Thread by @GasBugZa

Next is Lynette Cilliers on 'Nutritional Support Strategies in AKI'.
#CCSSA2022 #FOAMcc #critcare

These patients are at high risk of malnutrition - fluid limitations, disturbances in electrolytes, CHO metabolism alterations, loss of protein and energy stores, frailty, etc...
#CCSSA2022

All based on ESPEN guidelines from 2021. This is a critical resource!
doi.org/10.1016/j.clnu…
#CCSSA2022

Assessment of nutrition status in these patients is very difficult. BMI, albumin next to useless. CT/MRI expensive. Promising is the use of ultrasound (thigh muscle) as it is not affected by rapid fluid changes.
#CCSSA2022

If can feed orally, can add oral nutritional supplements
If cannot meet 70% of requirements --> enteral nutrition
EN is preferred over PN.
#CCSSA2022

Important to remember than renal replacement therapy may have an impact on energy provision - citrate, glucose containing fluid. #CCSSA2022

Ideally, the alterations in metabolic profile should be measure with indirect calorimetry, and this is becoming more accessible! Lipid and protein metabolism is very altered in critically ill patients.
#CCSSA2022

Micronutrients are also often deficient - zinc, vit C, folate, thiamine, magnesium (and more that I missed!)
doi.org/10.1097/MCC.00….
#CCSSA2022