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AMIN-RENAL INSTANT DRINK

AMIN-RENAL INSTANT DRINK. Renal Failure and Malnutrition Reutilization of Nitrogen New concept of non-essential amino acids Modification of vitamins and minerals in renal failure Usage in AMIN-RENAL Clinical Experience in EAA Supplement. 龐振宜 藥師.

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AMIN-RENAL INSTANT DRINK

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  1. AMIN-RENALINSTANT DRINK • Renal Failure and Malnutrition • Reutilization of Nitrogen • New concept of non-essential amino acids • Modification of vitamins and minerals in renal failure • Usage in AMIN-RENAL • Clinical Experience in EAA Supplement 龐振宜 藥師

  2. Factors Contributing to Accelerated Protein Breakdown in ARF • Circulating protease • Elaboration of catabolic hormones • Corticosteroids • Epinephrine • Glucagon • Decreased responsiveness to the anabolic effects of Insulin • Secondary hyperparathyroidism • Inadequate nutrient intake • catabolic effects of dialytic therapy • 6 - 9 g A. A. lost in hemodialysis • 130 - 180 gm / exchage during peritoneal dialysis

  3. Guildlines for protein administration in acute and chronic renal failure • Patients not regularly dialyzed • Dialysis undesirable or contraindicated 14-28 gm EAA /day • Dialysis not contraindicated • GFR≧70ml/min without progression no protein restriction • GFR≧70ml/min with progression 0.55-0.70gm/kg/day • GFR 5-70ml/min 0.55-0.60gm/kg/day • Supplement for each hemodialysis or peritoneal dialysis 40-42gm • Patient regularly dialysis • Hemodialysis 1.2-1.4gm/kg/day • Peritoneal dialysis (CAPD) 1.2-1.5gm/kg/day

  4. 急性腎衰竭的營養治療 EXTENT OF CATABOLISM MILD MODERATE SEVERE Excess urea appearance(above N intake) <5 g 6-12 g >12 g Clinical setting Drug toxicity Elective surgery Severe injury or +/- infection sespsis Mortality 20% 60% >80% Dialysis frequency rare As needed Frequent Route of nutrient Oral Enteral and/or Enteral and/or administration parenteral parenteral Energy recommendations 25 glucose 25-35 glucose + fat 35-45 glucose + fat (Kcal/kg/day) Protein (g/kg/day) 0.6-0.8 EAA 0..8-1.2 EAA + NEAA 1.0-1.5 EAA +NEAA Nutritions used Food, enteral formulas, Enteral Formulas, Glucose, Enteral Formulas, EAA solution 50-70%; fat emulsion 10-20%; Glucose, 50-70% EAA + NEAA Solution fat emulsion, 10-20%; EAA + NEAA Solution Nutrition management of ARF 3rd 1993,Chapter15

  5. Giordano - Giovannetti Theory Glucose Analine Cycle • 尿素氮再利用 • 合成非必須氨基酸 • 高必須氨基酸 • 高熱量

  6. Giordano - Giovannetti DietAmin-Renal Instant Drink • Decrease the rate of urea production • Improve uremic symptoms • Stable or decrease BUN • Increase lean body mass • Stable or decrease eletrolytes

  7. New concept of NEAA in renal failure • Histidine • Hemoglobin decrease progressively • Glycine and analine • As cytoprotective effect to proximal tubule cells • tyrosine • precursor of catecholamines and thyroid hormones • Negative nitrogen balance • Theoretically, it may be beneficial to include NEAAs to maintain N balance and optimize protein synthesis Parenteral Nutrition 2nd, 1993, p567-673

  8. New concept of NEAA in renal failure • Arginine • Intermediate in the urea cycle • improved and more rapid achievement of positive nitrogen balance • improved immunoglobulins J.Y. Pang

  9. Vitamin modification in renal failure • Increase pyridoxine and folic acid • Limited ascorbic acid • Increase soluble vitamins during dialytic procedures • Vitamin A should be withheld as hypervitaminosis A • Vitamin D is withdrown of hypercalcemia supervenes • J.Y. Pang

  10. AMIN-RENAL Instant Drink營養分析表 J.Y. Pang

  11. AMIN-RENAL Instant Drink蛋白質分析 (5gm/serving) Contain 74% Essential Amino Acid in total protein J.Y. Pang

  12. AMIN-RENAL Instant Drink Vitamins and Minerals J.Y. Pang

  13. AMIN-RENALINSTANT DRINK Approximate Osmolality 500mOsm/kg H20 Reconstituted pH Approx. 5-7 Calories:Nitrogen Ratio Approx. 312:1 Caloric density at standard dilution 1.3 Kcal/cc Essential amino acids content 74% of protein J.Y. Pang

  14. 杯中倒進150ml冷水 (流體量受限者120ml) 加入一包Amin-Renal 立即服用或冷藏 加入600ml冷水於攪拌器中 加入四包Amin-renal 低速攪拌約30秒 置於適當容器準備管餵 AMIN-RENALINSTANT DRINK 口服 管餵 J.Y. Pang

  15. AMIN-RENALINSTANT DRINK 用量 • 完全以Amin-Renal 為營養來源 每天6-8 包 • 最低有效劑量每天4包, 可供應50%所須 蛋白質及能量 • 嚴重代謝障礙須大量服用Amin-Renal時, 得額外攝取非蛋白質能量,以維持氮平衡 • 長期服用Amin-Renal 不須額外補充Vitamins and Minerals, 但須偵測調整 J.Y. Pang

  16. AMIN-RENALINSTANT DRINKEAA supplements with a low protein diet • Nitrogen balance • Increase total serum protein, Serum albumin, serum complement and serum transferrin • Slow nerve conducting velocity and reduced muscle membrane potential • correct abmormalities in plasma and muscle amino acids levels J.Y. Pang

  17. AMIN-RENALINSTANT DRINKCorrect of Uremic Cellular Injury Phase I : 1g protein/kg/day HD: 6hrs/3x/wk Phase II: 1g protein/kg/day HD: 6hrs/2x/wk Phase III: 0.5g protein/kg/day EAA supplement HD: 6hrs/2x/wk J.Y. Pang Am. J. kidney Disease Vol V,No5,May 1985

  18. AMIN-RENALINSTANT DRINK(口服, 管餵 )有效降低 BUN 值 維持體內電解質平衡 新一代 Essential Amino Acids Formula • 每日攝取4包AMIN-RENAL 時 • 額外攝取必須氨基酸量2.5克/包 x 4 =10 克 EAA • 可合成身體蛋白質量10 克 EAA / 40% = 25 克 • (蛋白質組成 EAA/NEAA為 40:60) • Positive Nitrogen 量25 克/ 6.25 = 4 克 • 體內合成蛋白質時被利用的總氮量4 克 - (2.5 克 x 4 包Amin-Renal /6.25) = 2.4 克 • 預估50公斤體重病患BUN減少量 • 2.4克氮 / 35公升體總水量 =6.8 mg/dl

  19. AMIN-RENALINSTANT DRINK(口服, 管餵 ) 腎衰竭氨基酸配方 • 降低急慢性腎衰竭BUN • 回復或減低高血鉀 • 回復或減低上升的血清磷及鎂 • 蛋白質合成改善細胞代謝平衡 • 促進ARF腎功能的恢復 • 降低ARF死亡率

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