Monday, March 7, 2011

Urinary Diversion

Most common electrolyte abnormality seen when the following conduits are used

1. Stomach- Hypochloremic metabolic alkalosis. This is secondary to the HCl secretion by                            the stomach segment, involving the H+/K+ ATPase secretory mechanism of the                                  gastric mucosa.

2. Jejunum- Hyponatremic, hypochloremic, hyperkalemic metabolic acidosis. Also                           known as “jejunal conduit syndrome.” This syndrome can be quite debilitating,                                 resulting in nausea, anorexia, lethargy, fever, and even death. The jejunum should                           be used only when there are no other acceptable segments available for use.

3. Ileum- Hyperchloremic metabolic acidosis. This is caused by the substitution of                              ammonium for sodium in the Na/H transport. Therefore, ammonium chloride is                              absorbed into the bloodstream in exchange for carbonic acid (CO2 and H2O).

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