Parenteral nutrition kidney

Nutritional Effects Due to the Presence of the Maillard Products. Many physiological or antinutritional effects have been attributed to the Maillard products. Specific effects have been attributed to the Amadori products deoxyfructosylphenylalanine (a model substance not likely to be present in large quantities in foods) appears to depress the rate of protein synthesis in chicks (32) and to partially inhibit in vitro and in vivo the absorption of tryptophan in rats (33). The compound e-deoxyfructosyllysine inhibits the intestinal absorption of threonine, proline, and glycine and induces cytomegaly of the tubular cells of the rat kidneys (34) as does lysinoalanine. In parenteral nutrition the infusion of the various Amadori compounds formed during sterilization of the amino acid mixture with glucose is associated with milk dehydration in infants and excessive excretion of zinc and other trace metals in both infants and adults (35,36,37). 

Copper occurs in many foods particularly good sources are liver, kidney, shellfish, nuts, raisins, and dried legumes. Copper deficiency due to diet is rare except in malnutrition and in children with chronic diarrhea. It occurs in total parenteral nutrition with fluids low in copper, particularly following intestinal resection and in patients who receive large amounts of zinc to improve wound healing or for management of sickle cell anemia. Copper is often removed from prepared foods to increase their shelf life. 

Foulks CJ. An evidence-based evaluation of intradialytic parenteral nutrition. Am J Kidney Dis 1999 33 186-192. 

The normative lithium requirement of humans is assessed at < 100 tg per day, as all German test subjects of both genders took in between < 100 and > 3500 tg Li per day without showing deficiency symptoms, even at the lowest intake amounts (Anke etal. 1995, 1997b). However, deficiency symptoms may occur in dialysis patients, in kidney failure and in parenteral nutrition. Based on intake data in different countries, Schrauzer (2002) suggested a provisional recommended dietary allowance (RDA) of 1 mg Li per day for a 70-kg adult. Compared with the above intake data, therapeutic effectiveness in the treatment of manic-depressive disorders is achieved at doses of 140 to 280 mg Li per day - about 100 to 300 times higher than RDA (Schou... 

Metabolic acidosis developed in two patients receiving total parenteral nutrition associated with the concurrent use of triamterene or amiloride. The cases were complicated by a number of pathological and other factors, but it was suggested that the major reason for the acidosis was because the diuretics prevented the kidneys from responding normally to the acid load. Caution is advised during concurrent use. ... 

Aluminium toxicity has been studied retrospectively in 36 hospitalized adults who had a serum creatinine concentration at least 1.5 times greater than on the first day of parenteral nutrition 12 were undergoing hemodialysis [8 ]. Mean aluminium exposure was 3.8 pg/kg/day in the 36 patients, of whom 29 had safe calculated exposures (5 pg/kg/day) and also significantly higher serum creatinine concentrations than those with high aluminium exposure. The authors suggested that most patients with acute kidney disease who require parenteral nutrition do not receive excessive exposure to aluminium. 

Brown RO, Morgan LM, Bhattacharya SK, Johnson PL, Minard G, Dickerson RN. Potential aluminum exposure from parenteral nutrition in patients with acute kidney injury. Ann Pharmacother 2008 42(10) 1410-5. 

Pure nutritional cobalamin deficiency being extremely rare, most other causes of cobalamin deficiency require lifelong treatment with parenteral, mainly intramuscular, administration of cobalamin. Both cyano- and hydroxocobalamin are being used for this purpose. Unbound cobalamin in the circulation cannot be retained by the kidney, and is excreted. As hydroxocobalamin binds more strongly to plasma proteins other than the specific cobalamin binders, it is better retained by the body and thus more effective. After replenishment of the cobalamin stores by about five doses of at least 250 p-g hydroxocobalamin on alternate days, cobalamin homeostasis can be maintained by bimonthly injections of 1000 pg cobalamin. 

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