Abstract: . . .      (g/day/1.73 m2)   NS Amino acid and protein losses with this prescription represent between 10-12% of total delivered nutritional proteins Glutamine loss accounted for approximately 20% of total AA loss Some Amino Acid preparations for TPN are deficient in glutamine   Nutritional losses  Replacement fluid vs dialysate  Maxvold et al, Crit Care Med 2000;28(4):1161-5   24 Hr Nitrogen Balance:   CVVH vs CVVHD  (Maxvold et al, Crit Care Med 2000 ;28(4):1161-5 )   24 hr Nitrogen Balance     (g/day/1.73 m2)   NS   ? Glucose . . .
. . .  and the child is at risk for deficiency   Trace elements and Vitamins   Vitamin A may be retained and cause toxicity manifested as hypercalemia Vitamin K is not cleared but in patients with MOSF on antibiotics will become deficient and will need supplementation Vitamin D may be depressed if pt had pre existing renal insufficiency Vitamin E levels are depressed in MOSF but are not cleared   So what do we do?   1. Keep glucose under control Use insulin freely (yes some of the insulin is cleared ?? How much?) If using ACD-A citrate the D stands for Dextrose (I missed that but I was educated by a NICU nurse) . . .
. . .  gluconeogenesis and protein degradation hormonal Insulin resistance, diminished protein synthesis metabolic acidosis   Nutritional Factors in ARF   Dialysis losses protein losses in PD amino acid losses in PCRRT Diminished nutrient utilization Inadequate supplementation failure to measure needs side effects of nutrition supplementation   Dialysis Losses   Peritoneal Dialysis albumin, protein, immunoglobulin and amino acid losses Katz et al, J Peds   IgG levels in Infants  (Katz et al, J Peds 117:258-261, 1990)   9301 3725   . . .
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