Forced high caloric, low protein diet and the treatment of uremia

Abstract

Many of the symptoms of so-called acute uremia are due to overloading the body with salt and fluids. Water restriction and salt deprivation are essential in the treatment of anuria. It is shown that catabolism of the body proteins and urea production can be greatly reduced if the patient's caloric requirements are met with carbohydrates and fat. It is emphasized that the patient should not be allowed to eat as little as he wants but that he should be persuaded or even forced to take the high caloric diet (Borst), hence the term forced high caloric diet. It is demonstrated in several of the cases reported herein that urea excretion (and production) can be reduced to 2 to 5 gm. per twenty-four hours. The patient's serum potassium may be lowered by this diet. Severe intoxication, infections, crushing injuries or necrosis may, however, cause a rapid rise in blood urea and potassium. Some patients were first seen after severe uremia and overhydration had already developed. In those patients dialysis with the artificial kidney or peritoneal dialysis improved their condition so that they were able to take the high caloric diet. Although there is no need to give protein to a patient with acute uremia so long as his caloric requirements are covered, the patient with chronic uremia should be given approximately 20 gm. of protein per day. This is well under the limit of 40 gm. generally advocated in this country, except by Kempner. With rice, butter, sugar, ice cream, potatoes, vegetables and fruits a satisfactory diet is possible. Some suggestions for the diet have been presented. It is the author's impression that patients with chronic, severely impaired kidney function may live longer and more comfortably when using this diet.