anustha dwivedi
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Objectives
Participant will be able to describe the importance ofnutrition intervention in patients with ESRD
Participant will be able to identify the components of a
nutritional assessment Participant will be able to identify the components of
the renal diet and the role of the dietitian
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Dietary challenge Anorexia
Taste challenge
Reduce food intake
The main focus on dietary management is on protein,sodium, potassium phosphate, water and adequate nonprotein.
Maintenance peritoneal or haemodialysis is required when
the GRF is below 5ml/min Maintain loss of ascorbic acid , folic acid, and water soluble
vitamins .
During hemodialysis ,amino acid are lost.
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Nutritional requirement during
various stages of renal faillureNutrient Acute renal faillure End-state renal disrase
perdialysis
Haemodialysis Peritoneal dialysis
Energy 30-50 kcal/kg of body
weight
35 kcal/kg ideal body
weight
35 kcal/kg ideal body
weight
35 kcal/kg ideal body
weight
Protein 0.6-0.8g/kg based on
kidney fuction
0.6-0.8g/kg
>60%* HBV
1.0-1.2g/kg ideal weight
>60%* HBV
Diabetic may need 1.2-1.5g/kg
1.2-1.5g/kg for ideal body
weight >60%* HBV
Sodium 1-2g/day, depends on B/P
oedema replace diuretic
phase
Usual 2-4g/day 2-3g/day
Or
no added salt
3-4g/day
Or
No added salt
Phosphorus Maint serum level 10-20mg/g protein 12-15 mg/g protein 12-15mg/g protein
Potassium 5.0 mEq/L replace loss in
diauretic phase
Not restricted unless
serum potassium is
elevated and urine output
1ltr/day
2-3g/day (individualise) 2-3g/day (individualise)
Fluid Output+600cc Unrestricted balance fluid
intake with urine output
to avoid oedema
Output+1000cc Output+1000cc
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Potassium content of vegetables in 100gmLOW
0-100 mg
Medium
101-200mg
High
201mg and above8Fenugreek leaves Cabbage Amaranth
Lettuce Carrots Coriainder leaves
Beetroot Onion-small Drumpstick leave
Radish pink Radishwhite Spinach
Bottle gourd Bitter gourd Colocasia
Broad beans Brinjal Potato
Cucumber Cauliflower Sweet potato
Kno l khol (ganth gobhi) French beans Tapioca
Green mango Ladies finger Yam
Peas Onion stalks Drumstick
Ridge gourd Plantain flower Green papaya
Snake gourd Green plantain
Chow chow pumpkin
Tamarind leaves Green tomato
Kurry leaves Parwar
Mint (ararot)
Giant chillies
Double boiling and draining excess water reduce potassium content
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Potassium content of fruits
mg/100gmFruits low in potassium Fruits high in potassium
Orange..9 Mango ..205
Pineapple37 Amla.225
Papaya..69 Plums..247
Apple75 Sapota.269
Banana..88 Lemon..270
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Daily supplements of proteins of HBV to provide EAA
Veg Non -veg
Milk 200ml, Egg 1 pc
Paneer 30gm Chiken/meat 30gm
Milk 100ml
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Liberally permitted
Sugar fat
Jiggery (cane/date) Butter
honey Ghee (clarified butter oil)
Sherbets
Jally
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Phosphorus10High Phosphorus Foods Dairy products
Beans & Nuts Processed meats
Chocolate
Pancakes, waffles,biscuits, cakes
Sardines
Whole wheat, brancereals
Lower Phosphorus Foods
Fresh meat products
Homemade baked goods
Nondairy creamer
Unenriched rice milk
Cream cheese
White flour products
Rice cakes
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