Figure 1817

Impairment of lipolysis and elimination of artificial lipid emulsions in acute renal failure (ARF). Fat particles of artificial fat emulsions for parenteral nutrition are degraded as endogenous very low-density lipoprotein is. Thus, the nutritional consequence of the impaired lipolysis in ARF is delayed elimination of intravenously infused lipid emulsions [33, 34]. The increase in plasma triglycerides during infusion of a lipid emulsion is doubled in patients with ARF (N=7) as compared with healthy subjects (N=6). The clearance of fat emulsions is reduced by more than 50% in ARF. The impairment of lipolysis in ARF cannot be bypassed by using medium-chain triglycerides (MCT); the elimination of fat emulsions containing long chain triglycerides (LCT) or MCT is equally retarded in ARF [34]. Nevertheless, the oxydation of free fatty acid released from triglycerides is not inpaired in patients with ARF [36]. (From Druml et al. [34]; with permission.)

Electrolytes and micronutrients

Hyperkalemia

Hyperphosphatemia

Decreased renal elimination

Decreased renal elimination

Increased release during catabolism

Increased release from bone

2.38 mEq/g nitrogen

Increased release during catabolism:

0.36 mEq/g glycogen

2 mmol/g nitrogen

Decreased cellular uptake/

Decreased cellular uptake/utilization

increased release

and/or increased release from cells

Metabolic acidosis: 0.6 mmol/L rise/0.1

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