Nephrology Unit, Shaare Zedek Medical Center, PO Box 3235, Jerusalem 91031, Israel.
Arch Gerontol Geriatr. 2012 Jan-Feb;54(1):228-31. doi: 10.1016/j.archger.2011.03.007. Epub 2011 Apr 13.
The purpose was to check the influence of enteric nutrition on BUN in very elderly patients. Clinical data on patients in whom enteral feeding was initiated after a period of poor oral intake are presented. Patients with evidence of volume depletion, signs of gastrointestinal bleeding or medicines that might increase BUN were excluded. We evaluated 5 patients (mean age 90.6 ± 3 years) who were admitted to geriatric department. Mean plasma creatinine concentration was 1.17 ± 0.34 mg/dl, but mean estimated glomerular filtration rate (eGFR) was 41.6 ± 17 ml/min/1.73 m(2). Enteral nutrition was administered at a dose of mean 1,580 ± 53ml/day at mean duration of 9 ± 4 days. Mean BUN was 52 ± 30 mg/dl at baseline, increases to 109 ± 9.4 mg/dl after initiation of feeding and decreased to 82 ± 1.1mg/dl with reduction of dose of enteral nutrition. Our conclusion was that initiation of enteral feeding may induce a large accumulation of nitrogen waste products in elderly patients in whom serum creatinine is an unreliable indicator of kidney function. High protein intake should be considered in differential diagnosis of disproportionate high increment of BUN.
目的在于检查肠内营养对高龄患者 BUN 的影响。本文呈现了经一段时间经口摄入不佳后开始肠内喂养患者的临床数据。排除了有容量不足证据、胃肠道出血迹象或可能增加 BUN 的药物的患者。我们评估了 5 名（平均年龄 90.6 ± 3 岁）入住老年科的患者。平均血浆肌酐浓度为 1.17 ± 0.34mg/dl，但平均估算肾小球滤过率（eGFR）为 41.6 ± 17ml/min/1.73m(2)。肠内营养以平均 1580 ± 53ml/天的剂量给予，平均持续 9 ± 4 天。起始喂养前平均 BUN 为 52 ± 30mg/dl，喂养后增加至 109 ± 9.4mg/dl，减少肠内营养剂量后降至 82 ± 1.1mg/dl。我们的结论是，血清肌酐不是肾功能的可靠指标，在启动肠内喂养时，高龄患者可能会导致大量氮废物的蓄积。在 BUN 不成比例升高的鉴别诊断中应考虑高蛋白摄入。
