Pediatrics Flashcards
What is protein-energy wasting in pediatrics?
Refers to malnutrition secondary to CKD defined by disease-associated alterations in addition to low PO intake.
Must have:
*Two or more clinical factors (alb <3.8, reduced body mass, reduced muscle mass, decreased appetite) AND positive indication of poor growth (ht-for-age less than 3rd percentile, poor growth velocity, decline in ht-for-age greater than 10% between measurements)
What are things to know about energy requirements for pediatrics with CKD?
*Lack of evidence to suggest kids with CKD have greater requirements than healthy children or that growth improves with intakes < prescribed amounts
*Soy formulas not typically recommended due to aluminum content
*Foods commonly found in the home will likely have better acceptance than ONS.
*Infants and toddlers who have been tube fed may experience difficult transition to oral feeding.
*Energy absorbed from dialysate glucose should not be included in the total energy intake unless kid is gaining wt rapidly despite lower than avg PO and enteral intakes
*IDPN is okay for peds
What are things to know about protein requirements for pediatrics with CKD?
CKD: avoid excess protein to limit uremia and phos
Dialysis: nitrogen balance = DPI, add 0.1 g/kg/day to replace HD losses
Research is limited on use of nPCR
How is normalized protein equivalent of nitrogen appearance (PNA) calculated in pediatrics?
Total nitrogen appearance x 6.25g protein/g nitrogen
What are things to know about fat requirements for pediatrics with CKD?
1-3 yrs: 30-40% total kcal
4-18 yrs: 25-35% total kcal
Avoid excessive intake especially trans fats
Dyslipidemia is equally attributable to impaired lipid metabolism rather than dietary excess–reserve TLC to kids with high chol/LDL or those who are overweight, severe TG (>500)
Carnitine depletion may contribute to hyperTG due to role in transportation of long-chain fatty acids across mitochondria to be oxidized in production of cellular energy.
What are things to know about vitamins in pediatrics?
Little is known–go with DRI
Only supplement with evidence of suboptimal intake
Hyperhomocysteinemia–assoc. w/ low folate
Hypervit. A–can contribute to hypercalcemia
Vit K–not cleared by dialysis or kidney but deficiency is possible and may affect bone health
What are the normal total calcium ranges for kids with CKD?
0-5 months: 8.7-11.3 mg/dL
6-12 months 8.7-11.0 mg/dL
1-5 yr: 9.4-10.8 mg/dL
6-12 yr: 9.4-10.3 mg/dL
13-20 yr: 8.8-10.2 mg/dL
What are the normal phos ranges for kids with CKD?
0-5 months: 5.2-8.4 mg/dL
6-12 months: 5.0-7.8 mg/dL
1-5 years: 4.5-6.5 mg/dL
6-12 years: 3.6-5.8 mg/dL
13-20 years: 2.3-4.5 mg/dL
What are the normal ionized calcium ranges for kids with CKD?
0-5 months: 1.22-1.40 mmol/L
6-12 months: 1.2-1.4 mmol/L
1-5 years: 1.22-1.32 mmol/L
6-12 years: 1.15-1.32 mmol/L
13-20 years: 1.12-1.30 mmol/L
What are the phos DRIs for kids with CKD?
What are the recommended max amounts of phos for kids if PTH is high and phos is normal?
0-6 months: 100 mg/d
7-12 months: 275 mg/day
1-3 years: 460 mg/day
4-8 years: 500 mg/day
9-18 years: 1250 mg/day
What are the recommended max amounts of phos for kids if PTH and phos are high?
0-6 months: 80 mg/d
7-12 months: 220 mg/day
1-3 years: 370 mg/day
4-8 years: 400 mg/day
9-18 years: 1000 mg/day
What are the DRIs and recommended max calcium amounts for kids with CKD?
0-6 months: 210 mg/day (420 mg/day)
7-12 months: 270 mg/day (540 mg/day)
1-3 years: 500 mg/day (1000 mg/day)
4-8 years: 1000 mg/day (1600 mg/day)
9-18 years: 1300 mg/day (2500 mg/day)
What are things to know about MBD in pediatrics?
Calcium-based phos binders are preferred (no calcium citrate)
Sevelamer okay to use and can be used to pretreat formula but may affect other nutrients
Only supplement phos below 2.0 mg/dL
Don’t take iron at same time as calcium b/c they compete for binding sites.
Optimal PTH level is unknown
Kids s/p transplant should avoid direct sun due to immunosuppressive therapy and risk of skin carcinoma and hypervit. D.
What are things to know about sodium in kids with CKD?
Polyuria and salt-wasting syndromes may need sodium and free water suppls. to promote growth and avoid chronic depletion
Restriction should be considered for kids with HTN (>95th percentile) or preHTN (90-95 percentile)
Reflects water balance and not total body sodium–not indicator of need to limit sodium intake
Consider supplements for infants on PD due to high UF requirements/kg BW
What are the adequate amounts of sodium for kids with CKD?
0-6 months: 110 mg/d
7-12 months: 370 mg/day
1-3 years: 800 mg/day
4-8 years: 1000 mg/day
9-13 years: 1000 mg/day
14-18 years: 1500 mg/day
