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de Freitas D, Jordaan A, Williams R, Alderdice J, Curwell J, Hurst H, Hutchison A, Brenchley PE, Augustine T, Summers AM. Nutritional Management of Patients Undergoing Surgery following Diagnosis with Encapsulating Peritoneal Sclerosis. Perit Dial Int 2020. [DOI: 10.1177/089686080802800314] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BackgroundEncapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD). Gastrointestinal (GI) symptoms affect appetite and dietary intake. Adequate nutrition is especially important if surgical interventions are required.AimTo investigate the nutritional management of 23 EPS patients that underwent surgical intervention between 1999 and 2005 at Manchester Royal Infirmary, United Kingdom.MethodsEPS was recognized by GI symptoms and diagnostically confirmed by laparotomy, computed tomographic scanning, or biopsy.ResultsMean time on PD was 74 months (interquartile range 42 – 89 months). During the 12 months pre-diagnosis, 65% of the group showed significant weight loss ( p = 0.0001), with 8 patients losing >10% of body weight; 74% of patients experienced significant albumin decrease ( p = 0.001); and 56% of patients experienced GI symptoms during the 6 months pre-diagnosis. Nasogastric (NG) feeding was recommended for 8 patients but continued in only 1. 15 patients (mean albumin 27 g/L) commenced parenteral nutrition (PN); 9 patients recovered, with albumin increasing over the 6-month follow-up. Mean hospital time was 62 days for the group receiving neither NG nor PN, compared with 124.3 for the PN/NG group ( p = 0.04). In patients that died of EPS, albumin continued to fall at 3 months post-diagnosis.ConclusionThere is currently little guidance for nutritional management of EPS. From this study we recommend ( 1 ) a high level of clinical suspicion for EPS, especially if PD patients have weight loss; ( 2 ) PN may be better than NG feeding but further studies into dual enteral nutrition and PN are needed; ( 3 ) aggressive nutritional supplementation pre- and postoperatively; and ( 4 ) dietitians need to recognize the high risk of refeeding syndrome.
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Affiliation(s)
- Declan de Freitas
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Antoinette Jordaan
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Rosalind Williams
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Jane Alderdice
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Janet Curwell
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Helen Hurst
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Alastair Hutchison
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Paul E.C. Brenchley
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Titus Augustine
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
| | - Angela M. Summers
- Department of Renal Research, Manchester Royal Infirmary, Manchester, United Kingdom
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Abstract
Medical nutrition therapy (MNT) plays an important role in management of hyperglycemia in hospitalized patients with diabetes mellitus. The goals of inpatient MNT are to optimize glycemic control, to provide adequate calories to meet metabolic demands, and to create a discharge plan for follow-up care. All patients with and without diabetes should undergo nutrition assessment on admission with subsequent implementation of physiologically sound caloric support. The use of a consistent carbohydrate diabetes meal-planning system has been shown to be effective in facilitating glycemic control in hospitalized patients with diabetes. This system is based on the total amount of carbohydrate offered rather than on specific calorie content at each meal, which facilitates matching the prandial insulin dose to the amount of carbohydrate consumed. In this article, we discuss general guidelines for the implementation of appropriate MNT in hospitalized patients with diabetes.
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Affiliation(s)
- Aidar R. Gosmanov
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Guillermo E. Umpierrez
- Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA
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Eipe N, Tarshis J. A system of classification for the clinical applications of capnography. J Clin Monit Comput 2007; 21:341-4. [DOI: 10.1007/s10877-007-9094-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2007] [Accepted: 09/18/2007] [Indexed: 10/22/2022]
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Bliss DZ. Monitors in nutrition support. Nutr Clin Pract 2005; 19:421-2. [PMID: 16215135 DOI: 10.1177/0115426504019005421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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