Answer to Question 1
Acute kidney injury is defined as an abrupt cessation or decline of kidney function. The injury can be classified as stage I, II, or III based on the serum creatinine level and urine output.
Patients who are on CRRT have increased protein needs up to 2-2.5 g/kg and electrolyte restriction is not indicated. Therefore, we will continue with the current regimen, monitor for recovery of renal function, and also change in treatment. Will monitor for vitamin A and C intakes and reduce doses if renal recovery is slow. If indirect calorimetry is available, doing so may provide a more accurate estimation of calorie needs with the additional stress of renal injury. Monitoring the patient's nitrogen balance will also allow the dietitian to determine if his high protein needs are being met.
Answer to Question 2
Factors to assess would include degree of malnutrition (>10 bodyweight/6 mo.); length of time prior to resuming an oral diet (>7 days and patient is malnourished); recovery time; functional status of the gastrointestinal tract (including clinical conditionhemodynami cally stable, soft/bowel sounds); access for parenteral support; and ability to tolerate the fluid volume required for PN. Enteral nutrition should be used, unless contraindications exist (e.g. severe GI bleed, distal high output fistulas >500 mL/day, mechanical obstruction, intractable diarrhea, etc.).
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