Re: Presurgery liquid diet and ARF

[Guest guest]

Hi ,

I asked the surgeon that I work with and we were wondering if you know the protein content of the full liquid diet they are on? And are the patients staying hydrated with water in between the protein supplements?

Mannon

From: andreastalbot <andrea@...> Sent: Thursday, July 19, 2012 1:57 PMSubject: Presurgery liquid diet and ARF

Our surgeons have all patients follow a 1-2 week preop liquid diet for patients preparing for weight loss surgery. We have had 2 patients that have gone into acute renal failure when doing the 2 week diet. They already had some kidney issues prior to this. Our surgeon is asking me what we could do to modify this diet, or if they need only do 1 week of liquids? Any suggestions or insights would be appreciated.Thank you, Talbot, RD CDBariatric Medicine Institute

[Guest guest]

Normally the pre-op diets are fairly high in protein (ours is 90-125 g protein, depending on which protein drink brand they select; the number of drinks they are using and the amount of protein in their meal).  For any patients with hx of CKD, I ensure that they limit their protein intake following KDOKI guidelines for the Stage CKD that they have (usually 0.6-0.8 kg/ kg IBW) and for all pts, (but esp those with CKD) it's very important to ensure that they keep well-hydrated throughout the day (64 oz +).

hope this helps,On Fri, Jul 20, 2012 at 12:31 PM, Mannon <elizabeth.mannon@...> wrote:

 

Hi ,

 

I asked the surgeon that I work with and we were wondering if you know the protein content of the full liquid diet they are on? And are the patients staying hydrated with water in between the protein supplements?

 

Mannon

From: andreastalbot <andrea@...>

Sent: Thursday, July 19, 2012 1:57 PM

Subject: Presurgery liquid diet and ARF

 

Our surgeons have all patients follow a 1-2 week preop liquid diet for patients preparing for weight loss surgery. We have had 2 patients that have gone into acute renal failure when doing the 2 week diet. They already had some kidney issues prior to this. Our surgeon is asking me what we could do to modify this diet, or if they need only do 1 week of liquids? Any suggestions or insights would be appreciated.

Thank you, Talbot, RD CDBariatric Medicine Institute

-- LeBrun, MPH,RDSenior Nutritionist Washington Medical Faculty Associates2150 Pennsylvania Ave., NWSte 6-105Washington, DC 20037

202.741.2422clebrun@...

[Guest guest]

Liquid diets need to meet all nutritional needs, using just straight protein drinks off the shelf are not going to meet all nutrition needs (may not have fat, micronutrients, electrolytes, etc). It would be much better to use a product that was meant for a total liquid diet, e.g. HMR, Optifast, etc. Many of the formulas I have seen are low in potassium and patients using these products pre-op have shown up for pre-op labs with low potassium levels. Additionally, patients will need very specific guidelines on how many shakes they MUST have daily to meet nutritional needs and how much water they will need on top of that. May even need to check in on them that they are doing that, I have had several patients that have less than I have told them as they want to lose more weight or just didn’t feel hungry or whatever. Even though it is only two weeks on the diet most of our patients are not healthy/well nourished to begin with so commercially available “protein drink” based diet is not going to optimize their nutritional status nor health prior to surgery. My 2 cents Laschkewitsch RD | Weight Management InstituteLegacy Health | 503.413.8135 From: [mailto: ] On Behalf Of LeBrunSent: Friday, July 20, 2012 10:10 AM Subject: Re: Presurgery liquid diet and ARF Normally the pre-op diets are fairly high in protein (ours is 90-125 g protein, depending on which protein drink brand they select; the number of drinks they are using and the amount of protein in their meal). For any patients with hx of CKD, I ensure that they limit their protein intake following KDOKI guidelines for the Stage CKD that they have (usually 0.6-0.8 kg/ kg IBW) and for all pts, (but esp those with CKD) it's very important to ensure that they keep well-hydrated throughout the day (64 oz +). hope this helps,On Fri, Jul 20, 2012 at 12:31 PM, Mannon <elizabeth.mannon@...> wrote: Hi , I asked the surgeon that I work with and we were wondering if you know the protein content of the full liquid diet they are on? And are the patients staying hydrated with water in between the protein supplements? Mannon From: andreastalbot <andrea@...> Sent: Thursday, July 19, 2012 1:57 PMSubject: Presurgery liquid diet and ARF Our surgeons have all patients follow a 1-2 week preop liquid diet for patients preparing for weight loss surgery. We have had 2 patients that have gone into acute renal failure when doing the 2 week diet. They already had some kidney issues prior to this. Our surgeon is asking me what we could do to modify this diet, or if they need only do 1 week of liquids? Any suggestions or insights would be appreciated.Thank you, Talbot, RD CDBariatric Medicine Institute -- LeBrun, MPH,RDSenior Nutritionist Washington Medical Faculty Associates2150 Pennsylvania Ave., NWSte 6-105Washington, DC 20037202.741.2422clebrun@...

