Nutrition and Fluid Management Flashcards

A dialysis patient complains of severe muscle cramps during the last hour of treatment every session. What dietary or fluid management change might help prevent this complication?

Answer: Reduce interdialytic weight gain through dietary sodium restriction to allow a lower ultrafiltration rate

Intradialytic muscle cramps are most commonly caused by aggressive ultrafiltration (removing fluid faster than the plasma refilling rate), particularly when the patient's IDWG is large. Reducing IDWG through dietary sodium restriction reduces the required ultrafiltration rate and volume, decreasing cramp frequency.

A patient on dialysis is prescribed a phosphate binder. When should the patient take this medication to achieve maximum effectiveness?

Answer: With or immediately before each meal and snack

Phosphate binders work by binding dietary phosphorus in the gastrointestinal tract and preventing its absorption. They must be taken with or immediately before meals and snacks to be in the gut at the same time as the ingested phosphorus.

What is the target daily caloric intake recommendation for a hemodialysis patient to maintain weight and prevent catabolism?

Answer: 30–35 kcal/kg/day

KDOQI and most nephrology nutrition guidelines recommend 30–35 kcal/kg of body weight per day for hemodialysis patients to meet energy needs, maintain nitrogen balance, and prevent protein catabolism. Patients under 60 years and those with higher activity levels typically need the higher end of this range.

Why is dietary phosphorus restriction challenging for hemodialysis patients who require adequate protein intake?

Answer: Phosphorus and protein are co-located in many foods, so restricting phosphorus often reduces protein intake below recommended levels

Protein-rich foods (meat, dairy, eggs, legumes) are also naturally high in phosphorus. Restricting dietary phosphorus often leads to reduced protein intake, creating a tension between two essential dietary goals: adequate protein (≥1.0 g/kg/day) and phosphorus restriction (<800–1000 mg/day).

Which of the following is an appropriate fluid intake for a hemodialysis patient who is anuric and has been instructed to limit fluid to 1000 mL/day?

Answer: 2 cups of coffee (480 mL), 1 small bowl of gelatin (120 mL), and 1 glass of water (240 mL)

2 cups of coffee (480 mL) + 1 small bowl of gelatin (120 mL) + 1 glass of water (240 mL) = 840 mL, which is within the 1000 mL daily limit. The other options all exceed 1000 mL significantly.

A hemodialysis patient reports eating the following foods since their last treatment: a banana, tomato soup, a glass of orange juice, and potato chips. Which electrolyte imbalance is most concerning?

Answer: Hyperkalemia from multiple high-potassium foods consumed simultaneously

Bananas, tomatoes, orange juice, and potatoes (in potato chips) are all high-potassium foods. Consuming multiple high-potassium items between treatments significantly increases the risk of dangerous hyperkalemia in an anuric dialysis patient.