing caliceal diverticula. Comparison of intravenous sedation versus general anesthesia on the efficacy of the Doli 50 lithotriptor. Effects of tamsulosin on lower urinary tract symptoms due to double-J stent: a prospective study. Shock wave lithotripsy success for renal stones based on patient and stone computed tomography characteristics. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. Music decreases anxiety and provides sedation in extracorporeal shock wave lithotripsy. Kalra 208 Regulation of vasomotor tone in the afferent and efferent arterioles 1729 Karlhans Endlich and Rodger Loutzenhiser 215 Renal artery stenosis: management and outcome 1782 James Ritchie, Darren Green, Constantina Chrysochou, and Philip A. Kalra 1738 1742 209 Tubuloglomerular feedback, renal autoregulation, and renal protection Karlhans Endlich and Rodger Loutzenhiser 216 Malignant hypertension 217 Resistant hypertension 218 the hypertensive child Wolfgang Rascher 1792 1799 Caroline Whitworth and Stewart Fleming Iain M. Ruilope 211 the effect of hypertension on renal vasculature and structure 1750 Ulrich Wenzel, Thorsten Wiech, and Udo Helmchen 219 Treatment of hypertension in children Wolfgang Rascher 212 Ischaemic nephropathy 1760 Helen Alderson, Constantina Chrysochou, James Ritchie, and Philip A. Kalra 213 Renal artery stenosis: clinical features and diagnosis 1766 James Ritchie, Darren Green, Constantina Chrysochou, and Philip A. The branching pattern and the ultrastructure of renal vessels are specialized with respect to: the glomerular capillary network and its supply, where a high capillary pressure drives glomerular filtration the peritubular capillaries, where massive reabsorption takes place the renal medulla, where urine concentration is controlled by the countercurrent system. Last but not least the renal vessels supply the metabolic needs of the kidney tissue.

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Thus the response of the proximal tubule to cellular acidification is hypocitraturia gastritis joghurt buy 15mg lansoprazole with amex. This wide range in the prevalence almost certainly reflects differences in the populations studied gastritis diet 8 day buy on line lansoprazole, in dietary background gastritis diet гоо buy lansoprazole 30 mg fast delivery, and in the definition of hypocitraturia gastritis lettuce discount lansoprazole 30mg with mastercard. Isolated hypocitraturia is not common, more typically hypocitraturia is accompanied by other abnormalities such as hypercalciuria in stone formers. While some groups report differences in normals related to age and sex (Parks and Coe, 1986; Minisola et al. Causes of hypocitraturia in the context of nephrolithiasis are those that acidify the proximal tubule cell. Occasionally, no underlying defect can be uncovered and the patient is thought to have idiopathic hypocitraturia. Hyperuricosuria Hyperuricosuria refers to an excess of the sum of urinary urate and uric acid regardless of the relative partition between these two species (Bushinsky et al. Hyperuricosuria can not only be a cause of uric acid nephrolithiasis but it is also a well-documented risk factor for calcium oxalate stones. In > 800 calcium stone formers, 15% have hyperuricosuria as the sole metabolic abnormality and 14% meet the criteria for both hyperuricosuria and hypercalciuria Treatment Therapy for hypocitraturia is directed at the correction of the disorders that reduce urine citrate, such as acidosis, an increased acid load, or hypokalaemia. However, using sodium as the cation for the alkali will lead to an increased urine calcium excretion which will offset the benefits of increased urine citrate (Lemann et al. However, the majority of pure uric acid stones are not due to hyperuricosuria but rather are due to an unduly acidic urine (Moe, 2006b). When urine pH is not acidic, hyperuricosuria leads to excessive urinary urate rather than uric acid and urate is far more soluble than is uric acid. The most abundant cation in urine is usually sodium and sodium urate has a lower solubility than potassium urate. In the presence of hyperuricosuria and absence of excessively acidic urine, sodium urate crystallizes and forms a clinically significant kidney stone. An increase in renal excretion should be accompanied by hypouricaemia in the absence of changes in production and intestinal degradation. The single most prevalent cause of hyperuricosuria from the view of kidney stones is excessive dietary purine. Treatment Hyperuricosuria is often not caused by a single risk factor, thus it is important to address all causative factors of nephrolithiasis in any given individual. Approximately 70% of hyperuricosuric patients have high purine intake as the cause of hyperuricosuria since their uric acid excretion falls with dietary purine restriction (Coe, 1978; Coe and Parks, 1981). Dietary modification should be the first line of therapy though, as with any dietary modification, compliance is variable. The non-compliant patients, along with the 30% which represents the non-responders to dietary changes, require other approaches. Allopurinol is oxidized by xanthine oxidase to oxypurinol which inhibits xanthine oxidase. At low concentrations, allopurinol is both a substrate and a competitive inhibitor of the enzyme while at high concentrations, it functions as a non-competitive inhibitor. The side effects of allopurinol include rash, gastrointestinal upset, abnormal liver enzymes, and an increased half-life in chronic kidney disease. More recently a number of other xanthine oxidase inhibitors have been marketed which have a more favourable toxicology profile, improved bioavailability, and more potent and persistent action than allopurinol (Pacher et al. Febuxostat is a thiazolecarboxylic acid derivative that is a potent xanthine oxidase inhibitor (Takano et al. While the efficacy of febuxostat to reduce hyperuricaemia and gouty episodes is established (Schumacher et al. Although xanthine oxidase inhibitors reduce hyperuricosuria and stone recurrence (Coe, 1977), whether they reduce stone recurrence in patients with combined hyperuricosuria and hypercalciuria remains to be determined. Other measures targeted at reducing urinary calcium, such as thiazides, are effective in reducing calcium stone recurrence in patients with or without hyperuricosuria (Pak and Peterson, 1986; Meschi et al. Pathogenesis of hyperuricosuria-associated calcium urolithiasis While the clinical entity of hyperuricosuric calcium urolithiasis is well established, the mechanism by which this occurs has not been firmly established. The role of hyperuricosuria in calcium stone formation can be attributed to several of its effects on urinary supersaturation and crystallization (Sorensen and Chandhoke, 2002). The crystal lattice dimensions for uric acid, sodium urate, calcium oxalate monohydrate, and calcium oxalate dehydrate are very similar so the presence of one in solid phase will promote the precipitation of the other (Lonsdale, 1968). Both Coe and co-workers and Pak and co-workers showed that in vitro, sodium urate, rather than uric acid, is responsible for epitaxic crystal growth (Coe et al. However, another in vitro study demonstrated that urate-induced calcium oxalate crystallization does not decrease urate concentration in solution so the authors questioned the epitaxy theory (Grover et al. While epitaxy requires a solid phase to initiate the crystallization, salting out refers to the ability of urate to lower the formation product of calcium oxalate by as yet unknown mechanisms (Grover et al. This theory was supported by studying clinical samples where it was found that the formation product of calcium oxalate increased with allopurinol therapy (Pak et al. A third model proposes that uric acid or sodium urate sequesters inhibitors of calcium crystallization. The addition of sodium urate to urine lowers the activity of inhibitors (Fellstrom et al.

