Protocols - Hemorio

- Currently there is a tendency to perform prophylactic cholescystectomy by laparoscopy in asymptomatic
patients, with purpose of prevent possible pictures of cholecystitis, or colangitis and/or the necessity of
urgency surgery. The occurrence of inflammatory/infectious pictures may also difficult the future use of
videolaparoscopy due to viscosity formation.
- Pre-surgical preparation at Hemotherapy discretion. Due to possible complications during surgery, the
patient, previously conducted to videolaparoscopy, may be submitted to laparotomy and respiratory
physiotherapy with spirometer.
- Post-surgical cares – respiratory physiotherapy with spriometer and early walking around (prevention of
STA and vase-occlusive).
15. HEPATITIS:
After the diagnose by confirmatory test, conduct patients to a Reference Centre for treatment. Note.:
RIBAVIRIN is not at MS protocol for DF, because its use in these patients are not established yet.
16. RENAL COMPLICATIONS
HYPOSTHENURIA: Caused by the difficulty of the kidney to concentrate the urine. It is noted around 3
years old. This condition results a mandatory urinary output of more than 2.000ml/day, in adults. The
increase of urinary loss becomes patient more likely to dehydration, which is a precipitate factor of vaso -
occlusive crisis. Hyposthenuria also leads to nocturia in adult and persistent enuresis in children.
Conduct: to provide from 3 to 5 ml/day to adults and 150ml/Kg/24h to children.
NOCTURNAL ENURESIS (No need to treatment until 5 years old)
- As of 5 years old:
1. Avoid ingestion of liquids near bedtime
2. To make conscious bladder control (training to hold urine for a longer period, urinate intermittently, urine
before bedtime)
3. Drug treatment: Imipramine - 25mg/day – adult and 10mg/day- children
ATTENTION: Conduct to Nephrology ALL patients that experience any of the changes described below.
RENAL TUBULAR DYSFUNCTION:
1 Unable to acidificate urine. It may lead to metabolic acidosis (Start therapy with Sodium Bicarbonate)
2 Hyperkalemia (Higher risk of hyperkalemia in patients using beta-blockers, ACE blockers or Potassiumsparing
diuretic). The drug must be withdrawn.
29