Explain the major nutrient/metabolic changes (glucose, lipid, protein, and energy expenditure) that may occur during AKI and that would potentially affect your nutrition recommendations

Question

What will be an ideal response?

Answer 1

• Major nutrient and metabolic changes that can occur during an AKI include a rapid decrease in urine output, which can lead to acidosis, electrolyte imbalances (hyperkalemia, hyperphosphatemia), fluid disturbances, impaired glucose utilization, protein catabolism, and accumulation of metabolic waste products.
• Energy: 25-35 kcal/kg based on the stress and normal nutrition status of the patient before the injury (if the patient was malnourished beforehand, he would have higher energy needs than this)
• Impaired glucose utilization and protein catabolism from uremia
Protein needs range from 0.8 to 2.0 g/kg/d
non-catabolic, not dialyzed: 0.8-1.0 g/kg/d
on renal replacement therapy: 1.0-1.5 g/kg/d
hypercatabolic, receiving CRRT: up to 2.0 g/kg/d
Hyperglycemia may arise due to calories from CRRT and response to metabolic stress
• Insulin may be needed due to insulin resistance resulting from AKI
• Serum TG should be within normal range if started on enteral or parenteral nutrition because a high TG value may indicate a reduced hepatic capacity for removal of long-chain and medium-chain fatty acids; if TG are high at first, these levels will need to be monitored closely for tolerance.