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36 2.3 Nutrition Support in Liver and Renal Diseases

front 1

Fasting state for cirrhosis patients

back 1

10-12 hrs

front 2

resting EE in cirrhosis

back 2

>30% and persist for 1 year post transplant

front 3

Vitamins deficiencies in liver disease

back 3

  1. A rare
  2. DEK
  3. B12 rare long term
  4. B6
  5. B9 common

front 4

Thiamine deficiency causes

back 4

Wer-nicke's encephalopathy

Kossak-off psychosis

front 5

Dry weight for ascites and edema

back 5

  1. Minimal 2.2 1
  2. moderate 6. 5
  3. Sever 14. 10

front 6

Golden standard assessment tool for per liver transplant

back 6

RFH SGA (4 domains )

front 7

measurement to predict 1 year mortality post-transplant and sarcopenia

back 7

Psoas Muscle Area (L3 PMA)

front 8

Nutritional requirements

back 8

Compensated 25-35 kcal/kg/d. 1.2-1.3 g

Decompensated 35-40 kcal/kg/d. 1.2-1.5 g

Post transplant 30% stress factor. 1.2-1.5g

front 9

No added salt diet content

back 9

recommended over low sodium diet

80-100 mmol/d

front 10

Glucose and AA requirement in alcoholic steatohepatitis and cirrhosis

back 10

IV 2-3 g/kg/day (fasting for >12 hrs)

50-60% of non-protein energy requirements

AA 1.2-1.5 g/kg/day

B1 prior to glucose infusion

front 11

ESPEN in Acute liver failure

back 11

IV 2-3 g/kg/day

Lipids 0.8-1.2 g/kg/day (if IR)

AA 0.8-1.2 g/kg/day

front 12

Is creatinine related to dietary protein intake

back 12

No, proportionate to muscle mass

marker for renal function, inadequate dialysis or muscle catabolism

front 13

Potassium goal, hyper, hypo levels, when to not restrict intake

back 13

goal 3.5-5.5 meq/l K+ number of lines = upper limit K=lower

hyper >6 meq/l

Urine >1000ml/day or serum normal level

front 14

CRF requirements

back 14

35 kcal/kg/day

Protein 0.55-0.6 g/kg/day

Po4 600-1000 mg/d

K+ 1500-2000 mgday

Na 1.8-2.5 g/day

front 15

Proposed solution to preserve renal function

back 15

Essential AA + ketoanalogues (low protein)

front 16

ESRF requirements

back 16

Protein intake (g/kg/day): 1.2–1.4 (50% HBV)

• Energy intake kcal/kg/day: 35

• Mineral Requirements:

– Phosphate (mg/day) 800–1000 or <17 mg/kg IBW (if GFR< 20-30 ml/min)

– Potassium (mg/g) 2000–2500 or 40mg/kg of IBW

– Sodium (g/day) 1.8–2.5

– Fluid (ml) 1000+urine volume

front 17

HD >5% weight gain reflect

back 17

reflect excessive fluid intake

front 18

HD Fluid gains of <2% reflect

back 18

Loss of body mass

front 19

Sodium and fluid balance based on urine output

back 19

- ≥ 1 L fluid output: 2-4 g Na and 2 L fluid

– ≤ 1 L fluid output: 2 g Na and 1-1.5 L fluid

– Anuria: 2 g Na and 1 L fluid

front 20

PD requirements

back 20

Energy: 35 kcals/kg/day

Sodium: (2-4 g/day)

Potassium: is easily cleared by PD

• Calcium: (<2000 mg elemental calcium)

– ~1500 mg: calcium-based phosphate binders

• Phosphorus: <800-1000 mg/day

– Use phosphate binders

• Fluid: can be adjusted by varying the dextrose

concentrations of the dialysate