- Maintain adequate caloric intake
- Restrict sodium and possibly K and phosphate
- Increase dietary fat
- Enteral nutrition
- restrict protein
=> The challenge of nutritional management in AKI is to provide adequate calories to prevent catabolism despite the restrictions necessary to prevent electrolyte disorders, fluid disorders, and azotemia.
A primary nutritional goal in AKI is to maintain adequate caloric intake (providing 30 to 35 kcal/kg and 0.8 to 1.0 g of protein per kilogram of desired body weight) to prevent the further breakdown of body protein for energy purposes.
Adequate energy should be primarily from carbohydrate and fat sources to prevent ketosis from endogenous fat breakdown and gluconeogenesis from muscle protein breakdown. Supplementation of essential amino acids can be given for amino acid replacement.
Sodium is restricted as needed to prevent edema, hypertension, and heart failure.
Dietary fat intake is increased so that the patient receives at least 30% to 40% of total calories from fat. Fat emulsion IV infusions given as a nutritional supplement provide a good source of nonprotein calories (see Chapter 40).
If a patient cannot maintain adequate oral intake, enteral nutrition is the preferred route for nutritional support (see Chapter 40).
When the gastrointestinal (GI) tract is not functional, parenteral nutrition is necessary to provide adequate nutrition. The patient treated with parenteral nutrition may need daily HD or CRRT to remove the excess fluid. Concentrated formulas of parenteral nutrition are available to minimize fluid volume.