Intravenous nutrition in uremic children with protein-energy malnutrition

Abstract

Intravenous nutrition (IVN) therapy is accepted as useful in patients who are unable to meet nutritional requirements by other means. Patients with gastrointestinal disorders, especially infants, and those with major injuries or stress, have been the principal recipients. Many of these patients suffer loss of body weight, have reduced muscle and adipose tissue mass, and show other signs of protein-energy malnutrition (PEM) (1). Some children with chronic renal failure are malnourished, and it is difficult to provide them with the energy and protein intake necessary to restore them to a satisfactory nutritional state (2). There are few reports on the use of IVN therapy in such patients. Several reports (3, 4) describe the effects of dextrose and essential amino acids (EAA) in adults with acute renal failure following surgery, and have focused on the effectiveness of IVN therapy in decreasing mortality. We have reported (5) results on the treatment of six anuric children treated with IVN therapy and have compared the relative effectiveness of using dextrose with dextrose-and-EAA in suppressing net urea nitrogen production (UNPr), and sparing body protein nitrogen. There are no reports comparing the relative effectiveness of essential amino acids with general amino acids (GAA) providing more nitrogen. The present report: 1) develops a basis for estimating the requirements for energy and for protein of children with PEM and uremia; 2) defines the constraints in meeting these requirements in anuric children; 3) describes a method for comparing the relative efficiency of using EAA and GAA in restoring nutritional well-being to anuric undernourished children; and 4) presents preliminary results from our studies of two children.