Call the Nephrologist! This patient has an elevated BUN and creatinine, decreased urinary output and is critically ill! Many patients in the icu will have nephrology consulted due to renal function. Most of them, in my experience, will try to assess the nutrition regimen and evaluate if protein provisions are too much. It seems that some nephrologists would be happier if patients were receiving no protein at all. That is somewhat of an exaggeration, but protein does seem to be a low hanging fruit for nephrology to comment on and want to point a finger as a cause of renal dysfunction or continuing cause of kidney failure not improving.
Kidney dysfunction is quite prevalent for many of the patients I see in the icu. It is a result of PVD, diabetes, CAD, polycystic disease, HTN, etc. Southeast Missouri seems to be ground central for chronic diseases caused by excess calories, lack of exercise and poor diet. I evaluate protein needs for patients with kidney disease or injury almost daily. Discussing protein needs with PCP from the renal service is common place. I could also phrase it as “defending protein needs and delivery” is common place.
An amazing tool that I use to assess protein needs for patients with kidney injury come from the Corridendum to the ESPN Practical Guidelines on Clinical Nutrition in the Hospitalized Patient with acute or chronic kidney disease.
.
This is a handy learning tool for everyone. Like I said, I carry it with me in my notebook when I work, I give copies to interns and review with PCPs whenever protein intake is discussed. I find it easier to convey to them that what I am recommending and providing is following best practice guidelines when I have something like this as ammunition, this seems to help satisfy any doubts. I have found, most PCPs do not know very much about nutrition, but most of them want to do what is best practice.
So, whenever you have any questions of if you are overfeeding your patient protein, review these guidelines, they are fairly self explanatory and you can have comfort in knowing this is expert opinion and recommendations.