Figure 1820

Micronutrients in acute renal failure (ARF): water-soluble vitamins. Balance studies on micronutrients (vitamins, trace elements) are not available for ARF. Because of losses associated with renal replacement therapy, requirements for water-soluble vitamins are expected to be increased also in patients with ARF. Malnutrition with depletion of vitamin body stores and associated hypercatabolic underlying disease in ARF can further increase the need for vitamins. Depletion of thiamine (vitamin B1) during continuous hemofiltra-tion and inadequate intake can result in lactic acidosis and heart failure [42]. This figure depicts the evolution of plasma lactate concentration before and after administration of 600 mg thiamine in two patients. Infusion of 600 mg of thiamine reversed the metabolic abnormality within a few hours. An exception to this approach to treatment is ascorbic acid (vitamin C); as a precursor of oxalic acid the intake should be kept below 200 mg per day because any excessive supply may precipitate secondary oxalosis [43]. (From Madl et al. [42]; with permission.)

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