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Contrast-induced nephropathy: is the and nephrotoxicity in patients undergoing coronary artery procedures hypertension organization order clonidine online pills. Proc West Pharmacol Soc 2005; 48: compared with iodinated media for digital subtraction angiography in 134–135 heart attack symptoms in women buy on line clonidine. Contrast-induced nephropathy in the critically-ill patient: focus artery stenosis: clinical outcomes excel blood pressure chart order clonidine 0.1mg on line. Renal effects of contrast media in prole of gadobenate dimeglumine in subjects with renal impairment arrhythmia general anesthesia generic 0.1mg clonidine amex. Nephrogenic systemic brosis: a gadolinium-associated brosing acetylcysteine and hydration before coronary angiography and intervention: disorder in patients with renal dysfunction. A prospective, double-blind, randomized, systemic brosis after exposure to the macrocyclic compound gadobutrol. Clinical signicance and preventive angiography with or without percutaneous coronary intervention. Meta-analysis: effectiveness of drugs versus ioversol in patients with chronic kidney disease: the Visipaque for preventing contrast-induced nephropathy. Ann Intern Med 2008; 148: Angiography/Interventions with Laboratory Outcomes in Renal Insuffi284–294. Nephrotoxicity of iso-osmolar prevent contrast nephropathy in patients with renal disease. Am J Med iodixanol compared with nonionic low-osmolar contrast media: meta 1989; 86: 649–652. Renal function following patients with chronic kidney disease undergoing abdominal computed infusion of radiologic contrast material. Failure to demonstrate contrast osmolality iodinated contrast medium at intravenous contrast-enhanced nephrotoxicity. Prevention of contrast-induced nephropathy tration of contrast material: a critical literature analysis. Management of shock and acute renal failure in tomography: a double-blind comparison of iodixanol and iopamidol. Contrast-induced nephropathy after intravenous outcomes of contrast-induced acute kidney injury. Radiology 2007; 243: of prevention measures in patients at high risk for contrast nephropathy: 622–628. Reducing the risk of contrast-induced nephropathy: in 1620 patients undergoing coronary angioplasty. Low-osmolality contrast media nephropathy with sodium bicarbonate: a randomized controlled trial. Metaanalysis of the relative nephrotoxicity of in oxygenated nitric oxide solutions. Acetazolamide for prevention of contrast-induced nephropathy: Nephrol 2006; 66: 322–330. High-dose N-acetylcysteine for the based preprocedural hydration for the prevention of contrast-induced acute prevention of contrast-induced nephropathy. N-acetylcysteine and contrast prevention of contrast-induced acute kidney injury: a systematic review and induced nephropathy in primary angioplasty. A randomized controlled trial of induced nephropathy by isotonic sodium bicarbonate: a meta-analysis. Intravenous N-acetylcysteine plus cysteine, and saline for prevention of radiocontrast-induced nephropathy. Role for intrarenal adenosine in chloride for the prevention of contrast medium-induced nephropathy in the renal hemodynamic response to contrast media. J Lab Clin Med 1987; patients undergoing coronary angiography: a randomized trial. Sodium bicarbonate versus normal nephropathy: a systematic review and meta-analysis. Sodium bicarbonate versus saline for cysteine theophylline for the prevention of contrast nephropathy. Eur J the prevention of contrast-induced nephropathy in patients with renal Clin Invest 2009; 39: 793–799. Strategies to reduce the risk of contrast retrospective cohort study of 7977 patients at mayo clinic. The role of extracorporeal blood noninferior to intravenous therapy for prevention of contrast-induced purication therapies in the prevention of radiocontrast-induced nephro nephropathy in patients with chronic kidney disease. J Am Coll Cardiol radiocontrast media in patients with renal insufciency is potentially 2008; 51: 1419–1428. Prophylactic hemodialysis does elevation myocardial infarction undergoing primary percutaneous coronary not prevent contrast-induced nephropathy after cardiac catheterization in intervention. Renal protection for coronary angiography the prospective pediatric continuous renal replacement therapy registry. Toxic alcohol ingestions: clinical features, diagnosis, and organ dysfunction syndrome in children. Acute kidney injury in an infant after recovery of renal function in intensive care patients with acute renal failure: cardiopulmonary bypass. A controlled evaluation of prophylactic dialysis in post in pediatric stem cell transplant patients. Description and value of an improved dialyser critically ill patients with acute kidney injury. Outcome in post-traumatic acute withdrawal of life support from the critically ill. Am J Respir Crit Care renal failure when continuous renal replacement therapy