[Nutritional support of patients treated with continuous hemofiltration methods in intensive care units].
The use of continuous renal replacement therapy (CRRT) can directly or indirectly influence patient's metabolism and nutritional status. The loss of nutrients into the filtrate is significant. It concerns aminoacids, glucose, water-soluble vitamins, some minerals and trace elements. The loss of aminoacids is about 1.2 to 7.0 g per day. The glucose balance during CRRT depends on the concentration of glucose in substitution solutions. When concentration between 80 to 180 mg/dl is used, the glucose balance in most of patients is kept. The loss of lipids and lipid-soluble vitamins is neglectable. From the micronutrients, significant becomes the loss of magnesium, calcium, phosphorus and that of water-soluble vitamins (mainly B1, B6, C and folic acid). Contrary to it, some components can cross from the substitution solution to the blood (e.g. lactate). Indirect effect of CRRT on the nutrition and metabolism represents the release of cytokins and inflammatory mediators resulting from the first contact of the blood with the filter membrane. The decrease of glutamine level in the beginning of therapy is probably a consequence of this inflammatory reaction. Nutritional plan of most of patients treated with CRRT is therefore necessary to adjust.
Polák
F
F
Klinika anesteziologie a resuscitace 1. LF UK a VFN, Praha. ferdinand.polak@atlas.cz
D006440:Hemofiltration / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D018529:Nutritional Support