Medico Surgeon

  It is easier to learn by watching a video, to Watch Click here HIE is an insult to the fetus or newborn due to a lack of Oxygen (hypoxia) and / or a  lack of perfusion (ischemia) to various organs. It is often associated with tissue lactic acidosis and hypercarbia. Hypoxia is an evolving process that starts at the onset of the insult and continues after resuscitation and thereafter manifests in form of sequelae These manifestations change over time and are clinically noted in babies of gestational age more than 36 weeks by classification on the basis of Levene stages of HIE. Stage 1 HIE / Mild HIE: Irritability Hypotonia  Seizures Absent Poor Suck Stage 2 HIE / Moderate HIE: Lethargy Marked Hypotonia Seizures Present Unable to Suck Stage 3 HIE / Severe HIE: Comatose Severe Hypotonia Prolonged Seizures Unable to sustain spontaneous respiration Prognosis: Stage 1 : Good prognosis Stage 2 : 20% - Adverse neurological outcomes Stage 3 : 50% - Dies 50% - Poor neurodevelopmental outcom

Proximal RTA (Type 2 RTA):   ·          Generalized Proximal Tubular dysfunction. ·          Manifested by glycosuria, generalized aminoaciduria, and phosphaturia   (Fanconi syndrome). ·          Therapy with NaHCO 3 causes hypokalemia. ·          Drug induced: Acetazolamide, topiramate Treatment: ·          Sodium and Potassium citrate syrup (citric acid 334mg, sodium citrate 500mg, potassium citrate 550mg per 5ml) ·          Syrup preparation is not recommended for chronic administration.   Classic Distal RTA (Type 1 RTA): ·          Hypokalemia, a non-AG metabolic acidosis, low urinary NH 4 + excretion, inappropriately high urine pH (pH > 5.5). ·          Hypocitraturia, hypercalciuria, so nephrolithiasis, neprocalcinosis and bone disease are common. ·          Drug induced: Amphotericin B, ifofamide Treatment: ·          Acutely acidotic patient with Hypokalemia: administer potassium. ·          Chronic therapy: Sodium citrate (Shohl’s solution) O