文档介绍：Implications of nutritional support during continuous veno-venous haemofiltration
Present by Ri 陳宇光
Introduction :
CVVH
Wide accepted therapy for acute renal failure in intensive care
Correct uremia , fluid overload and eliminate metabolic wastes.
In the application of clearance by convection
One type of the CRRT (continuous renal replacement therapy)
Advantages
Improve hamodynamic stability
Possibility for unlimited nutrition, optimal fluid balance
Gradual toxin removal without fluctuations
Indication
ARF ,CRI and hemodynamic unstable P’t
Respiratory distress syndrome
an failure
CHF or hepatic failure
ARF an transplantation
Intoxication
Nutrient loss by CRRT
Loss of Nutrients during CVVH
Water-soluble nutrients with low molecular size and low protein binding : amino acids or vitamins
Lipids and liposoluble vitamins : nearly no loss
Cholesterol and/or triglycerides : only trace amount loss
Amino acids losses
Losses : approximately 10-15 g/day
10% of infused amino acids are lost
Depend upon the rate of ultrafiltration and free serum amino acid levels
Not upon molecular size or charge
Amino acid supply : increased by g/kg/day
Carbohydrates
Dextrose-containing dialysate: significant amount can be absorbed (35-45 %)
Fluid replacement with dextrose containing electrolyte : significant gains of energy …>Possible Hyperglycemia
Together with the energy derived from the metabolism of lactate (45 mmol of lactate yields 12 kcal /l): take into account when designing regiments
Gains of energy in CVVH
Water-soluble vitamin and trace element losses
Participate in a variety of physiological functions
May attenuate the effects of the inflammatory cascade, particularly the effects of oxygen-derived free radicals
Significant lower vitamins and trace elements during the first 24 h of CVVH
Actual micronutrient requirement : unknown