is applied early vs. Early hemoltration improves patients with acute renal injury: a retrospective cohort study. Timing of renal replacement weaning from postoperative acute renal replacement therapy. Intensive Care therapy and clinical outcomes in critically ill patients with severe acute Med 2008; 34: 101–108. Late initiation of renal replacement therapy pediatric patients after acute renal failure. Clin J Am Soc uid restriction on postoperative complications: comparison of two Nephrol 2007; 2: 732–738. Use of continuous haemodialtration: continuous hemoltration and survival in critically ill children: a an approach to the management of acute renal failure in the critically ill. Pediatr Nephrol 2004; 19: therapies: anticoagulation in the critically ill at high risk of bleeding. Continuous renal replacement therapy requiring continuous renal replacement therapy. Review article: Low-molecular-weight heparin as an anticoagulation for continuous venovenous hemoltration. Int J Artif alternative anticoagulant to unfractionated heparin for routine outpatient Organs 2007; 30: 301–307. Parenteral anticoagulants: American anticoagulation for continuous venovenous hemoltration. Crit Care Med College of Chest Physicians Evidence-Based Clinical Practice Guidelines 2009; 37: 545–552. Treatment and prevention of coagulation for continuous arteriovenous hemodialysis in critically ill heparin-induced thrombocytopenia: American College of Chest Physicians patients. Heparin and low-molecular-weight coagulation using a citrate-based substitution solution for continuous heparin. 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Specifc training is given in dealing with death and dying blood pressure iphone purchase clonidine discount, and with the difcult patient pulse pressure meaning purchase clonidine 0.1 mg on-line. The idea of screening for medical students at risk of developing emotional problems is fraught with difculties hypertension yahoo purchase 0.1 mg clonidine with mastercard. Those who are more anxious are often more empathic with patients and less likely to blood pressure up and down causes purchase clonidine 0.1 mg without a prescription blame others for their mistakes. Moreover, any method of screening runs the risk of being abused as a vehicle for discrimination against minority groups. Treatment is coordinated by a senior general practitioner and delivered by senior specialists. Doctors’ health advisory services provide confdential advice, as well as assessment and referral services. A Manual of Mental Health Care in General Practice 267 Negative attitudes to admitting one’s own vulnerability and a tendency to denigrate those who run into difculties have been prevalent within training institutions, but may be beginning to change. Intern year was often a period of initiation in which new graduates were given considerable clinical responsibility and left to either sink or swim, often with deleterious consequences for patients. A sort of gallows humour is a feature of training hospitals and is certainly an adaptive way of coping. One of the commonest defences against the sort of denigration that is inficted on junior doctors is the claim that it was ‘only a joke. Allow time each day for breaks, lunch and physical exercise—for example, a 30-minute walk. Schedule regular holidays and other breaks away from work, such as conferences and education sessions. Rebut the voice that tells you that you cannot aford to take time of, or that your patients cannot cope without you. Avoid professional isolation by remaining in contact with peers, for example, through taking part in activities within your local division of general practice. Setting aside time for your family and friends and for your own hobbies and interests will improve your health and leave you refreshed for work. Beware of using alcohol, cigarettes and other drugs to cope with symptoms of stress. Take steps to make your work environment as pleasant as possible with adequate lighting, sound insulation and ventilation. Choose comfortable furniture and select paintings and other decorations that you fnd relaxing. Learn and use a relaxation technique, such as controlled breathing, progressive muscular relaxation, self-hypnosis, meditation or massage. For emotional processing, you need to be able to discuss your problems with others whom you trust. This may occur to some extent within your own social networks, but it is also desirable to fnd support among peers who understand the sort of challenges that you face. Formally or informally constituted peer review groups can serve not only educational and quality assurance functions, but also provide forums for mutual support. In particular, fnd a colleague or counsellor with whom you can debrief after traumatic or other difcult events. Use the Doctors’ Health Advisory Service for advice on your own problems or when a colleague needs help. The section was written by people