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2018, Número S1

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Gac Med Mex 2018; 154 (S1)


Ajuste de fármacos y nutrición en terapias de reemplazo renal continuo

Echeverri J, Molano A

Idioma: Español
Referencias bibliográficas: 73
Paginas: 48-60
Archivo PDF: 255.41 Kb.


RESUMEN

Del 6 al 23% de los pacientes con lesión renal aguda (LRA) en unidades de cuidados intensivos (UCI) requieren apoyo renal, siendo la terapia continua una modalidad de alta frecuencia de uso en el paciente críticamente enfermo. Si bien el objetivo general de las terapias de reemplazo renal continuo (TRRC) es restablecer el equilibrio hídrico y ácido-base, junto con la eliminación de toxinas urémicas e inflamatorias relacionadas con la pérdida de depuración renal y la disfunción multiorgánica; reconocemos como efecto colateral la depuración (K) no deseado de moléculas y sustancias deseadas en la recuperación del paciente crítico, como pueden ser antimicrobianos y nutrientes. La sepsis es la causa más frecuente de LRA en la UCI y en este contexto la terapia antimicrobiana adecuadamente seleccionada y a la dosis correcta es la médica terapéutica más importante. De la misma manera, es indispensable garantizar el adecuado apoyo nutricional en este grupo poblacional. Proponemos en esta revisión una aproximación teórica y práctica para seleccionar el tratamiento farmacológico de antimicrobianos y el apoyo nutricional en el paciente en TRRC.


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