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Combined diuretic treatment of refractory edema in nephrotic syndrome

. All patients had no response or reaction of diuretics generally very poor,[link widoczny dla zalogowanych], of which 46 patients were treated with albumin preparations had no significant effect. 2, treatment with heparin 6250U, dopamine 20rng 250rnI in 5% glucose solution intravenously,[link widoczny dla zalogowanych], 2o ~ 30 drops / min, day 1, 2o days I treatment; hydroxyethyl starch infusion 500ml furosemide 100nag , finished 30 minutes drops every other day or 3 1. Routine inspection before and after treatment urinary protein, plasma proteins, lipids, ESR, electrolytes, renal function and blood coagulation function and record changes in urine volume and weight, urine potassium increased the attention, amount of protein in food control in O. 5 ~ 1g / (kg-d), to high-quality protein-based. 3 therapeutic evaluation and results markedly: edema,[link widoczny dla zalogowanych], pleural and peritoneal effusions disappear, weight loss> 15%, urine output increased, decreased urinary protein, plasma protein increase than before. Effective: edema, increased urine output, body weight decreased by 3% to 15%; invalid: not to reduce edema, weight loss (3%. After 1 to 2 courses of treatment, effective in 58 cases (77.3%), effective in 13 cases ( 17.3%), 4 cases (5.3%), the effect is satisfactory. hypokalemia during treatment, 16 cases were promptly corrected. 4 to discuss the pathological changes in adult primary nephrotic syndrome is more complex than a few hormone-sensitive minimal change, most of the hormones or not sensitive to cytotoxic drugs, there is no effective clinical therapy, particularly prone to cause persistent edema, treatment is quite difficult. using the program on treatment of 75 patients that the results are satisfactory. Heparin through its anticoagulant effect to prevent micro-thrombosis, improve the glomerular microcirculation. now that it can effectively suppress mesangial cell proliferation and mesangial matrix, the majority of cations against kidney damage, protect the glomerular filtration membrane charge barrier function, repair of a direct role in glomerular injury. while a small dose of dopamine is the use of dopamine receptor excitability, expansion of renal blood vessels, improving renal blood flow, glomerular filtration rate increased role to strengthen the local effects of heparin in the kidney. Because of these two drugs is relatively moderate onset, while providing continuous application of hydroxyethyl starch rapid intravenous infusion of furosemide is due to hydroxyethyl starch to improve the blood colloid osmotic pressure in a short time, increase blood circulation, so to play a diuretic furosemide, intravenous albumin in the same generation and rapid diuretic effect, and considerable savings for patients. diuretic swelling lasting effect of this method, less recurrence, and no significant adverse reactions. is the treatment nephrotic syndrome, one of refractory edema. Received :2004-03-23 elderly patients with acute organophosphorus pesticide poisoning death of Dan Shengrong 14 cases (a subject within the Fuling Central Hospital, Chongqing, Fuling 408000) Article ID :1009 -5519 ( 2004) 13-1244-02 CLC number: R5 Document code: B1998 to 2003 a total of organophosphorus pesticide poisoning patients admitted to 115 cases of death in 19 cases, including 6o years of age in 14 cases. are poisoning the 14 cases of elderly patients The cause of death as follows. 1II Fou-bed data in the 14 cases, 6 males and 8 females. aged 6I ~ 82 years old,[link widoczny dla zalogowanych], were confirmed by oral poisoning. Among them, five cases of methamidophos, dimethoate one case, three cases of dichlorvos , parathion one case, oxidation results Le 2 cases of mixed poisoning in 2 cases. poisoned to death 8 hours to 4 days. The cause of death: (1) by oral pesticide dose, treatment of oral poisoning from time to time, more than 4 hours 4 deaths, accounting for 28.6%. (2) less than the amount of atropine, 3 died, accounting for 21.4%. (3) gastric lavage is not timely is not complete in 2 cases of death caused by poisoning, accounting for 14.3%. ( 4) reduction of the excessive rebound of atropine in 2 cases of death, accounting for 14,3%. (5) 2 cases of atropine poisoning,[link widoczny dla zalogowanych], accounting for 14.3%. (6) with cerebral hemorrhage and 1 died. accounted for 7 .1%. 2 discussions organophosphorus pesticide poisoning death of elderly is high, the reason is taking or large doses of pesticides, is the fundamental reason behind the treatment, the patients and their families for the rescue co-operate, and patient observation and treatment of existing disease. The Group 2 cases of elderly patients with sick sinus syndrome, 1 case of heart medication that is near 130 beats / min, when heart failure patients themselves, especially in the pesticide directly after myocardial injury, coupled with the use of atropine, the heart heart failure caused by excessive load of the heart rate from time to time there. signs of swelling in 10 cases. these patients have lung disease itself, poisoning is not easy identification of both pulmonary rales, rales in the former will not disappear. organophosphorus pesticides into the body, except for suppression
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