Guidelines for the Dosage and Application of the Intravenous Provision of Nutrient Substances in Patients with Renal Failure

Abstract

Guidelines for the requirement-oriented provision of water and electrolytes as basic therapy in acute and chronic renal insufficiency are generally agreed upon. However, we must also consider, in the context of coverage of energy-requirements, the uremic changes in the endocrine system and other physiological control systems which may have an undesirable influence on metabolism. According to HENNEMANN (5), renal failure is associated with a severe sympathetic disturbance, with diminished norepinephrine content in the synaptic vesicles. On the other hand, cyclic AMP in the serum is increased. One should also note the increase in immunoreactive insulin and glucagon, with simultaneous slight elevation in blood glucose. In the hypercatabolic type of acute and chronic renal failure, the glucagon:insulin quotient is probably displaced in the direction of glucagon; this should result in a stimulation of gluconeogenesis from amino-acids, at the cost of protein synthesis (9). Moreover, the augmented renal losses of amino-acids (secondary to renal failure) must be added to the calculation. This necessarily results in far-reaching disturbances in protein metabolism during uremic intoxication.