ABSTRACT
The causes of malnutrition in chronic terminal kidney failure are reviewed in the situation both before and after dialysis, as are the malnutrition rates in both circumstances and their treatment. Malnutrition has a high prevalence in terminal kidney patients, partly as a result of the therapeutic restriction on calories and proteins, but also due to the metabolic reactions typical of the disease and to anorexia. In patients subjected to dialytical methods, certain other mechanisms are added. In addition to malnutrition, there are alterations in the metabolism of calcium, phosphorus and potassium, as well as lipids, thus limiting nutritional therapy's ability to restore the nutritional status to normal. An awareness of energy expenditure in chronic terminal kidney failure and the consequences of malnutrition have led to new challenges in nutritional therapy, both in the dose and quality of the proteins, with a debate raging over the advantages of ketoanalogues, and also in the methods for providing nutrients. The ideal nutritional method for repletion is oral administration, but this can be enhanced with artificial support such as oral supplements, parenteral nutrition during dialysis or such alternatives as enteral nutrition at home in the case of chronic kidney problems in children, using percutaneous endoscopic gastrostomy (PEG), in order to nourish the patients and minimize growth disorders.
Subject(s)
Kidney Failure, Chronic/therapy , Nutritional Physiological Phenomena , Humans , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/metabolism , Nutrition Assessment , Nutrition Disorders/etiology , Nutritional Requirements , Nutritional Support , Parenteral Nutrition , Renal Dialysis , Uremia/etiology , Uremia/metabolismABSTRACT
The use of Enteral Nutrition (EN) in patients with AIDS with a severe nutritional deterioration, is the most common route, not only because of the risk/benefit relation, bur also because this is a physiological route that is easily managed and is profitable in terms of renutrition. However, and given the characteristics of the affected population, whose origin in a large percentage is the addiction to parenteral drugs, implanting this route in these patients is a challenge, as these patients refuse in more than 50% of the cases. Moreover, the risk group is not only a factor in the difficulty for applying the ideal across route, but also the combination of other elements like sex or the disease itself, force the clinical to use more aggressive methods (Parenteral Nutrition) or those that are less profitable nutritionally (Supplements). The negative aspects with regard to tube feeding of these patients are shown, in relation to the factors, and these are compared with the negative aspects of other diagnosis groups (rest of the Hospital).
Subject(s)
Acquired Immunodeficiency Syndrome/physiopathology , Enteral Nutrition , Parenteral Nutrition , Dose-Response Relationship, Drug , Drug Administration Routes , Female , Humans , Informed Consent , Male , Substance-Related Disorders/etiology , Substance-Related Disorders/prevention & controlABSTRACT
A rare case of left atrial dissection as a consequence of infectious endocarditis is reported. We present a patient with infectious endocarditis with involvement of mitral and aortic valves; in whom the trans-esophageal echocardiography was able to visualise the left atrial dissection. This complication has been reported after surgical repair of the mitral valve, but never in infectious endocarditis.
