- Carbohydrate calories absorbed and protein lost via renal replacement therapy must be accounted for when designing a parenteral (PN) or enteral nutrition (EN) regimen for patients with renal failure.
- Administration of renally excreted or regulated electrolytes, such as potassium, magnesium, and phosphorus, should be limited in patients with renal failure unless refeeding syndrome is present or continuous renal replacement therapies are used.
- Hyperglycemia is common in cirrhosis. Patients with fulminant hepatitis are prone instead to hypoglycemia.
- Folic acid and thiamine supplementation is important in patients with liver disease for the prevention of anemia and Wernicke encephalopathy, respectively.
- In short bowel syndrome, PN should be used to meet nutritional needs in the immediate postoperative period after intestinal resection.
- Increased fluid and electrolyte replacement is often necessary in patients with short bowel syndrome to replace GI losses. Patients may need increased calcium, magnesium, zinc, and other trace elements because of decreased absorption and/or excessive GI losses.
- Patients with ileal resection commonly develop vitamin B12 deficiency, necessitating therapy with parenteral cyanocobalamin.
- As small bowel adaptation occurs, some patients with short bowel syndrome receiving PN can be transitioned successfully to EN. Early initiation of enteral intake affects adaptation because intraluminal nutrients are a stimulus for this process.
- Care should be taken to avoid overfeeding of patients with respiratory failure, as excessive carbon dioxide production may limit the patients' ability to have mechanical ventilation discontinued.
- Excessive fluid administration should be avoided in patients with pulmonary disease because it may worsen already compromised pulmonary function.
On completion of the chapter, the reader will be able to:
- 1. Describe macro- and micronutrient alterations seen
in patients with acute renal failure and chronic kidney failure.
- 2. Estimate nonprotein energy and protein requirements in
patients with acute renal failure and chronic kidney disease.
- 3. Recommend appropriate initial nutrition regimens for patients
with acute renal failure and chronic kidney disease.
- 4. Recommend a nutrition monitoring plan for patients with
end-stage renal disease (ESRD).
- 5. Describe macro- and micronutrient alterations seen in patients
with hepatic disease.
- 6. State the differences in energy and protein requirements
for patients with liver failure compared to those with out this
- 7. Describe the role of dietary protein restriction in nutrition
support of patients with cirrhosis.
- 8. Recommend appropriate initial nutrition regimens for patients
with liver failure.
- 9. Propose nutrition monitoring parameters that will optimize
nutrition clinical outcomes in patients with liver failure.
- 10. Recommend an appropriate initial nutrition plan for a
patient following a bowel resection that results in short bowel
- 11. Predict which micronutrient and electrolyte abnormalities
are most likely to occur in patients with short bowel syndrome.
- 12. Identify nutrition interventions that are appropriate
for short bowel syndrome patients with colon in continuity, but
that are of no benefit in patients without a colon.
- 13. Recommend parameters that should be used to determine
when one should attempt to wean short bowel syndrome patients from
- 14. Describe the ...