within Logan City who are living with mental illness. Unfortunately, people like us are often described in ways that only refect the nature of our illnesses, such as bipolar, schizophrenic or even obsessive–compulsive. To enable the delivery of a reasonably concise message to general practitioners we address the following questions: • What is most important to tell general practitioners We have included some vignettes from our life experiences to personalise this work—however, the underlying theme of the article is that despite the illness or the labels used to describe it, we are still people. Therefore, what we ask of our general practitioner is most often the same as that asked of everyone in the community. That is, to be treated with respect and express a willingness to help whatever the presenting problem. People with mental illnesses ask to be treated with respect by their general practitioners. First, I need to feel confdent that I will receive continuity of care across diferent health care settings. While it is sometimes difcult to establish a new relationship with a health professional, this situation is exacerbated for a person with mental illness. It can be quite difcult to start over and to share quite intimate and often emotionally painful details from our life story with a relative stranger. In general, I do not wish to be perceived as diferent from any other person in the community; however, I accept that at times my behaviour will difer from societal norms to some degree. There are times when I may need a longer consultation, however, I often feel that general practitioners are reluctant to give of their time. When I appear to be unwell because of my presenting symptoms, I am not absent from the room. It can be quite hurtful to be discounted as a person because of presenting symptoms. I should always be treated with respect and fairness and not with fear and uncertainty. This caused a signifcant amount of personal stress for me, because I feared that there was something seriously wrong. The symptoms were real for me; however, I did not understand what was wrong or why it was happening. It appears to me that good communication skills are needed to gather all information required to assess an individual’s condition. I accept my share of the responsibility for good communication; however, at times there are impediments to my ability to communicate well. Listen to people’s complaints, empathise with how they feel, and be sensitive to verbal and non-verbal cues. At times, I fear the consequences of my own behaviour because I sometimes behave in ways that do not align with societal norms. Others in the community do not understand or accept me at these times and this causes me to feel that I do not ft in to society in general. The result is that I have isolated myself from mainstream society in much the same way that an anxious person may avoid places because of fear of other people noticing that something is wrong with or diferent about them. It was scary when I was told that I had to stay in a mental hospital for a number of weeks or months and be isolated from the world outside. I became angry with people who found it hard to understand that unwell does not equal unaware. It was difcult enough to cope with the outcomes of my own behaviour without others treating me as though I had taken leave of absence from my physical self. Where possible, people generally prefer to be treated in the community rather than in a hospital. I would lose so much in terms of love, security and 270 Consumer and carer perspective acceptance of those I cared about. The fear of the illness that was created by these consequences caused me to feel absolute terror. Underlying the terror, I am sure there was a deep sadness, which remains with me now. Certainly, I might have been going into hospital to have my kidney removed, but my loved ones still loved me and I didn’t feel as though I would quite likely lose my family life as I knew it. I sometimes do not have control over my own thoughts, or control of events that are seemingly happening around me. Although these episodes can be infrequent, the efects on me, both personally and emotionally, are no less devastating. At times, I am unable to concentrate as too many thoughts are entering and rushing through my mind.

