Fluid and Nutrition Management in AKI

Study Notes

Fluid Management

Once vascular volume and renal perfusion are restored, fluid intake is usually restricted.
Restricted daily fluid intake is calculated by allowing 500 mL for insensible losses (respiration, perspiration, and bowel losses) and adding the amount excreted as urine (or lost in vomitus) during the previous 24 hours.
For example, if a patient with AKI excretes 325 mL of urine in 24 hours, the nurse should allow the patient a fluid intake (including oral and IV fluids) of 825 mL for the next 24 hours.
The nurse should carefully monitor fluid balance by using accurate weight measurements and serum sodium as the primary indicators.

Nutrition Management

Renal insufficiency and the underlying disease process increase the rate of catabolism (the breakdown of body proteins) and decrease the rate of anabolism (body tissue repair).
Patients with AKI need adequate nutrients and calories to prevent catabolism.
Proteins are limited to 0.6 g/kg of body weight per day to minimize the degree of azotemia.
Dietary proteins should be of high biological value (rich in essential amino acids).
Carbohydrates are increased to maintain adequate calorie intake and provide a protein-sparing effect.
Parenteral nutrition providing amino acids, concentrated carbohydrates, and fats may be instituted when the patient cannot consume an adequate diet (e.g., because of nausea and/or vomiting or underlying critical illness).
The disadvantages of parenteral nutrition in the patient with AKI are the high volume of fluid required and the risk for infection through the venous line.

Manifestations of Uremia

Uremia is the accumulation of metabolic wastes, severe fluid overload, hyperkalemia, or metabolic acidosis in a patient with renal failure.
These manifestations indicate a need to replace renal function.

Dialysis

Dialysis uses a semipermeable membrane to remove excess fluid and metabolic waste products in renal failure.
Diffusion of solute molecules across the membrane occurs from an area of higher solute concentration to one of lower concentration, according to the rules of osmosis.

Dialysis and Acute Tubular Necrosis (ATN)

Dialysis can be used to rapidly remove nephrotoxins in ATN.

Dialysis and Anemia

Dialysis compensates for lost renal elimination functions but does not replace lost erythropoietin production, leading to a continuing anemia problem in patients receiving dialysis.

Hemodialysis

Hemodialysis is a procedure where the patient's blood flows through vascular catheters, is pumped through a dialyzer unit, and is then returned to the patient.

Peritoneal Dialysis

Peritoneal dialysis uses the peritoneum surrounding the abdominal cavity as the dialyzing membrane

Continuous Renal Replacement Therapy (CRRT)

CRRT is another form of dialysis that continuously circulates blood through a highly porous hemofilter from artery to vein or from vein to vein.
CRRT may be used to treat AKI.

Description

This quiz focuses on the management of fluid intake and nutritional needs in patients with Acute Kidney Injury (AKI). It covers the calculation of restricted fluid intake based on urine output and the importance of adequate nutrients to prevent protein breakdown. Test your knowledge on these critical aspects of AKI care.