about 600 ml/d in an adult of 70 kg. Extra 200 ml fluid should be
added in febrile patient for every one degree centigrade increase in
the body temperature.- Electrolytes: Sodium restriction with hypertension or oedema, and
potassium restriction with severe oliguria and with hyperkalaemia - Calories: Patient should receive about 35 K. calories/kg/day with
carbohydrate 60% of non protein calories and fat 40%.
b. Treatment of Bone disease:
- Phosphate Binders such as aluminium hydroxide, magnesium
oxide and calcium carbonate or acetate which combine with
phosphorus in the gut and are excreted with the stool. Calcium
containing compounds are better than aluminium and magnesium
salts which could be dangerous on long term use. Calcium
carbonate or acetate may be given orally t.d.s. with meals in a
dose of 500-1000 mg orally. - Active vitamin D " 1-OH vitamin D" which is given orally in a
daily dose of 0.25-1.0 ug. - Acidosis is corrected by oral Na bicarbonate supplementation.
- Parathyroidectomy may be done for cases with tertiary
hyperpara- thyroidism. Three glands and part of the fourth are
removed and the remaining is implanted subcutaneously.
c. Anaemia:
Is responsible for major part of uraemic symptoms. The first line of
treatment is by giving proper nutrition, iron, folic acid, and vitamins
especially B12. Failure to respond may indicate repeated blood
transfusion or treatment with recombinant human Erythropoietin. Blood
transfusion carries the advantage of being cheap but have the disadvantage
of transmitting diseases (especially HIV, HBV and HCV) beside other