While conducting a nutrition-focused physical examination, the RD discovers that Mr. Maddox exhibits evidence of temporal wasting and loss of preorbital fat pads, as well as some evidence of triceps fat loss

Question

How might this impact the nutrition recommendations the RD will make? Describe the etiology of the protein-energy wasting that may occur with AKI.

Answer 1

• The temporal wasting is evidence of muscle-wasting
• Losses in the preorbital pads and triceps suggests subcutaneous fat loss.
• These pieces of evidence should indicate acute malnutrition and the RD should adjust his/her energy/protein recommendations:
- Energy: 30-35 kcal/kg
- Protein: 2.0 g/kg
• The etiology of protein-energy malnutrition from AKI is related to the metabolic derangements that occur from it (and from the underlying catabolic illness/precipitating factor) and results in the degradation of proteins and amino acids. Additionally, fuel substrates may not be utilized efficiently due to the presence of cortisol and epinephrine. Together, these will result in an increase in lipolysis, lower the uptake of glucose by peripheral tissues, and result in protein sparing. This overactive use of the Cori cycle is an inefficient utilization of energy substrates.