AMIN-RENAL INSTANT DRINK
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Transcript of AMIN-RENAL INSTANT DRINK
AMIN-RENALAMIN-RENAL INSTANT DRINKINSTANT DRINK
Renal Failure and MalnutritionRenal Failure and Malnutrition Reutilization of NitrogenReutilization of Nitrogen New concept of non-essential amino acidsNew concept of non-essential amino acids Modification of vitamins and minerals in renal Modification of vitamins and minerals in renal
failurefailure Usage in AMIN-RENALUsage in AMIN-RENAL Clinical Experience in EAA SupplementClinical Experience in EAA Supplement
龐振宜 藥師
Factors Contributing to Accelerated Protein Factors Contributing to Accelerated Protein Breakdown in ARFBreakdown in ARF
Circulating proteaseCirculating protease Elaboration of catabolic hormonesElaboration of catabolic hormones
CorticosteroidsCorticosteroids EpinephrineEpinephrine GlucagonGlucagon
Decreased responsiveness to the anabolic effects of Decreased responsiveness to the anabolic effects of InsulinInsulin
Secondary hyperparathyroidismSecondary hyperparathyroidism Inadequate nutrient intakeInadequate nutrient intake catabolic effects of dialytic therapycatabolic effects of dialytic therapy
6 - 9 g A. A. lost in hemodialysis6 - 9 g A. A. lost in hemodialysis 130 - 180 gm / exchage during peritoneal dialysis130 - 180 gm / exchage during peritoneal dialysis
Guildlines for protein administration in acute Guildlines for protein administration in acute and chronic renal failureand chronic renal failure
Patients not regularly dialyzedPatients not regularly dialyzed Dialysis undesirable or contraindicated 14-28 gm EAA /day
Dialysis not contraindicatedDialysis not contraindicatedGFR 70ml/min without progression ≧ no protein restrictionGFR 70ml/min with progression≧ 0.55-0.70gm/kg/dayGFR 5-70ml/min 0.55-0.60gm/kg/daySupplement for each hemodialysis or peritoneal dialysis 40-42gm
Patient regularly dialysisPatient regularly dialysisHemodialysis 1.2-1.4gm/kg/dayPeritoneal dialysis (CAPD) 1.2-1.5gm/kg/day
急性腎衰竭的營養治療急性腎衰竭的營養治療 EXTENT OF CATABOLISM MILD MODERATEEXTENT OF CATABOLISM MILD MODERATE SEVERE SEVERE
Excess urea appearanceExcess urea appearance(above N intake)(above N intake)
<5 g<5 g 6-12 g >12 g 6-12 g >12 g
Clinical settingClinical setting Drug toxicity Elective surgery Severe injury or Drug toxicity Elective surgery Severe injury or +/- infection sespsis+/- infection sespsis Mortality 20% 60%Mortality 20% 60% >80% >80%
Dialysis frequency rareDialysis frequency rare As needed As needed Frequent Frequent
Route of nutrient Oral Enteral and/or Enteral and/or Route of nutrient Oral Enteral and/or Enteral and/or administration parenteral parenteraladministration parenteral parenteral Energy recommendations 25 glucose 25-35 glucose + fatEnergy recommendations 25 glucose 25-35 glucose + fat 35-45 glucose + fat 35-45 glucose + fat (Kcal/kg/day) (Kcal/kg/day)
Protein (g/kg/day) 0.6-0.8 EAA 0..8-1.2 EAA + NEAA 1.0-1.5 EAA +NEAAProtein (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, Nutritions used Food, enteral formulas, Enteral Formulas, Glucose, Enteral Formulas, EAA solution 50-70%; fat emulsion 10-20%; Glucose, 50-70% EAA solution 50-70%; fat emulsion 10-20%; Glucose, 50-70% EAA + NEAA Solution fat emulsion, 10-20%;EAA + NEAA Solution fat emulsion, 10-20%; EAA + NEAA SolutionEAA + NEAA SolutionNutrition management of ARF 3rd 1993,Chapter15
