Question

Type 2 DM, ESRD 2 diabetic nephropathy –End stage Renal Disease; third month on dialysis

•Labs:

–K+ 5.8mEq/L; BUN 74mg/dL (blood urea N); Creat 5.51mg/dL (creatinine); Albumin 3.6g/dL; FBS 289mg/dL (Fasting blood sugar); HbgA1c 9.4%; Phosphorus 5.3mEq/L

•Rx (diagnosis):

–2 PhosLo/meal, 2000IU cholecalciferol, Metformin, Lipitor

•Adhering to phosphate binders.

•Diet hx (history):

– 60 gm protein (10%), 350gm CHO (65%), 61gm fat (25%) 2200 kcal, about 3gm K, 1000ml fluid: pt (patient) states she is okay with fluid restriction, but is overwhelmed with dialysis and new diet modifications; not sure what she is allowed to eat anymore; familiar with diet for diabetes but not renal; good appetite.

•Ht. 5’6”, Wt. 160, BMI 25

Answer 1

End stage renal disease is the last and serious stage of kidney disease in which the patient undergoes weeklyot twice weekly hemodialysis as the kidneys are not functioning. Patients need dialysis to eliminate the toxic and waste products from the body . Along with dialysis modification in the patient's diet is done . The modifications in the diet are :-

- patient is restricted to foods containing potassium like banana ,green leafy vegetables etc

- patient is restricted to foods containing sodium like canned foods, pickles ,aged food products etc

- fluid restriction to 1000ml

- patient is restricted to foods containing phosphorus, calcium like dairy products

- less protein intake but of high biological value like fish ,egg etc

- calories from simple carbohydrates like rice Poha etc

- encouraging fruits and vegetables which are allowed like strawberry's, raspberrie, red grapes etc

- fat in the form of olive oil , home made butter etc but in less volume