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عمومی::
داخل عروقی، درون عروقی
Body weight, physical examination, and to a lesser degree labo- ratory markers are subject to significant fluctuations in ICU patients as a result of fluid shifts between intravascular and extra- vascular compartments, which masks loss of muscle or adipose mass.
Simple urinalysis contains a wealth of information to guide the workup of AKI because a high urine specific gravity and low pH are consistent with prerenal causes of AKI, whereas the presence of tubular or muddy brown casts is indicative of renal parenchymal disease such as ATN. fte presence of eosinophils is associated with interstitial nephritis, whereas "large blood" with no red blood cells is indicative of muscle breakdown or intravascular hemolysis.
Perioperative fluid management in patients with liver disease requires special attention to minimize delivery of sodium- containing solutions, which in the setting of a low intravascular oncotic pressure cause increased ascites and interstitial edema.
Even albumin and other blood product colloids will leak from the intravascular space, especially in sepsis, and the cycle of ascites continues particularly if liver failure worsens.
Inferior vena cava filters are typically placed in the operating room, but bedside placement using intravascular ultrasound or fluoroscopic guidance is gaining interest.،loss occurs primarily from the interstitial and intracellular spaces and clinical signs of intravascular volume depletion may be minimal.
Vasoocclusive sickle episodes are due to intravascular sickling, which leads to tissue ischemia and infarction.
Transfusion should be gradual (5 mL/kg), as return of the seques- tered RBCs to the intravascular space can occur, causing hyperviscosity.
If the CBC is concerning for acute leukemia, obtain a chest radiograph (for mediastinal mass); electrolytes with creatinine, calcium, uric acid, and phosphate (for evidence of tumor lysis); liver function tests and lactate dehydrogenase, prothrombin time (PT)/partial prothrombin tine (PTT) (looking for disseminated intravascular coagula- tion); peripheral smear; type and screen if anemic; and blood and urine cultures if febrile.
Disseminated intravascular coagulation and hemolytic-uremic syndrome should be considered in the ill patient with thrombocytopenia.
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