Georgetown Week 5

I am now finishing up my transplant (kidney/liver) rotation. The RD for this rotation is both inpatient and outpatient. On Monday, I went to 2 liver transplant evaluations, and on Tuesday 2 kidney evals. The RD made up her own check list/form with questions for each pt considering a transplant.

Today, I attended the selection committee meeting for all of the kidney transplant evals from the prior week. It was very interesting to hear how they decided whether or not to list pts for transplants, and sad to hear when they deny people! The RD said that she has a bigger role at the kidney selection committee meetings than at the liver because she has to deal with wt loss in these pts. The kidney surgeons do not transplant pts with a BMI>40.

As far as inpatients, I have written several notes, and I've noticed that I'm getting quicker!

Here are some tips I picked up:

- in general, albumin doesn't mean anything in liver disease because there is a decreased production of it. A better method for assessing nutritional status in liver pts is wasting in the temporal and collar bone areas.

-I didn't pick this up during MNT - liver pts with ascites are generally given albumin. Normally, albumin is produced in the liver, but with liver disease there is decreased production of albumin (which maintains serum colloidal osmotic pressure), and therefore causes ascites.

-when albumin is low, Ca can be falsely low.
Corrected Calcium for Low Albumin: [(4-albumin level) x 0.8] + serum calcium level

- when there is liver Tx rejection, Alk Phos and Tbili are the first to increase

- Hepatic encephalopathy is treated with lactulose (a laxative) first to remove ammonia. Very rarely will protein restriction be used. If fact, there are no conclusive studies showing that liver pts benefit from low-protein diets.