[Guest guest]

Agreed with , important to recommend that they use specific products that you are comfortable with the nutritional balance and to have a specific number of shakes they must have (our norm is 3-4 shakes, depending on the pt need but usually 3 for women, 4 for men).  we normally include a structure meal of lean protein and veggies (specifics on this as well) or 2 protein bars (of course, recommended brands only)

I didn't bother mentioning these details as I assumed most RD's would be putting their own specifics in place...On Fri, Jul 20, 2012 at 2:18 PM, Laschkwitsch, :LPH Weight Management Institute <KLaschke@...> wrote:

 

Liquid diets need to meet all nutritional needs, using just straight protein drinks off the shelf are not going to meet all nutrition needs (may not have fat, micronutrients, electrolytes, etc).  It would be much better to use a product that was meant for a total liquid diet, e.g. HMR, Optifast, etc.  Many of the formulas I have seen are low in potassium and patients using these products pre-op have shown up for pre-op labs with low potassium levels.  Additionally, patients will need very specific guidelines on how many shakes they MUST have daily to meet nutritional needs and how much water they will need on top of that.  May even need to check in on them that they are doing that, I have had several patients that have less than I have told them as they want to lose more weight or just didn’t feel hungry or whatever.  Even though it is only two weeks on the diet most of our patients are not healthy/well nourished to begin with so commercially available “protein drink”  based diet is not going to optimize their nutritional status nor health prior to surgery.  My 2 cents

   Laschkewitsch  RD |  Weight Management Institute

Legacy Health  | 503.413.8135     

  

From: [mailto: ] On Behalf Of LeBrun

Sent: Friday, July 20, 2012 10:10 AM Subject: Re: Presurgery liquid diet and ARF

   Normally the pre-op diets are fairly high in protein (ours is 90-125 g protein, depending on which protein drink brand they select; the number of drinks they are using and the amount of protein in their meal).  

For any patients with hx of CKD, I ensure that they limit their protein intake following KDOKI guidelines for the Stage CKD that they have (usually 0.6-0.8 kg/ kg IBW) and for all pts, (but esp those with CKD) it's very important to ensure that they keep well-hydrated throughout the day (64 oz +).

 hope this helps,

On Fri, Jul 20, 2012 at 12:31 PM, Mannon <elizabeth.mannon@...> wrote: 

Hi , I asked the surgeon that I work with and we were wondering if you know the protein content of the full liquid diet they are on? And are the patients staying hydrated with water in between the protein supplements?

  Mannon From: andreastalbot <andrea@...>

Sent: Thursday, July 19, 2012 1:57 PMSubject: Presurgery liquid diet and ARF

   Our surgeons have all patients follow a 1-2 week preop liquid diet for patients preparing for weight loss surgery. We have had 2 patients that have gone into acute renal failure when doing the 2 week diet. They already had some kidney issues prior to this. Our surgeon is asking me what we could do to modify this diet, or if they need only do 1 week of liquids? Any suggestions or insights would be appreciated.

Thank you, Talbot, RD CDBariatric Medicine Institute 

 -- LeBrun, MPH,RDSenior Nutritionist Washington Medical Faculty Associates

2150 Pennsylvania Ave., NWSte 6-105Washington, DC 20037202.741.2422clebrun@...

-- LeBrun, MPH,RDSenior Nutritionist Washington Medical Faculty Associates2150 Pennsylvania Ave., NWSte 6-105Washington, DC 20037

202.741.2422clebrun@...

[Guest guest]

We recommend a protein drink with at least 20 grams of protein, and they consume 3-4 per day. One of our surgeons did mention she thinks these 2 patients weren’twell hydrated. Thank you, Talbot, RD CDRegistered DietitianBariatric Medicine Institute1046 East 100 SouthSLC, UT 84102www.bmiut.comwww.facebook.com/bmiut Email:andrea@...Direct Phone: 801-869-7113Direct Fax: 801-869-7133 Office Phone: 801-746-2885 NOTICE: This e-mail may contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed.IT may contain Protected Health Information that is privileged and confidential. Protected Health Information may be used or disclosed in accordance with law and you may be subject to penalties under law for improper use or further disclosure of the ProtectedHealth Information in this e-mail. If you are not an intended recipient of this e-mail, you are hereby notified that any unauthorized use, dissemination or copying of this e-mail or the information contained in it or attached to it is strictly prohibited.If you have received this e-mail in error, please delete it and immediately notify the person named above by reply e-mail. Thank you. From: [mailto: ]On Behalf Of MannonSent: Friday, July 20, 2012 10:32 AM Subject: Re: Presurgery liquid diet and ARF Hi , I asked the surgeon that I work with and we were wondering if you know the protein content of the full liquid diet they are on? And are the patients staying hydrated with water in betweenthe protein supplements? Mannon From: andreastalbot <andrea@...> Sent: Thursday, July 19, 2012 1:57 PMSubject: Presurgery liquid diet and ARF Our surgeons have all patients follow a 1-2 week preop liquid diet for patients preparing for weight loss surgery. We have had 2 patients that have gone into acuterenal failure when doing the 2 week diet. They already had some kidney issues prior to this. Our surgeon is asking me what we could do to modify this diet, or if they need only do 1 week of liquids? Any suggestions or insights would be appreciated.Thank you, Talbot, RD CDBariatric Medicine Institute