PC Ng1, YT Er1, Nurfazlin R2, BX Ang2,
1Department of Dietetics, Faculty of Medicine and Health Sciences, University Putra Malaysia.
The current work is a case study report on Acute Kidney Injury (AKI) patient on chronic kidney disease (CKD) who presented with catabolism and protein degradation. Nutrition Assessment: A 66 years old Malay man was admitted for bilateral lower leg pain and referred for nutrition optimization of admission. Patient was diagnosed with acute gouty arthritis, AKI on CKD, anemia, and left knee septic arthritis. Patient was 73kg and 1.7m height with BMI of 25.3 kg/m2. Urea, creatinine, CRP, phosphate and uric acid were high while hemoglobin, total protein and albumin were low. Patient presence with bed sore grade III, look ill and weak. Dietary intake was poor attributed to lethargic and poor appetite, and only able to finish quarter of the hospital meal. Patient was undergoing acute hemodialysis on demand with restriction of fluid (ROF) of 800-1000ml/day.
Nutrition Diagnosis: Inadequate protein-energy intake related to physiological causes increasing nutrient needs due to hemodialysis as evidenced by food history of 41% energy adequacy and 0.52g/kg BW of protein.
Nutrition Intervention: Prescribed energy and protein were 1825 kcal (25kcal/kg ABW) and 73g (1.0g/kg ABW), respectively, aimed to enhance wound healing (bed sores), replace protein loss during dialysis, and minimize further body protein breakdown. Due to limited oral intake, Novasource (1 pack) was prescribed as oral nutrition supplement, in addition to low purine renal soft diet as per preference of patient.
Monitoring & Evaluation
Nutritional Monitoring and Evaluation: On day-15 after nutrition optimization, patient had remarkable improvement on appetite, achieved energy and protein adequacy of 75% and 95% respectively. Renal profile, uric acid and CRP were improved. Patient complied ROF with intake of 500ml/day. Bed sore was improved to grade II and allowed to be discharged on day-21. Conclusion: Dietitian plays a significant role in ensuring the best individualized optimization of nutrition and shorten length of hospitalization.