Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Insuficiencia renal aguda

Autor: López Martínez,J., Sánchez-Izquierdo Riera,J. A., Jiménez Jiménez,F. J.
Přispěvatelé: [López Martínez,J] Hospital Universitario Severo Ochoa. Madrid. Spain. [Sánchez-Izquierdo Riera,JA] Hospital Universitario 12 de Octubre. Madrid. Spain.[Jiménez Jiménez,FJ] Hospital Universitario Virgen del Rocío. Sevilla. Spain.
Jazyk: angličtina
Rok vydání: 2011
Předmět:
Analytical
Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Renal Dialysis::Peritoneal Dialysis [Medical Subject Headings]
Phenomena and Processes::Reproductive and Urinary Physiological Phenomena::Urinary Tract Physiological Phenomena::Urinary Tract Physiological Processes::Diuresis [Medical Subject Headings]
Psychiatry and Psychology::Behavior and Behavior Mechanisms::Psychology
Social::Group Processes::Consensus [Medical Subject Headings]
Extrarenal clearance
Diseases::Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Acute Kidney Injury [Medical Subject Headings]
Technology
Industry
Agriculture::Food and Beverages::Food::Foods
Specialized::Food
Formulated [Medical Subject Headings]
Analytical
Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Hemofiltration [Medical Subject Headings]
Analytical
Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Nutrition Therapy::Nutritional Support [Medical Subject Headings]
Phenomena and Processes::Metabolic Phenomena::Water-Electrolyte Balance [Medical Subject Headings]
Phenomena and Processes::Physiological Phenomena::Nutritional Physiological Phenomena::Diet::Energy Intake [Medical Subject Headings]
Depuración extrarrenal
Chemicals and Drugs::Amino Acids
Peptides
and Proteins::Proteins::Dietary Proteins [Medical Subject Headings]
Necesidades nutricionales
Analytical
Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy [Medical Subject Headings]
Nutritional requirements
Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings]
Acute renal failure
Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Physiological Effects of Drugs::Growth Substances::Micronutrients [Medical Subject Headings]
Insuficiencia renal aguda
Phenomena and Processes::Physiological Phenomena::Nutritional Physiological Phenomena::Nutritional Requirements [Medical Subject Headings]
Analytical
Diagnostic and Therapeutic Techniques and Equipment::Therapeutics::Renal Replacement Therapy::Renal Dialysis [Medical Subject Headings]
Diseases::Pathological Conditions
Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness [Medical Subject Headings]
Zdroj: Nutrición Hospitalaria v.26 suppl.2 2011
SciELO España. Revistas Científicas Españolas de Ciencias de la Salud
instname
Popis: Guideline; Journal Article; Review; Nutritional support in acute renal failure must take into account the patient's catabolism and the treatment of the renal failure. Hypermetabolic failure is common in these patients, requiring continuous renal replacement therapy or daily hemodialysis. In patients with normal catabolism (urea nitrogen below 10 g/day) and preserved diuresis, conservative treatment can be attempted. In these patients, relatively hypoproteic nutritional support is essential, using proteins with high biological value and limiting fluid and electrolyte intake according to the patient's individual requirements. Micronutrient intake should be adjusted, the only buffering agent used being bicarbonate. Limitations on fluid, electrolyte and nitrogen intake no longer apply when extrarenal clearance techniques are used but intake of these substances should be modified according to the type of clearance. Depending on their hemofiltration flow, continuous renal replacement systems require high daily nitrogen intake, which can sometimes reach 2.5 g protein/kg. The amount of volume replacement can induce energy overload and therefore the use of glucose-free replacement fluids and glucose-free dialysis or a glucose concentration of 1 g/L, with bicarbonate as a buffer, is recommended. Monitoring of electrolyte levels (especially those of phosphorus, potassium and magnesium) and of micronutrients is essential and administration of these substances should be individually-tailored. Yes El soporte nutricional en la insuficiencia renal aguda está condicionado por el catabolismo del paciente y por el tratamiento del fallo renal. En el paciente crítico es frecuente el fracaso hipermetabólico que obliga a técnicas continuas de reemplazo renal o a hemodiálisis diarias. En los enfermos con catabolismo normal (aparición de nitrógeno ureico inferior a 10 g/día) y diuresis conservada se puede intentar un tratamiento conservador. En estos casos es preciso realizar un soporte nutricional relativamente hipoprotéico, con proteínas de alto valor biológico y limitaciones hidroelectrolíticas individualizadas. Es necesario un ajuste del aporte de micronutrientes, siendo el bicarbonato el único buffer utilizado. Cuando se utilizan técnicas de depuración extrarrenal desaparecen las limitaciones a los aportes hidroelectrolíticos y nitrogenados, pero éstos deben ser modificados en función del tipo de depuración. Los sistemas continuos de reemplazo renal, en función de su flujo de hemofiltración, precisan altos aporte nitrogenados diarios que en ocasiones pueden alcanzar los 2,5 g de proteínas/kg. La cuantía de la reposición de volumen puede inducir sobrecargas energéticas, siendo recomendable utilizar líquidos de reposición y diálisis sin glucosa o con una oncentración de glucosa de 1 g/l, con bicarbonato como buffer.Es preciso monitorizar los valores de electrolitos (sobre todo de fósforo, potasio y magnesio) y de micronutrientes, y realizar aportes individualizados.
Databáze: OpenAIRE
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