Importance of caloric intake during renal failure

Abstract

Loss of excretory function in acute renal failure results in the retention of catabolites and fluid. In the absence of available carbohydrate, endogenous fat and protein become the main caloric sources. This results in the rapid accumulation of keto acids and nitrogenous wastes. By providing readily available non-nitrogenous calories, protein catabolism is reduced, complete oxidation of fat is obtained and energy is provided to drive potassium into the intracellular compartment. The patient should be encouraged to eat despite his apathy, fear of vomiting and characteristically paranoid mood. Tube or parenteral feeding is complicated by the need to restrict fluid. Numerous small feedings are more successful than large meals. Hard candy and alcohol are often acceptable sources of calories, fat emulsions seldom. Oral hygiene aids feeding, and tranquilizers and anticholinergics are useful. If the patient does not take food by mouth, tube feeding may be carried out. Because of the bleeding tendency so often occurring in uremia, tube feeding may be contraindicated if it causes erosion of the pharynx or esophagus. Intravenous infusion of invert sugar, glucose and alcohol may be necessary if nutrition cannot be accomplished by other means.