Intradialytic Parenteral Nutrition (IDPN) Commercial PN (1) All-in-one admixture (2) Separate bags
Commercial all-in-one Admixture Available Total fluid 1,000 ml. Total calories 950 kcal Total AA 40 g ESPEN guideline2009 ; at least 5 Kcal/kg/day and 0.25 g protein/kg/day for 70 kg patient
Separate Bags Total fluid 1250 ml. Total calorie 1,100 kcal Total protein 50 g • 5-7 g/kg/day • 1-2 g/kg/day • 1-2 g/kg/day • 4 hrs. • 1-1.5 hrs. end HD • 4 hrs. 50 Kg BW 50 Kg BW 50 Kg BW • 50% DW 250 ml. • 10% AA 500 ml. • 20% IVFE 250 ml. • 420 kcal • 150 kcal • 450 kcal ESPEN guideline2009 ; at least 5 Kcal/kg/day and 0.25 g protein/kg/day for 70 kg patient
All-in-one
Separate
Practical aspects of IDPN -Dextrose Administration • Glucose 5 g/kg, not exceed 250 g • Venous chamber • Rate: 2-3 ml/min 3-4 h Monitoring • Monitor blood glucose pre-dialysis, 1 hr, post HD • BS > 300 mg/dL, add RI 0.1-0.3 UI/1 g of CHO • post HD hypoglycemia maybe occurs in lipids - free formula, prevent by oral 30 g CHO intake
Practical aspects of IDPN –Amino Acids Administration • Amino acids (AA) 1-2 g/kg • Venous chamber • Rate: 1-2 h before end of dialysis Monitoring • Calories should be adequate • Prefer renal specific formula, electrolyte-free
Practical aspects of IDPN–Lipid emulsion Administration • Lipids 1-2 g/kg, not exceed 250 g 20% lipids emulsion • Venous chamber • Rate: 1 ml/min Monitoring Contraindications: • Allergic to egg • Hemodynamic instability • Serum triglyceride > 300 mg/dL
Complications Rebound hypoglycemia – CHO snack before end of HD Hyperglycemia – add short acting insulin Fluid overload – Set net UF goal Refeeding syndrome - Adjusted dialysate K - IV vitamin B1 - Go low and go slow (1/3 of target amount in 1st week or 100 ml/ h)
Dialysis unit Division of nephrology Phramongkutklao hospital Bangkok, thailand
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