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Serum creatinine: intracellular energy production largely depends upon presence of creatine; it is released in large quantities from damaged myocytes gastritis diet 14 purchase lansoprazole online, and converted into creatinine in the circulation gastritis diet coffee buy lansoprazole 15 mg low cost. Alternatively gastritis diet quiz buy discount lansoprazole 30mg on-line, increased urea synthesis by the liver in highly catabolic patients (Rose and Post gastritis diet bland purchase lansoprazole 30 mg free shipping, 2001) may contribute to the maintenance of this physiologic ratio. In practice, myoglobinuria is most often detected by dipstick testing; a positive test can indicate haematuria, myoglobinuria, or haemoglobinuria, but is not typical for final diagnosis (Vanholder et al. At microscopic investigation, the presence of only few erythrocytes despite a strong blood reaction at dipstick testing rule out haematuria and suggest pigment in the urine. The suggestion that this is due to myoglobinuria is sustained by detection of dark-pigmented urine casts. Serum myoglobin: the most reliable finding of rhabdomyolysis is increased myoglobin in serum. Except for early admitted patients, myoglobin level is usually normal at admission to hospitals. Indeed, mortality rates up to 40% are reported in the literature (Ward, 1988; Atef et al. This improvement may be related to increased awareness, better treatment, and overall more accurate and faster disaster response. The goals of volume repletion are reversing hypovolaemic shock, enhancing renal perfusion to minimize ischaemic injury, and increasing the urine flow rate to wash out obstructive casts. Systemic alkalinization for reducing acidosis and hyperkalaemia is important, but has lower priority than rehydration per se. The following issues should be considered for fluid resuscitation: Timing Fluids (preferably isotonic saline) should be given intravenously at the earliest occasion (Better and Stein, 1990). For crush casualties, if possible, volume resuscitation should be started even when the victim is still entrapped under the rubble, and continued during and after extrication. Therefore, priority is given to saline solutions, essentially because of practical reasons. Mannitol expands extracellular volume, increases urine output, prevents renal tubular cast deposition, and decreases muscle intracompartmental pressure (Better et al. By no means should potassium-containing solutions be used empirically, as they are a cause of hyperkalaemia and subsequently of death. Colloids should not be used for fluid resuscitation in crush cases considering no major benefit on morbidity, and mortality, and a high risk of side effects (Choi et al. Loop diuretics may be beneficial by increasing urine volume; however, they may worsen hypocalcaemia by inducing calciuria and increase the risk of cast formation by acidifying the urine (Better and Stein, 1990; Slater and Mullins, 1998). Despite these concerns, however, in older patients, especially if they are hypervolaemic, use of loop diuretics is justified. Demographic features, medical signs, and symptoms, as well as fluid losses should be considered for defining this volume (Sever et al. For further fluid policy, urinary response, and also environmental, and logistic factors should be considered. In case of close follow-up, however, more fluids even up to 12 L/day may be administered (Sever et al. Extensive volumes carry the risk of hypervolaemia, hypertension, and heart failure, especially in the elderly patients. On the other hand, even authors who disfavour fasciotomy for a more conservative approach, support urgent fasciotomy in the case of open crush injury, absence of distal pulses, and overall failure of the perfusion of the extremity (Michaelson et al. Intracompartmental pressure measurement is the best method as an objective criterion for decision-making with regard to the performing of fasciotomies (Mubarak et al. Type Isotonic saline is effective in volume replacement, is readily available, and carries the lowest risk of side effects. Isotonic saline + 5% dextrose solution provides the additional advantage of supplying calories, and attenuating hyperkalaemia. Sodium bicarbonate, added to half-isotonic solutions is effective for alkalinizing the urine to prevent the tubular deposition of myoglobin, and uric acid, correcting metabolic acidosis, and also reducing hyperkalaemia (Zager, 1989; Better and Stein, 1990). If available, alkaline solutions could therefore be administered as well (and even preferred), unless symptoms of alkalosis are present.

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