高必須氨基酸高必須氨基酸高熱量高熱量
尿素氮再利用尿素氮再利用 合成非必須氨基合成非必須氨基酸酸
Giordano - Giovannetti TheoryGiordano - Giovannetti TheoryGlucose Analine Cycle
Giordano - Giovannetti DietGiordano - Giovannetti DietAmin-Renal Instant DrinkAmin-Renal Instant Drink
Decrease the rate of urea productionDecrease the rate of urea production Improve uremic symptomsImprove uremic symptoms Stable or decrease BUNStable or decrease BUN Increase lean body massIncrease lean body mass Stable or decrease eletrolytesStable or decrease eletrolytes
New concept of NEAA in renal failureNew concept of NEAA in renal failureHistidineHistidine
Hemoglobin decrease progressivelyHemoglobin decrease progressivelyGlycine and analine Glycine and analine
As cytoprotective effect to proximal tubule cellsAs cytoprotective effect to proximal tubule cells tyrosine tyrosine
precursor of catecholamines and thyroid hormones precursor of catecholamines and thyroid hormones Negative nitrogen balanceNegative nitrogen balance
Theoretically, it may be beneficial to include NEAAs tTheoretically, it may be beneficial to include NEAAs to maintain N balance and optimize protein synthesiso maintain N balance and optimize protein synthesis
Parenteral Nutrition 2nd, 1993, p567-673
New concept of NEAA in renal failureNew concept of NEAA in renal failure
ArginineArginine– Intermediate in the urea cycleIntermediate in the urea cycle– improved and more rapid achievement of improved and more rapid achievement of
positive nitrogen balancepositive nitrogen balance– improved immunoglobulinsimproved immunoglobulins
J.Y. Pang
Vitamin modification in renal failureVitamin modification in renal failure
Increase pyridoxine and folic acidIncrease pyridoxine and folic acid Limited ascorbic acidLimited ascorbic acid Increase soluble vitamins during dialytic proceIncrease soluble vitamins during dialytic proce
duresdures Vitamin A should be withheld as hypervitaminVitamin A should be withheld as hypervitamin
osis Aosis A Vitamin D is withdrown of hypercalcemia supVitamin D is withdrown of hypercalcemia sup
erveneservenes
J.Y. Pang
AMIN-RENAL AMIN-RENAL Instant DrinkInstant Drink營養分析表營養分析表Per serving % Calories
Serving Size 50 gmCalories 250 KcalCarbohydrate Maltodextrin Sucrose
31 gm 25 gm 5.5 gm
51
Fat Vegetable Oil
11 gm 41
Protein 5 gm 8
J.Y. Pang
AMIN-RENAL AMIN-RENAL Instant DrinkInstant Drink
蛋白質分析 蛋白質分析 (5gm/serving)(5gm/serving)Lactalbumin Hydrolysate 2.50 gmL-Leucine 0.35 gmL-Isoleucine 0.22 gmL-Valine 0.25 gmL-Methionine 0.35 gmL-Lysine 0.26 gmL-Phenylalanine 0.35 gmL-Tryptophan 0.08 gmL-threonine 0.16 gmL-Histidine 0.08 gmL-Arginine 0.39 gm
J.Y. PangContain 74% Essential Amino Acid in total proteinContain 74% Essential Amino Acid in total protein
Vitamins Per Serving %USRDA
Minerals Per Serving %USRDA
Vit. A 625 I.U. 12.5 Sodium 98mg **Vit. D 50 I.U. 12.5 Potassium 70mg **Vit. E 8 I.U. 25.0 Chloride 115mg **Vit. K 10 ug ** Calcium 150mg 15.0Vit. C 15 mg 25.0 Phosphorus 90mg 9.0Vit. B1 0.37mg 25.0 Magnesium 50mg 12.5Vit. B2 0.43mg 25.0 Iodine 18.8ug 12.5Vit. B6 1.0mg 50.0 Manganese 0.62mg **Vit. B12 1.5ug 25.0 Copper 0.25mg 12.5Folic Acid 100 ug 25.0 Zinc 1.88mg 12.5Niacin 5mg 25.0 Iron 2.25mg 12.5Biotin 75ug 25.0 Selenium 25ug **Pantothenic Acid 2.5mg 25.0 Chromium 18.8ug **Choline 75mg ** Molybdenum 18.8ug **