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Treatment examines Persons With Developmental Disabilities the person’s understanding of the mean may be consulted by surveyors seeking Intellectual Disability (Intellectual Developmental Disorder) 15 to pulmonary hypertension zebra best purchase clonidine determine whether a facility is in com though not reported in this systematic pliance with regulations for psychotropic review blood pressure 44 buy clonidine canada, other authors (Fodstad et al blood pressure medication effects purchase clonidine 0.1mg visa. Older persons are at greater risk consensus-based guide for practitioners for these symptoms pulse pressure close together 0.1mg clonidine with mastercard, but children and regarding the use of psychotropic medi adolescents with long-term use are also cations for problem behaviors (Deb et al. These guidelines include discus Before prescribing medication for be sions of formulation, initiation of treat havior management, the clinician should ment, assessment of outcomes and ad assess the causes and consequences of verse effects, follow-up arrangements, behavior and consider all medication and and discontinuation of medication. For exam In the United Kingdom a series of sys ple, behavioral treatment often can be ef tematic reviews has been conducted for fective. Most studies reviewed had chotic for which randomized trial data methodological flaws, so the authors ad were available. Risperidone was signifi vise caution in interpreting these results cantly more effective than placebo in (Deb et al. Tardive dyskinesia has long been a base for the effectiveness of antidepres concern with typical antipsychotics. Seven prospective uncon trolled trials and two retrospective stud Thuppal and Fink (1999) reported that ies were identified. Despite depression does not respond to several small numbers of participants, frequently trials of antidepressant medication. The effects were greater with co-occurring anxiety or a concurrent Conclusion diagnosis of obsessive-compulsive disor der. The study authors highlighted con Ongoing efforts are being made to im cerns regarding adverse effects (Sohanpal prove mental health treatment for per et al. The litera ture on psychotherapy, behavioral Stimulants and Clonidine treatments, and psychopharmacological Rowles and Findling (2010), in their re treatments has grown substantially in re view of pharmacotherapy options for the cent years. Ther children with a known neurodevelop apist characteristics, the importance of mental syndrome, such as fragile X syn family support, and adherence to practice drome and fetal alcohol spectrum disor parameters are important. Better, more der, in which attention deficits and valid outcome measures are needed. There Considerable progress is being made is evidence for improvement in children in the psychopharmacological treatment with neurodevelopmental disorders and of behavioral and psychiatric disorders. When success ment and increased side effects (Ghuman fully applied, findings from new research et al. J In tardation: An Update of Expert Consen tellect Disabil Res 47(Pt 1):51–58, 2003 sus Guidelines. Br J Psychiatry 191:493– tic and Statistical Manual of Mental Dis 499, 2007 orders, 5th Edition. Psychiat Ideas for an Evolving Disability in the ric Aspects of Intellectual Disability Re 21st Century. Greenspan S, Loughlin G, Black R: Credulity Psychiatric Aspects of Intellectual Disabil and gullibility in persons with mental ity Reviews 6:15, 1987 retardation, in International Review of Kanner L: Parents’ feelings about retarded Research in Mental Retardation, Vol 24. J Dev intellectual disability involves risk Behav Pediatr 33(5):431–440, 2012 unawareness: implications of a theory of Lynch C: Psychotherapy for persons with men common sense. J Am Acad Child Adolesc Psy pathology, and long-term psychotropic chiatry 30(2):241–245, 1991 use. Dev Disabil Res Adolescent Psychiatry Working Group Rev 16(3):273–282, 2010 on Quality Issues. J Intellect Disabil Res in the treatment of aggressive challeng 51(Pt 10):750–765, 2007 ing behaviour in patients with intellec Stavrakaki C, Klein J: Psychotherapies with tual disability: a randomised controlled the mentally retarded. Can J Psychiatry 57(10):593– with intellectual disabilities and border 600, 2012 line intelligence: a systematic review. Communication is a pro cess by which information is ex Systems of changed between individuals through a Classification common system of symbols, signs, or be havior. The emergence of communica the ability to receive, send, process, and tion skills in the developing child is neces comprehend concepts or verbal, nonver sary for human socialization (Gemelli bal and graphic symbol systems” (Block 1996); likewise, the development of ap et al. Impairments in speech or language speech sounds, fluency and/or voice,” in childhood are often associated with and language disorder is defined as “im deficits in other areas of functioning, such paired comprehension and/or use of spo as academics and developmental compe ken, written and/or other symbol sys tencies (Beitchman et al. Language emotional health (Conti-Ramsden and disorders are noted to involve three spe Botting 2008). The Individuals With Disabilities guage disorder) or pragmatics (social Education Act (2004) defines speech or lan [pragmatic] communication disorder). Along with this high de Social (pragmatic) communication gree of parallel and developmental conti disorder nuity between normal speech and lan guage, there is a high rate of comorbidity