Labs Report And Forms > Nutrit~11

Renal Dietitian:

Nutrition Report For

For the year 2006

Important Laboratory Values and Your Values

What can you do to improve this lab value?

ALBUMIN ~ a protein in your blood

To increase your albumin, try to eat more foods that contain high quality protein. You might try including them more often into your meals and snacks, as well as trying to eat larger portions of them.

High quality protein foods include: • Beef, veal • Pork • Chicken, turkey • Fish • Lamb • Eggs • Cheese 2-3 times / week • Milk, (usually ½ cup /day is OK) yogurt Your target: Jan Feb Mar

Apr

May

Ideal range greater than 35 Jun July Aug Sep Oct

Even though some of these foods are high in phosphorus, it is okay to use them more liberally for now in order to increase your albumin. Make sure you are remembering to take your phosphate binders (i.e.: calcium pills) with these foods. Some people require nutritional supplements (such as “Renal”, “Nepro”, “Ensure”, etc.) to help them get enough protein and calories. However, some of these commercial supplements are high in potassium and phosphorus, which could cause other nutritional problems, so do not take any supplements without checking first with the Doctor or Dietitian. Nov

Dec

POTASSIUM – a mineral that affects muscles, heart rate Foods high in potassium include (usually need to avoid these): • Fruits (such as oranges, bananas, cantaloupes, honeydew melons, dried fruit, oranges, nectarines) • Vegetables (such as baked potatoes, French fries, yams, squash, tomato sauce, tomato paste-(usually a few slices of tomatoes are OK) • Whole grain breads and cereals • Milk and milk products (usually ½ cup/day is OK) • Dried beans and peas (baked beans, pea soup etc) • Chocolate

High potassium in your blood can cause muscle weakness, irregular heart beat and even heart attack. Because these side effects are so serious it is very important that you keep your blood potassium within the normal range. If your potassium is too high, try to avoid foods high in potassium such as those listed. For more details and examples of low potassium foods to choose instead, ask to speak to the Dietitian. Low blood potassium may be caused by recent severe diarrhea or vomiting, by poor appetite, or by over restriction of fruits and vegetables.

Your target: 3.5- 5.0mmol/L Jan

Feb

Mar

Apr

May

Jun

July

Aug

Sep

Oct

Nov

Dec

- For the year 2006

Important Laboratory Values and Your Values

What can you do to improve this lab value?

CALCIUM ~ a mineral that affects your bones

The level of calcium in your blood is affected by: your phosphorus level, the amount of calcium supplement you are taking, and the amount of vitamin D Rocaltrol Calcijex you take.

Calcium supplements such as calcium carbonate, Oscal, and Tums are the main sources of calcium in renal disease since the use of milk and dairy products are usually limited.

If your calcium is too high, these medications will be reviewed. Make sure you are taking all your medications exactly as prescribed.

Your target: 2.10-2.62 mmol/L Jan

Feb

Mar

Apr

May

Jun

July

Aug

Sep

Oct

Nov

Dec

If your calcium is too low, make sure you are remembering to take your calcium supplement as prescribed. The dose will be revised as needed.

PHOSPHORUS~ a mineral that affects bones High phosphorus foods include: • Milk, (usually ½ cup/day is OK) yogurt, ice cream • Cheese 2-3 times per week • Peanut butter –usually 2-3 times per week, nuts and seeds • Organ meats such as liver • Dried beans and peas—pea soup, baked beans, chili/kidney beans • Whole grain breads and cereals—bran, All bran, shredded wheat • Chocolate • Colas, beer Your target: Ideal range: 0.8-1.60 mmol/L Jan

Feb

Mar

Apr

May

Jun

July

Aug

Sep

Oct

Nov

If your phosphorus is too low, you may be restricting your diet too much or just not eating well. If your appetite is poor, ask to speak to the Dietitian.

“If we were dialyzing off real body weight, we’d have a line up out the door of our unit.” The point is when you have a dialysis treatment and lose weight, you are not losing fat, you are taking the built up fluid out of your body. The amount of fluid you should drink between dialysis treatments depends partly on how much urine your kidneys are making, and how active you are. If you notice you are urinating less than you used to, you may need to drink less fluid overall. If your fluid weight gain between treatments is too high, try to decrease the amount of salt or salty foods you are eating and decrease the amount of liquid you are drinking now. If you are diabetic, and you have high blood sugars, these too will make you thirsty. Getting your blood sugars under control will help. If you are losing body weight, you may be carrying around excess or extra fluid, which can cause blood pressure problems. It can be difficult at times to estimate your dry weight, especially if your appetite is up or down. If you are gaining weight, you may experience some cramping or dizziness towards the end of your treatment. At the first sign of cramps, let your nurse know!

