Protein Requirements in Acute Care: NCM, Escott-Stump, & Krause.
Acute encephalopathy:
 Begin at .5 g/kg and
progress as tolerated to
1-1.5 (this is not a
contraindication for
adequate protein
administration). WITH
coma, use 0.5 – 0.6
g/kg, and advance to
1-1.5 g/kg (euvolemic
wt)
 If using parenteral
nutrition, can use 1-1.5
g/kg immediately d/t
avoidance of gut
bacteria
Acute Respiratory Distress
Syndrome
 1.5-2 g/kg of actual
body weight
Age (55+ years)
 1.2-1.5 g/kg to reduce
sarcopenia
Alcoholic Liver Disease
 1.5 g/kg if malnourished
Ascites
 1.5 g/kg
Amputations
 Emphasize proteins of
high biological value,
especially for short-term.
Adhere to wound
protein guidelines.
Bed Rest
 1.2 g/kg
Burns





25 kcal/kg – 30 kcal/kg ----- BEE * 1.3-1.4
1.5-2.0 g/kg protein
Should be 20-25% of
needs
1.2 g/kg of actual body
weight for burns less
than 10%, or for obese
patients
1.5-3 g/kg body weight
depending on burn
extent
Bronchitis
 Normal protein
requirements
Bleeding Disorders
 Ensure a diet rich in
protein, iron, copper, B
vitamins, folid acid, B12
Cancer
 Intake should be high: 11.5 g/kg to maintain,
1.5-2 g/kg to gain
Cardiac Cachexia
 1-1.5 g/kg (increase or
decrease dependent
on renal/hepatic status)
Cardiomyopathies
 1-1.5 g/kg (increase or
decrease dependent
on renal/hepatic status)
Celiac Disease
 1-2 g/kg for adults
Cholestasis (acute)
 0.5-1.2 g/kg
Crohn’s Disease
 WITH strictures/fistulas, 11.5 g/kg
Chronic Kidney Disease
 Stages 1, 2, 3: Limit
protein to 12-15% (0.8-1
g/kg)
 Stage 4, reduce to 10%
(0.6 g/kg, with 50% from
high biological value
sources)
 WITH HEMODIALYSIS 1.2
g/kg
 WITH PERITONEAL
DIALYSIS 1.2-1.3 g/kg,
with peritonitis 1.5 g/kg
until infection subsides
Colostomy
 Increased protein needs
depending on protein
malabsorption,
decrease intake, etc.
COPD
 1.2-1.7 g/kg (high
protein, high-fat, high
calorie diet)
Critical Care (hemo stable)
 For patients with a BMI
of 30-40, 2.0 g/kg of IBW
 Patients with BMI of
greater than 40, at least
2.5 g/kg IBW
 All others: 1.2-2.0 g/kg
actual body weight
Cushing’s Syndrome
 1 g/kg if losses are
excessive
Cystic Fibrosis
 Protein should be 10-35%
of calories
o 4 g/kg for infants
o 3 g/kg for
children
o 2 g/kg for teens
o 1.5 g/kg for
adults
Diabetes Type 1
 To reduce the risk of
nephropathy, keep
protein intake to the
RDA 1 g or less per kg
body weight is
recommended but
should not go below 0.8
g/kg.
Diabetes Type 2
 With normal renal
function, 15-20% of kcals
 With impaired renal
function, control at 0.8-1
g/kg
Respiratory Failure w/ Vent
 1.2-1.5 g/kg (Mechanick
and Chiolero, 2008)
Lung Transplant
 Post-op: 1.3-1.5 g/kg
Fat Malabsorption Disorders
 Increase protein
requirements but do not
use protein bound to fat
(e.g. Eggs with yolk,
meat, etc.)
Fractures
 20-25% kcal needs
Gastric Bypass, Post-op
 1.5-2 g/kg
 Include 60-80 g protein
per day
Gestational Diabetes
 Regular intake. 20% total
kcals. RDA during
pregnancy is 1.1 g/kg or
at leats 56 g protein
Giant Hypertrophic
Gastritis/Menetrier’s Disease
 High-protein diet
comprising 20% of kcal
Gout

Ileostomy
 high-energy, highprotein diet
Refeeding Syndrome
 Start protein slowly – 1.21.5 g/kg goal
Kidney disease, glomerular and
autoimmune
 Stage 1-4 not on
dialysis: 0.6-0.8 g/kg
o GFR < 20 not on
dialysis: 0.3-0.5
g/kg
 Stage 5 HD: >1.2 g/kg
 Stage 5 PD: > 1.2-1.3
g/kg
Surgery
 In general, 1-1.5 g/kg for
wound healing
(dependent on extent
of catabolism and
surgical intervention)
Kidney Transplant, stable
 0.8-1 g/kg
Liver Transplant
 0.8-1 g.kg dry wt in
compensated liver
disease
 1.5-2 g/kg dry wt in
decompensated
Malaria and Parasitic Anemias
 High protein diet
Eat a moderate amount
of protein. Avoid animal
sources of protein (to
reduce purine load)
during flare ups. During
remission, consume a
general diet as
tolerated.
Heart Failure
 “HF patients have
significantly higher
protein needs than
those without HF.”
Malnutrition, general
 25-35%
Multiple Organ Dysfunction
Syndrome
 1.2-1.5 g/kg
Short Bowel Syndrome:
 Start with 1.2-1.5 g/kg
then keep at 20% kcals
Trauma
 1.5-2 g/kg
Renal transplant
 Immediately after, 1.3-2
g/kg , then 0.8-1 in the
chronic phase
Ulcerative Colitis
 May be restricted in
renal disease, but
generally 1-1.5 g/kg as
long as patient is
progressing
UTI

Nephrotic syndrome
 0.8 g/kg
Oncology
 Patients will require highprotein meals.
Hepatitis (acute)
 1-1.2 g/kg
Pancreatitis (acute)
 1.2-1.5 g/kg
Hepatic Cirrhosis
 1-1.5 g/kg of highquality protein
Pancreatitis (chronic)
 1-1.5 g/kg
HIV/AIDS
 2-2.5 g/kg, may increase
with fever and infection
Polycystic kidney disease
Meet RDA unless proteinuria is
excessive
Hyperthyroidism
 Correct negative
nitrogen balance. 1-1.75
g/kg
Sepsis
 1.5-2 g/kg
Underweight with unintentional
weight loss
 15-20%
Restrict ONLY if renal
function is decreased.
Otherwise, use proteins
of high biological value
Whipple’s Disease
 High protein, highcalorie diet
General Guidelines




Protein is usually 0.8-1
g/kg to maintain status
1.25 g/kg mild stress
1.5 g/kg moderate stress
1.75-2 g/kg for severe
stress, trauma, burns