Unspecified communication disorder among the speech and language disor ders (Grigorenko 2007). There is also a substantial co-occur Communication Disorders 23 rence with learning disorders (Hallahan et for emotional, anxiety, and behavioral dis al. Communication disorders also carry Although language and learning disor an increased risk for psychiatric disor ders are common, they remain underdi ders and other emotional and behavioral agnosed in community and psychiatric problems. Problems leagues examined the prevalence of psy related to language are among the most chiatric disorders in children with speech common reasons for clinical presenta and language disorders. Their research tion in children ages 3–16 years, regard confirmed a high rate of psychiatric dis less of psychiatric diagnosis (Toppelberg orders (48. Therefore, mental speech and language impairments, with health clinicians need to have a basic un attention-deficit disorder accounting for derstanding of the normal developmental the largest percentage (30. Specifi also examined longitudinal psychiatric cally, clinicians should have a working outcome at follow-ups of 7 years (Beitch knowledge of language dimensions, in man et al. The assessment should gardless of current speech and language include first and foremost a detailed disorder status. Pa children who had a speech and language rental report and collateral records from impairment at age 5 had higher rates of the child’s school or pediatrician offer im psychiatric diagnoses; specifically, anxi portant enhancement to the office-based ety disorders and antisocial personality clinical assessments of cognitive skills disorder occurred at significantly higher (American Academy of Child and Ado rates. Most formal (2002) indicated that approximately three language assessments are limited in the of four (71%) children formally identified range of skills measured; therefore, the with emotional and behavioral disorders clinical evaluation remains crucial be had clinically significant language defi cause it can help to quantify and qualify cits and approximately one of two (57%) the child’s ability to communicate effec children with diagnosed language defi tively in real-life settings (Toppelberg cits were identified as also having emo and Shapiro 2000). Overall, disorder is suspected following initial early language disorders are risk indica assessment, basic psychoeducational tors for concurrent and future psychiatric testing is warranted. Although the re problems, with a prognostic preference quirement of a substantial discrepancy 24 Gabbard’s Treatments of Psychiatric Disorders, Fifth Edition between cognitive and language function lored to his or her specific needs and ing obtained from standardized mea symptoms. Addi tion 2013), testing can help to direct the tional techniques can be used to improve need for more in-depth assessment or word comprehension, word recall, listen referral to a speech-language patholo ing comprehension, and sentence formu gist (American Academy of Child and lation. The such as audiometric testing (Sadock and mental health clinician can also provide Sadock 2007) or a pediatric or neurolog an educational and supportive role for ical evaluation for cerebral palsy or parent and child. Importantly, the men other organic neurological impairments tal health clinician acts as a liaison be affecting speech, should be considered. Communication disorders are generally treated by speech-language pathologists; however, a multimodal treatment ap Specific Disorders proach is considered the standard. This Language Disorder approach typically involves referral of the child to the appropriate treatment Language disorders are currently con provider. The current system where the child is enrolled (Amer discussion will present the information ican Academy of Child and Adolescent concerning treatment based on the do Psychiatry 1998). In general, treatment in mains of language development, expres terventions for speech and language dis sion, and understanding/comprehension orders focus on functional improvement. Persistent difficulties in the acquisition and use of language across modalities. Limited sentence structure (ability to put words and word endings together to form sentences based on the rules of grammar and morphology). Impairments in discourse (ability to use vocabulary and connect sentences to ex plain or describe a topic or series of events or have a conversation). Language abilities are substantially and quantifiably below those expected for age, result ing in functional limitations in effective communication, social participation, academic achievement, or occupational performance, individually or in any combination. The difficulties are not attributable to hearing or other sensory impairment, motor dys function, or another medical or neurological condition and are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Delays in language emergence