Anaesthesiology and intensive care : Topic 1: Acid-base balance; Topic 2: Acute renal and hepatic insufficiency

Abstract

The most different pathological conditions of patients regardless of their reason are always accompanied by severe disorders of homoeostasis. As a first line the water-electrolyte exchange and acid base state disturbances are presents. They are inherent to the diseases of respiratory, central nervous, and secretory systems, tor the acute surgical and infectious pathology of abdomen organs, to the traumas and shocks. They also can occur as a result of the diseases, which are accompanied by the liquid losses - fever, vomiting, diarrhea, excessive sweating, or by excessive accumulation of water, including iatrogenic stimulus. Such disorders are compensated by an organism, but then can cause decompensation of organism all systems function and cell metabolism. For the critical care patients, as a rule, compensation of water-electrolyte and acid-basic disturbances broken or ineffective. It is occurred because of continuous pathological losses, damages of water and food enteral intake and assimilate mechanisms. In such situations the parenteral correction of homoeostasis is extremely important. Therefore, a doctor using clinical and laboratory findings musts in good time diagnose and interpret the water-electrolyte and acid-base disorders. They should to know about pharmacology of fluid resuscitation agents and be able to apply them in complex intensive care.Acute renal and hepatic insufficiency are the life-threatening rapidly progressed conditions, which complicate the course of great number of diseases. Among main causes of acute renal failure (ARF) most frequent are the shock states, inflammatory and toxic damages. Acute hepatic insufficiency (AHI) more frequent complicates the course of viral, autoimmune and toxic hepatitis. Development of these syndromes considerably worsen the course of essential disease and prognosis. Therefore, a doctor must be able to diagnose development of these states fast and in good time, be able to perform conservative therapy and choose the most rational method of efferent therapy.