Impaired glucose tolerance: impaired glucose tolerance in patients with uremia, similar to glucose tolerance in patients with mild diabetes, but this change is not sensitive to exogenous insulin. The mechanism of impaired glucose tolerance may be as follows: the decrease of insulin secretion; uremia due to increased secretion of the basic level of growth hormone, strengthen the antagonistic effect of insulin; insulin receptor binding and disorder, make insulin action is weakened; the liver glycogen synthase activity reduced disorders caused liver glycogen synthesis. It is thought that the major cause of these changes may be the toxic effects of urea, creatinine and middle molecular weight toxicants.
Negative nitrogen balance: negative nitrogen balance can cause wasting, cachexia and hypoalbuminemia. Hypoalbuminemia is one of the important causes of renal edema. Factors that cause negative nitrogen balance: patient intake of protein restricted or because of anorexia, nausea and vomiting caused by reduced protein intake; certain substances such as methyl guanidine can make tissue protein catabolism strengthen; combined infection can lead to protein catabolism; protein loss caused by bleeding; lost a certain amount with the urine protein.
When suffer uremia, a large number of urea can be infiltrated into the intestinal cavity by the blood. Intestinal bacteria can decompose urea and release ammonia. When ammonia is transported to the liver by the blood, urea can be synthesized, and non essential amino acids can also be synthesized. The latter is beneficial to the organism. So some people think that uremia protein intake may be lower than the normal people, even less than 20g per day to maintain nitrogen balance, but must be given a higher nutritional value of protein, which contains essential nutrients rich amino acid.
In order to maintain nitrogen balance in uremic patients, protein intake should be no significant difference between normal people; and that, in order to reduce the pursuit of pure blood urea nitrogen and over limit the intake of protein, the protein itself consumes too much.
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