and its and facilitated play) to the least natural, use (expression) are frequent develop totally clinic-based interventions (drills, mental problems, with reported preva drill play, and clinician-directed model lences ranging from 2. The deployment of the expression and reception of language treatment interventions can also be de constitute a smaller portion of those with scribed as being either direct or indirect/ a language disorder. A direct intervention is deliv with age, with up to 5% of preschoolers ered by a speech-language pathologist and 3% of school-age children being af working directly with a child in a clinical fected (American Psychiatric Association setting. A common model that most speech language pathologist (Sadock and Sadock language pathologists practice is based 2007). This model can be seen whether to provide language interven as a continuum from the most natural tion for children younger than 5 years. Kindergarten age children benefit tified, or 2) hold off until the child is pre from additional teaching of prereading school age (commonly known as the “wait skills, and young children benefit from and see” approach) (Sadock and Sadock achieving rudimentary reading skills 2007). Direct and in tervention is effective for the 2 to 3-year direct therapy interventions are equally old child with language delay (Busch effective overall in children with recep mann et al. Children up to age 3 years are effect is smaller than that for delays in likely to do well with play-based therapy language emergence and use (Law et al.

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En un segundo tiempo se hara la cirugia correctora arrhythmia ketosis buy 0.1mg clonidine overnight delivery, reim Pulsos femorales ausentes o muy disminuidos en comparacion plantando cada arteria en su ventriculo correspondiente blood pressure medication lack of energy purchase clonidine line. Clinica Son muy tipicas las crisis hipoxemicas desencadenadas por el llanto o el ejercicio (son maniobras que disminuyen las resis tencias vasculares y facilitan el shunt derecha > izquierda) heart attack low vs diamond order clonidine without prescription. Sin embargo mejoran cuando el nino se pone en cuclillas por au mento de las resistencias vasculares heart attack 49ers effective 0.1 mg clonidine. Tratamiento Medico durante las crisis: oxigeno, betabloqueantes El trata miento definitivo es quirurgico. Notese la zona de coartacion distal a la subclavia (flecha verde) asi como la gran circulacion cola 2 Estenosis pulmonar teral con arterias mamarias e intercostales muy desarrolladas (flechas azules). Debes conocer los aspectos clinicos y diag nosticos de las principales enfermedades, entre ellas, enfermedad Es la causa mas frecuente de vomito no bilioso en el neonato. Despues del senta complicaciones asociadas se considera fisiologico hasta vomito el nino queda irritable por hambre. Enfermedad por reflujo gastroesofagico Masa dura, movil, por encima y a la derecha del ombligo. Existe mayor incidencia en ninos con paralisis cerebral, sindrome de Down y retraso del desarrollo. Rechazo de las tomas e irritabilidad (por dolor o ardor retroes ternal al tragar). Enfermedad congenita producida por un deficit de la inervacion Tratamiento parasimpatica del colon (por ausencia de celulas ganglionares Medidas posturales. El seg Decubito prono para los lactantes y posicion semiincorporada mento aganglionico comienza en el esfinter anal interno y se o erecta en ninos mayores. Para la esofagitis se usan antiacidos, antiH2 o inhibidores de la Clinica bomba de protones. En enfermedad por reflujo gastroesofagico Retraso en la eliminacion del meconio, y posteriormente estre que no responde al tratamiento medico se realiza cirugia (fun nimiento cronico. Consiste en distender el recto para comprobar como varia la presion en el esfinter anal interno. En individuos sanos dis minuye; en la enfermedad de Hirschprung no disminuye, e incluso puede aumentar. Al progresar el cuadro pueden eliminar heces con sangre roja y moco (“en jarabe de grosella”). Diverticulo de Meckel Reduccion con enema (de aire, agua o bario) bajo control radiolo gico. El exito es del 75-80% de los casos si se realiza antes de las Persistencia del conducto onfalomesenterico. La cirugia esta indicada en casos gastrointestinal congenita mas frecuente y se localiza en el ileon. Entre estos se han descrito los antitransglutaminasa tisular, que au mentan la especificidad. Debe realizarse cuando existen Ac antitransglutaminasa posi tivos o ante alta sospecha. La respuesta clinica es gratificante y en la mayoria de los casos la mejoria se produce a la semana de iniciar el tratamiento. Alergia a las proteinas de leche incumplimiento de la dieta es la causa mas frecuente de ausen de vaca. Centeno No mediada por IgE (mas frecuente) > intolerancia a pro teinas de leche de vaca. Si se sospecha la enfermedad es necesario confirmarlo con biopsia antes de retirar el