Parenteral nutrition in renal failure.

THE MODERN management of acute oliguric renal failure includes careful control of fluid, electrolyte, vitamin and calorie intake. Such treatment is designed to maintain the constancy of the 'milieu interieure' and prevent excess catabolism. With the advent of treatment using extracorporeal haemodialysis and peritoneal dialysis techniques the survival rate of such patients has been considerably increased. Nevertheless, in patients with prolonged renal failure secondary to trauma, gross sepsis or surgical operation in whom a strict oliguric renal failure regime has to be maintained in addition to repeated haemodialysis, severe wasting and evidence of malnutrition have become increasingly apparent. Lawson et al. (1962) designed a diet containing 1200-1400 calories with 30-40 g firstclass proteins in about 650 ml fluid. Lawson et al. (1962) and Kille & Lawson (1963) have also shown that provision of up to 40 g first-class protein in the diet do-zs not significantly increase the daily increment of blood urea. More recently, Berlyne et al. (1966) have designed a diet for the treatment of acute renal failure containing 2000 calories, 18 g protein and minimal amounts of sodium and potassium in 500 ml fluid. Furthermore, this diet contains adequate amounts of all essential amino acids, except methionine, of which a supplement is given, and also a 3-day rotation in menu. Again, Silva et al. (1964) in the treatment of patients with hypercatabolic acute renal failure with daily haemodialysis permitted 60 g protein, 2500 calories and 1500 ml fluid in the diet. Recently, the use of high liquid glucose concentrates in the management of acute renal failure (Parsons & Fore, 1963) has helped supply more calories in a smaller volume of fluid virtually free of electrolytes but does not compensate for the absence of protein.