By Charlotte Kerner; Elizabeth D Crawford
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Hypertensive issues stay one the foremost reasons of maternal and fetal morbidity and loss of life. it's also a number one reason behind preterm delivery referred to now to be a possibility think about distant heart problems. regardless of this the hypertensive problems stay marginally studied and administration is frequently debatable.
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Regular insulin 10 units IV push with 1 ampule of 50% glucose IV push. -Kayexalate 30-45 gm premixed in sorbitol solution PO/NG/PR now and q3-4h prn. -Furosemide 40-80 mg IV, repeat prn. -Consider emergent dialysis if cardiac complications or renal failure. Extras: ECG. UA, urine specific gravity, urine sodium, pH, 24h urine potassium, creatinine. Vital Signs: Vitals, urine output q4h. 5°C. Activity: Bed rest; up in chair as tolerated. Special Medications: Acute Therapy: -KCL 20-40 mEq in 100 cc saline infused IVPB over 2 hours; or add 40-80 mEq to 1 liter of IV fluid and infuse over 4-8 hours.
Hyperkalemia is treated with sodium polystyrene sulfonate (Kayexalate), 15-30 gm PO/NG/PR q4-6h. -Hyperphosphatemia is controlled with calcium acetate (PhosLo), 2-3 tabs with meals. 2 and the bicarbonate level >20 mEq/L. 1-2 amps (50-100 mEq) IV push, followed by infusion of 2-3 amps in 1000 mL of D5W at 150 mL/hr. -Adjust all medications to creatinine clearance, and remove potassium phosphate and magnesium from IV. Avoid NSAIDs and nephrotoxic drugs. Extras: CXR, ECG, renal ultrasound, nephrology and dietetics consults.
10 mL/d Vitamin K (in solution, SQ, IM) . . . . . . . . . . . . . . . . . . . . . 10 mg/week Vitamin B12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1000 mcg/week Se l e n i u m ( a fte r 2 0 d a ys of continuous T P N ) . . . . . . . . . . . . . . . . 80 mcg/d Intralipid 20%, 500 mL/d IVPB; infuse in parallel with standard solution at 1 mL/min for 15 min; if no adverse reactions, increase to 100 mL/hr once daily or 20 mg/hr continuously.