By D. G. Oreopoulus (auth.), Dimitrios G. Oreopoulos MD (eds.)
The yr was once 1943. As a third-year scientific scholar at Stanford, i used to be approximately to witness the start of a scientific miracle. Dr. Arthur Bloomfield, Professor of drugs, had chosen my sufferer, a center elderly guy, who was once death of acute pneumococcal pneumonia, as one of many first sufferers to obtain miniscule doses (by contemporary criteria) of his meagre offer of a brand new drug - penicillin. The patient's reaction surprised every person in particular this impressionable clinical pupil. the remainder of the tale is background. With one stroke, the creation of penicillin faraway from the clinical scene the 'friend of the elderly' - lobar pneumonia. the implications, which nobody may have imagined on the time, are nonetheless turning into appear as different 'miracles' akin to respirators, man made kidneys and lots of effective new antibiotics have stumble upon the scene. we all are conscious that those miracles have created quite a few new demanding situations round the states of death and close to demise. we don't have any effortless solutions for those difficulties. however as dialysis innovations, in particular CAPD, are utilized extra broadly to the therapy of the aged, the duty of aiding the sufferer meet demise with dignity turns into more and more very important and vexing simply because as soon as began, dialysis is tough to terminate.
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Extra resources for Geriatric Nephrology: The medical, psychosocial, nursing, financial and ethical issues of treating end-stage renal disease in the elderly
SURVIVAL AND LONGEVITY Contemporary changes in survival and longevity have altered greatly traditional life experiences. Health more than age per se determines the place of work and marriage, and intergenerational relationships in individual lives, and declining health forces profound changes in individual functioning. Morale, another key factor, includes a zest for life in the present, a positive self-concept and mood tone, qualities of resolution and fortitude, a sense of congruence of future goals, and a sense of achievement in the past -- similar to the sense of continuity.
The validity of these phenomena is supported further by the observation of a significant negative correlation between endogenous creatinine clearance and FENa in both essential and renovascular hypertension both (Table V). Thus FENa becomes an important tool in clinical investigation in elderly hypertensives who tend to lose more urinary sodium than young ones and during the summer often develop symptoms of hyponatremia if there is complete salt restriction. The situation worsens when diuretics are administered to treat the hypertension, because hyponatremia often increases renin secretion.
ADH levels may be increased and cause hyponatremia where none of the factors listed in Table V seem to operate. In this case, patients are said to have the 'syndrome of inappropriate ADH' release, (SIADH). This may result from ectopic hormone production by tumors, or from central release of ADH due to central nervous system disorders, intrathoracic disease or drugs (Table VI). Often, the elderly have disorders which cause ADH release. Frequently they are ECF volume depleted and often they develop heart failure or are using diuretics.