Giving ProSource to renal failure patients

[detroitdano]

I've had numerous patients on ProSource, pretty much all of our tube-fed patients seem to end up with it. But today brought a new scenario for me and I wanted a little input.

Septic patient who was on 50% Venti mask and was on Glucerna 1.5 was switched over to BiPAP for poor oxygenation. Not sure what it's like everywhere else, but at my hospital BiPAP contraindicates tube feedings. That's not my question, just an FYI.

Anyways, she was on 30 gm BID ProSource which was not discontinued along with tube feeds. It was my understanding before today that ProSource was just a backup to missed protein in the tube feed formula. Her renal function plummeted overnight and I drew a lytes in the afternoon and her BUN came back 144 (FWIW, creatinine was 2.8).

My very basic thinking told me ProSource is protein which would elevate her BUN. Why not stop it then if she's not getting tube feeds and has this worsening renal function?

I asked another RN on my floor and she said they'll continue the ProSource since it increases your albumin which helps with all that lovely stuff albumin does for your body. Makes sense, but still, couldn't we just give albumin itself if we needed the benefits of it and try to lower her BUN in the process?

I didn't look into it much further, but just based on my basic understanding I would think ProSource would be discontinued for such a high BUN. Does it not affect your BUN that much, or it a benefits/risk thing? Something else I'm missing here?

Discuss!

[dorimar, BSN, RN]

Hello Detroid,

I agree with your thinking. I would have definitely held the Tube Feed while administering BIiPAP mask. Also, I would have questioned the ProSource with this patients renal function.

This is why night shift nursing is so difficult. You have to try to figure all the stuff you need to clarify and call the doc about before 9pm and yet report goes until 8pm and you have littel time to see your patient an figure it all out.

These are questions I would have laid in the doctor's lap, even if it was after 9pm. Better to error on the side of caution. I will get yelled at for calling a doc at 10PM any day over being sued for aspiration or renal failure...

[tutored]

What about a simple albumin infusion for a short time, even if just to suspend medication in the bloodstream and maintain osmolarity? Did this patient need the calories from the prosource?