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Nutrition Interventions for Children with Special Health Care Needs

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Chapter 19 - <strong>Nutrition</strong> <strong>Interventions</strong> <strong>for</strong> Chronic Renal Failure<br />

Assessment Intervention Evaluation/Outcome<br />

If serum Ca is high:<br />

• Decrease Ca intake and temporarily<br />

discontinue or decrease calcitriol<br />

(vitamin D)<br />

If serum Ca is high AND serum P is high:<br />

• Strictly limit dietary P; if on tube<br />

feeding, further decrease P<br />

• Temporarily discontinue calcitriol<br />

• Temporarily give a non-Ca containing P<br />

binder such as Renagel ® (inert binder<br />

made by Genzyme) or aluminum<br />

hydroxide, (if Renagel ® unavailable)<br />

Normal Intact Parathyroid Hormone: ◊<br />

10–65 pg/mL<br />

100, or increasing<br />

Goal <strong>for</strong> ESRD 2-3 times normal level<br />

Normal serum bicarbonate level: ≠<br />

Bicarbonate If serum bicarbonate is low, add or<br />

increase bicarbonate supplement.<br />

18-27 (desired range: ≥22)<br />

Iron Studies, use laboratory normal values ≠<br />

If iron stores are low, increase oral iron<br />

supplements or consider IV iron.<br />

Iron studies:<br />

• Serum Fe: 20-123 ug/dL<br />

• TIBC: 250 – 400 ug/dL<br />

• % Saturation: 15-50%<br />

• Hemoglobin: 11.5-15.5 ug/dL<br />

• Hematocrit > 30% in patient <strong>with</strong> CKD<br />

If hemoglobin is low, recommend increase<br />

in ESA.<br />

• Serum iron<br />

• Total iron binding capacity (TIBC)<br />

• % saturation<br />

• Hemoglobin<br />

• Hematocrit

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