ELECTROLYTE ABNORMALITIES IN PATIENTS WITH CHRONIC-RENAL-FAILURE RECEIVING PARENTERAL-NUTRITION

Background and Methods: Chronic renal failure frequently is complicate d by elevations in serum potassium phosphate, and magnesium. Consequen tly parenteral nutrition (PN) solutions used to treat malnourished pat ients with chronic renal failure usually are prepared with little supp lementation of these cations. Four malnourished patients with chronic renal failure and electrolyte abnormalities are reported. Results: Fou r patients developed significant hypophosphatemia 3 to 5 days after st arting PN. Although carbohydrate infused Tia PN initially was not exce ssive (1.4 to 2.0 mg/kg/min), two patients received additional dextros e through continuous ambulatory peritoneal dialysis (CAPD). Two of the four patients received insulin during PN. Outer electrolyte abnormali ties included hypomagnesemia (1 patient) and hypokalemia (3 patients). Conclusions: Malnourished patients with chronic renal failure receivi ng PM are at risk of developing electrolyte abnormalities, particularl y hypophosphatemia. The electrolytes of these patients should be monit ored closely when nutrition support is begun, and supplementation shou ld be star ted as levels begin to fall within a normal range.