A common cause of edema caused by
(1) Excessive intake of salt: sodium peritoneal dialysis itself scavenging low, especially in patients with fluid retention occurred when the more obvious. Many patients often because of thirst, or difficult to change the habits of the past, or understand the importance of controlling liquids and other reasons, unable to control salt intake, leading to edema. Once edema, are often more difficult to correct.
(2) Salt clear reduction: With prolonged peritoneal dialysis, residual renal function in patients with decreased or loss of the patient's peritoneal membrane function even if there is no change, the total water clear also due to the decrease of residual renal function decline. On the other hand, since the change in peritoneal transport, will lead to reduced clearance of the water. Coupled with increased lymphatic drainage, lymphatic reabsorption increased, resulting in patient volume overload, edema.
(3) the emergence of new complications: such as cardiac dysfunction or aggravate existing heart disease, hypoalbuminemia, mechanical or anatomical complications, so that peritoneal ultrafiltration volume reduction.
(4) Age: Compared to normal adult weight accounted for the proportion of body fluids (male 60%, female 55%), the elderly fluid volume accounted for only 45% of body weight, elderly fluid volume decrease was mainly cellular dehydration retreat , reduce the intracellular fluid, extracellular fluid relative increase in non-dominant edema easy to state. Therefore, elderly dialysis patients are more likely in non-dominant edema state, and sometimes rely solely on clinical symptoms and signs to determine its capacity state are inaccurate and need to rely on physical examination.
2 How to assess edema
(1) Clinical Assessment: Review history, to understand whether chest tightness, suffocation, whether new or existing cardiovascular disease aggravated, if not tolerate dialysis prescription now, with or without salt intake increases, with or without decreased urine output and so on. Blood pressure is a reflection of the importance of the body volume load status symbol, especially when limiting water and salt intake and increased peritoneal ultrafiltration, the blood pressure failed to return to normal, then better able to explain the existence of the load capacity.
(2) laboratory tests: the conduct of clinical assessment can also carry out some laboratory tests to help determine the cause edema, such as B-type natriuretic peptide (BNP), echocardiography, bioelectrical impedance analysis (BIA) and so on. But these are not the assessment of the state of the gold standard in vivo capacity, so they need doctors combine comprehensive assessment of the patient's condition.
3 peritoneal dialysis patients how to avoid edema
(A) record daily volume of urine and ultrafiltration, periodically check the load capacity of relevant indicators, based on urine output restrictions on drinking water.
(2) periodic assessment of peritoneal function (PET), according to the type of peritoneal transport, timely adjustment of dialysis prescriptions, maintain the appropriate amount of peritoneal ultrafiltration.
(3) have occurred in patients with edema, should actively look for reasons to strengthen restrictions salt intake. For patients with residual renal function may be used under the guidance of doctors diuretics, as appropriate, the use of high concentrations of glucose dialysis solution, if necessary, diverted automated peritoneal dialysis. Diabetic patients should strictly control blood sugar.
(4) attention to the protection of residual renal function, avoiding the use of nephrotoxic drugs, to avoid dehydration.
(5) prevention of peritonitis occurred in strict accordance with the operating rules for fluid.
4 limiting salt intake method
(A) control salt intake: Excessive salt should lead to water retention. Daily salt intake should be <3 g, avoid foods high in salt, such as pickles, soy sauce, avoid the use of chicken, MSG and other spices with high salt, low sodium can be used when cooking can add more flavoring agents, such as green pepper, chili, pepper, pepper, lemon, onion, ginger, garlic, onions, etc., to increase the taste of food.
(2) control of water intake: try to eat with high moisture, low nutritional value foods such as soup, porridge, etc., preferably in milk, soup and other nutritious foods instead of water, tea, although may be liquid meals to medication; may be allowed to drink water every day with a fixed glass bloom and fractionated drinking, and small mouth slowly swallow, do not gulp, both for the control of water can accurately Record the total daily water intake. In addition, the water temperature to cool side appropriate to avoid overheating, in order to achieve the purpose of thirst, we recommend gargling with cold water containing ice (especially lemonade made of ice), but do not swallow. Regular brushing, toothpaste, toothbrushes in the refrigerator, with sour foods, chewing gum can keep your mouth moist.
(3) do intake and output records, especially snacks, soup, fruit, infusion volume and water intake, etc., including the amount of dialysis ultrafiltration volume, urine, vomit and a daily volume of about 500 ~ 700mL not dominant negative water (change with the seasons), keeping the total daily intake and the amount roughly equal.