AMIN-RENAL AMIN-RENAL Instant DrinkInstant Drink
Vitamins and MineralsVitamins and Minerals
J.Y. Pang
AMIN-RENALAMIN-RENAL INSTANT DRINKINSTANT DRINK
Approximate Osmolality 500mOsm/kg HApproximate Osmolality 500mOsm/kg H2200Reconstituted pH Approx. 5-7Reconstituted pH Approx. 5-7Calories:Nitrogen Ratio Approx. 312:1Calories:Nitrogen Ratio Approx. 312:1Caloric density at standard dilution 1.3 Kcal/ccCaloric density at standard dilution 1.3 Kcal/ccEssential amino acids content 74% of proteinEssential amino acids content 74% of protein
J.Y. Pang
AMIN-RENALAMIN-RENAL INSTANT DRINKINSTANT DRINK
杯中倒進杯中倒進 150ml150ml 冷水冷水 (( 流體量受限者流體量受限者 120m120m
l)l) 加入一包加入一包 Amin-RenalAmin-Renal 立即服用或冷藏立即服用或冷藏
口服口服 加入加入 600ml600ml 冷水於攪拌冷水於攪拌器中器中 加入四包加入四包 Amin-renalAmin-renal 低速攪拌約低速攪拌約 3030 秒秒 置於適當容器準備管餵置於適當容器準備管餵
管餵管餵
J.Y. Pang
AMIN-RENALAMIN-RENAL INSTANT INSTANT DRINKDRINK
完全以完全以 Amin-Renal Amin-Renal 為營養來源為營養來源 每天每天 6-8 6-8 包包 最低有效劑量每天最低有效劑量每天 44 包包 , , 可供應可供應 50%50% 所須所須 蛋白質及能量蛋白質及能量 嚴重代謝障礙須大量服用嚴重代謝障礙須大量服用 Amin-RenalAmin-Renal 時時 ,, 得額外攝取非蛋白質能量得額外攝取非蛋白質能量 ,, 以維持氮平衡以維持氮平衡 長期服用長期服用 Amin-Renal Amin-Renal 不須額外補充不須額外補充 Vitamins aVitamins and Minerals, nd Minerals, 但須偵測調整但須偵測調整
J.Y. Pang
用量用量
AMIN-RENALAMIN-RENAL INSTANT DRINKINSTANT DRINK EAA supplements with a low protein dietEAA supplements with a low protein diet
J.Y. Pang
Nitrogen balanceNitrogen balance Increase total serum protein, Serum albumiIncrease total serum protein, Serum albumi
n, serum complement and serum transferrinn, serum complement and serum transferrin Slow nerve conducting velocity and reduced Slow nerve conducting velocity and reduced
muscle membrane potentialmuscle membrane potential correct abmormalities in plasma and muscle correct abmormalities in plasma and muscle
amino acids levelsamino acids levels
AMIN-RENALAMIN-RENAL INSTANT DRINKINSTANT DRINKCorrect of Uremic Cellular InjuryCorrect of Uremic Cellular Injury
J.Y. Pang
Patient Phase 1 Phase II Phase III1 93.6 75.6 92.62 89.6 80.3 88.13 86.1 81.0 93.44 92.3 78.1 91.85 97.0 77.9 90.26 90.7 78.0 73.3
Mean 91.6 78.5 88.2SD 3.7 1.9 7.6
Phase I :Phase I : 1g protein/kg/day1g protein/kg/day HD: 6hrs/3x/wkHD: 6hrs/3x/wkPhase II:Phase II: 1g protein/kg/day1g protein/kg/day HD: 6hrs/2x/wkHD: 6hrs/2x/wkPhase III:Phase III: 0.5g protein/kg/day0.5g protein/kg/day EAA supplementEAA supplement HD: 6hrs/2x/wkHD: 6hrs/2x/wk
Am. J. kidney Disease Vol V,No5,May 1985
AMIN-RENALAMIN-RENAL INSTANT DRINK( 口服 , 管餵 )有效降低 BUN 值 維持體內電解質平衡每日攝取 4包 AMIN-RENAL 時
額外攝取必須氨基酸量 2.52.5 克克 // 包 包 x 4 =10 x 4 =10 克 克 EAAEAA可合成身體蛋白質量 10 10 克 克 EAA / 40% = 25 EAA / 40% = 25 克克 (( 蛋白質組成 蛋白質組成 EAA/NEAAEAA/NEAA 為 為 40:60)40:60)Positive Nitrogen 量 25 25 克克 / 6.25 = 4 / 6.25 = 4 克克體內合成蛋白質時被利用的總氮量 4 4 克 克 - (2.5 - (2.5 克 克 x 4 x 4 包包Amin-Renal /6.25) = 2.4 Amin-Renal /6.25) = 2.4 克克預估 50公斤體重病患 BUN 減少量
2.42.4 克氮 克氮 / 35/ 35 公升體總水量 公升體總水量 == 6.8 mg/dl6.8 mg/dl
新一代Essential
Amino AcidsFormula
AMIN-RENALAMIN-RENAL INSTANT 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