“Fluids" include:  All beverages (water, milk, juice, pop, tea, coffee) including any you use to take your pills. • All foods that are liquid in your mouth: Frozen liquids (ice, ice cream, sherbet, Popsicles) Soups, Jello etc. Your fluid gain target: Ideal: urine output + 2-4 cups/day Feb

Mar

Apr

You must also try to reduce or avoid high phosphorus foods, such as those listed.

Dec

WEIGHT ~ Fluid or Actual Weight?

Jan

If your phosphorus is too high, first make sure you are taking your phosphate binders Oscal Calcium carbonate TUMS ES Renagel exactly as prescribed. This means the correct dosage mg with each meal and snack as well as the correct timing—usually with the first bite of food. It is important for this medication to be in your stomach at the same time as the food that contains phosphorus. This is so that the medication can bind to the phosphorus, and prevent much of it from being absorbed into your body

May

Jun

July

Aug

Sep

Oct

Nov

Dec

Your dry or actual target weight: Jan Feb Mar Apr May

Jun

July

Aug

Sep

Oct

Nov

Dec

--For the year 2006

Keeping track of your overall diabetes control can help you determine if your diabetes control is getting better, getting worse, or staying about the same. A blood test called A1c can give you an idea of how well controlled your diabetes is. As blood sugar can change greatly from day to day and even hour to hour this test can help you judge your overall control.

DIABETES CONTROL   

An important goal of treating diabetes is to keep blood sugar levels close to normal at all times. Ideal blood sugar ranges: fasting 4-7 mmol/L 1-2 hours after a meal 7-10mmol/L Follow-regular meal times, take medication as prescribed, do daily physical activity and test your blood sugars to help avoid long-term health problems that can result from diabetes.

Your target: Jan Feb Mar

Apr

May

Ideal range for A1c is less than 7% Jun July Aug Sep Oct Nov

Dec

Sugar is sticky and it sticks to proteins in the body. One of the body proteins is hemoglobin, the part of red blood cells that carries oxygen through the blood. Red blood cells (hemoglobin) normally travel in the bloodstream for about 3 months. During this time the cell picks up sugar from the blood. If blood sugar is often high during that time, the cell will have a large amount of sugar on it. The A1c test measures the amount of sugar attached to red blood cells and can give an average blood sugar level over the previous 3 months.

Random blood sugar-taken just before your dialysis treatment (best range 5-10)

CHOLESTEROL The most concentrated sources are found in  Egg yolks  Fatty meats and Organ meats  Shellfish  Whole milk dairy products  Most animal fats (lard, bacon, butter, cream lard, whole milk)  Some vegetable fats (palm, coconut oils,) have a high amount of saturated fats, which can reduce the clearance of cholesterol by the liver.  Hydrogenated vegetable oils (manufacturers use this process to harden vegetable oils) should be limited. Found in processed foods, baked goods (cakes, cookies, crackers and fried foods), and stick margarines. Your target: Idea cholesterol-< 5.2mmol/L Jan Feb Mar Apr May Jun July Aug Sep Oct Nov Dec

TRIGLYCERIDES 

Ideal body weight, decrease in alcohol intake, decrease in foods high in sugar (ie. desserts, sherbet, ice cream, sugar, honey, regular soft drinks etc.) and fat, regular daily exercise and good diabetes control often help your triglycerides go back to normal.

Your target: Jan

Feb

Ideal <2.3 mmol/L Mar

Apr

May

Jun

July

Aug

Sep

Oct

Nov

Dec

Cholesterol is a natural substance found in our bodies. Our bodies need cholesterol to make hormones, vitamin D and bile and are also part of the walls around our cells. We get cholesterol from our food, but the liver also makes cholesterol to meet our body’s needs. Achieving ideal body weight, quitting smoking, regular exercise and following a low fat meal plan is the best ways to reduce cholesterol levels. * Egg whites do not contain any cholesterol and do not need to be restricted.

Most fat in the body is stored as Triglycerides. An increase in triglycerides has been associated with heart disease, as it can make your blood to clot easier. Some causes of high Triglycerides include:  Being Over weight  High blood pressure  Smoking  Diabetes  Eating a diet high in sugar or sweet foods  Or eating a diet high in fat