gluten de la dieta, ya que esto modificaria las caracteristicas de la mucosa y no llegariamos Diagnostico a un diagnostico correcto. Se confirma con la desaparicion de los sintomas tras retirar el alimento y la posterior provocacion con el alimento. Trastorno de la nutricion por disminucion de la ingesta energe Tratamiento tica que sigue a los episodios prolongados de gastroenteritis. Su consumo provoca un Rehidratacion y correccion hidroelectrolitica, con nutricion pre dano en la mucosa del intestino delgado. En los ninos con diarrea es importante y recomendable el inicio Clinica precoz de la ingesta de leche (se consigue asi un buen aporte El modo de presentacion es muy variable. No se ha demostrado cuente de inicio de los sintomas es entre los 6 meses y los 2 que sea beneficioso modificar la dieta durante el proceso. Los cambios Este tema solo ha sido preguntado en un ocasion; sin embargo es de osmolaridad en un compartimento producen desviaciones importante y susceptible de ser mas preguntado. Estudia los tipos de compensadoras de agua (que sigue siempre al sodio) a traves deshidratacion y su clinica. Puede clasificarse en: Se define como el deficit de liquido acompanado o no de al Isotonica. No existe gradiente osmotico y peso, suele deberse a perdida de liquidos mas que a perdida de el volumen intracelular permanece constante. El agua se desplaza al espacio extracelular, disminuyendo el Tipos de deshidratacion volumen intracelular de forma significativa (riesgo de deseca Segun la intensidad cion celular). El tipo de deshidratacion marcara el uso de una u otra solucion y la velocidad de rehidratacion (la deshidratacion hipernatremica debe corregirse lentamente para evitar posible edema cerebral). Ojos hundidos, llanto sin lagrima Cuando haya que rehidratar a un deshidratado por via i. Las necesidades basales segun la regla de Holliday: Los primeros 10 kg: 100 cc/kg Entre 10-20 kg: 50 cc/kg >20 kg: 20 cc/kg Asi, un nino que pese 30 kg necesita 1700 cc diarios basales a los que luego hay que sumar el porcentaje de deficit que corresponda. Calculo del deficit total 10 peso deficit estimado clinicamente (%) Segun el tipo de deshidratacion que sea le corregiremos el deficit el primer dia o en 48-72 horas (en deshidratacion hipernatremica). Clinica: disuria, urgencia miccional, Tema poco importante, con preguntas muy ocasionales. Enterobacterias: Escherichia coli (mas frecuente), Klebsiella y Hay distintas tecnicas para la recogida de orina en funcion de Proteus. Existencia de flujo retrogrado ascendente de la orina desde la vejiga hacia el ureter y pelvis renal. A mayor intensidad del La mayoria descendera de manera espontanea hacia los 3 reflujo, mayor posibilidad de lesion renal. Enfermedades exantematicas Complicaciones Infeccion bacteriana secundaria (lo mas frecuente). En este grupo de enfermedades la clinica es similar (erupcion cu Tipica aunque poco frecuente, afecta sobre todo a inmunode tanea generalizada acompanada o no de fiebre), pero siempre hay primidos. El sarampion es la enfermedad exantematica que con mayor frecuencia da manifestaciones neurologicas. Enfermedad rarisima hoy en dia gracias a la vacunacion univer Pocos dias tras el exantema. Maximo periodo de contagiosidad: fase prodromica, antes de la aparicion del exantema, aunque el aislamiento debe mante Profilaxis nerse desde 5 dias tras la exposicion hasta 5 dias despues de la Activa: aparicion del exantema. Los anticuerpos que pasan a Maculopapuloso, confluyente y rojo intenso, no se blanquea traves de la placenta protegen durante 6 meses. Se inicia en zonas laterales del cuello y areas retroauriculares, y tiene tendencia descendente y centrifuga, Clinica con afectacion palmo-plantar. El signo caracteristico es la aparicion, antes del exantema, de adenopatias retroauriculares, cervi cales posteriores y posterooccipitales, dolorosas a la palpa cion. Se inicia en region retroau ricular y base de implantacion del pelo con tendencia des cendente y centrifuga, llegando a afectar a todo el cuerpo. Inmunoglobulina; esta indicada en el primer trimestre del em Complicaciones barazo si existe exposicion de riesgo, para prevenir el contagio Infeccion de las vias respiratorias superiores (por extension fetal. Tratamiento Escarlatina (Estreptococo hemolitico grupo A o Strep Penicilina oral 10 dias. Contagiosidad: desde 1 dia antes de la aparicion del exantema y hasta que todas las lesiones estan en fase de costra. Durante los primeros dias aparece la lengua blanquecina en En el primer contacto se produce la varicela y posteriormente la que destacan las papilas hipertroficas (en fresa blanca). El las eritematosas > vesiculas > pustulas > tras su ruptura exantema es confluyente en cara, intenso en mejillas y respeta se convierten en costras. Se inicia en el torax y desde alli se el surco nasogeniano dando lugar a la facies de Filatov. A los extiende a cara, cuero cabelludo, zonas de presion (predo 7 dias se descama.