Protein Energy Malnutrition Flashcards
Definition of PEW?
1. biochemical:
- Se Alb < 38g/L
- pre albumin < 30mg/dL mmol/L
- TC < 2.6mmo/L
**2. body mass **
- BMI < 23
- unintentional wt loss 5% in 3/12 or 10% in 6/12
- total body fat < 10%
3. muscle wasting
- 5% over 3/12
- 10% over 6/12
- reduce arm circumference (>10% in relation to preference 50th centile)
**
4. low protein and energy intake**
- unintentional low dietary pt intake < 0.8g/kg/day for at least 2/12
- unintentional low dietary energy intake < 25kcal/kg/day at least 2/12
*at least 3/4 listed categories
(at least one test in each cat)
(at least 3 occasions)
(2-3 weeks apart)
Cause of PEW?
Type of malnutrition ?
Type 1:
Ureamic syndrome
Type 2:
Cytokine Driven Malnutrition
Malnutrition Inflammatory Syndrome (MIS)
- marked low alb
- marked increase oxidative stress
- greater resting energy expenditure
- increase pt catabolism
- high inflammatory markers
- comorbids
Nutritional requirement in HD
**1. calorie:
- 30-35kcal/kg/day **
- depends on activity
2. protein
- 1.0 - 1.2 g/kg/day
- fat
- vege fat
- 25% of total energy req - calcium
- 1200mg/day - phosphate
- 800 - 1000mg daily - sodium
- 2g sodium/day
- 5-6g sodium chloride /day - vitamins
vit c: 75-90mg/day
folic acid: 1g/day
iron: 200mg/day
K: 1mmol/kg (50-70mmol/day)
pt HD < PD
Nutritional req in PD
**1. energy intake
- 30-35 kcal/kg/day
- protein intake
- 1.2-1.3 g/kg**/day
Pt in PD > HD
NKF USA,
RRT CPG 2017
Limitations with TPN
- hyperK
- hyperPO3
- hyperMg
- need central line
Management of PEW
- Multidiciplinary approach
- Drug: stop those impair appetite / cal carbonate
- gastroparesis: maxolon / EES
- Nutritional supplement:PEG / NG tube
HD:
* achieve HD adequacy
* IDPN / TPN
Assessment of nutrition
RRT CPG 2017
