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Ask Dr. Y. Vasavada Your Own Question
Dr. Y. Vasavada
Dr. Y. Vasavada, Pediatrician
Category: Paediatrics
Satisfied Customers: 3246
Experience:  M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
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How do you balance the electrolyte intake in a ckd patience

Customer Question

How do you balance the electrolyte intake in a ckd patience at stage 3b? he is well but slight change in diet- taking out red meat and banana, seems to have shown some alteration to his body composistion and growth, in just a couple of weeks.
Can I return him to his normal diet? He is jus 15.
Submitted: 2 years ago.
Category: Paediatrics
Expert:  Dr. Y. Vasavada replied 2 years ago.
Dr. Yogindra Vasavada :

Hello, Sorry about this condition. If there is no edema and additional salt is not added to dishes, he may be allowed half a banana or some other sugary fruit. Cane juice is also good.

Dr. Yogindra Vasavada :

Calories may be added with starchy food and oils.

Dr. Yogindra Vasavada :

Most fruits are rich in potassium which may be toxic for him in excess.

Dr. Yogindra Vasavada :

Puberty changes may also lead to reduced growth in height.

Dr. Yogindra Vasavada :

A dietitian may be involved in planning detailed diet plan.

JACUSTOMER-g15zm0mc- :

thank you for your advise.

JACUSTOMER-g15zm0mc- :

please can you tell me which fruits should be avoided.

JACUSTOMER-g15zm0mc- :

his pottassium reading is 4.7

JACUSTOMER-g15zm0mc- :

is this level high

Dr. Yogindra Vasavada :

All fruits are rich in potassium so any one fruit may be allowed in small portion.


Lighter colored fruits and berries are among the better choices for low potassium fruits. Apples, blackberries, cranberries, grapes, peaches and strawberries are some of the best low potassium feeds that he can eat.

Read More About A Renal Diet here: http://www.renaldiethq.com/low-potassium-foods-create-a-fruit-and-veggie-plate-for-your-next-party/
JACUSTOMER-g15zm0mc- :

thank you again

JACUSTOMER-g15zm0mc- :

I do not add salt to his food. But some food contain salt. He gets crampling as he does alot of athletics. he is an acomplished athlete for his age category.

JACUSTOMER-g15zm0mc- :

how do i know the balance that will help with this cramps he suffers?

JACUSTOMER-g15zm0mc- :

he does not have any signs of odema. I do not cook with salt. Is there a guideline - quantitative/qualitative i could follow for ratio for balanced electrolytes.

JACUSTOMER-g15zm0mc- :

I am also trying to time when he takes protein, due to his athletics. What would you advise?

JACUSTOMER-g15zm0mc- :

before training session I let him eat a little food with protein and when he comes back to eat properly. I discourage the protein drink athletes seem to drink after training. He is saying some are ok as long as they are not whey protein.

JACUSTOMER-g15zm0mc- :

Can he really drink any of these protein drinks at stage 3b ckd?

Dr. Yogindra Vasavada :

Again protein is broken down into urea and so his levels will rise. It is carbs he needs during athletic sessions. Please try vitamin E tablets 100-200 mg for muscle cramps, apart from stretching and massage.

Dr. Yogindra Vasavada :

Foods do contain salt and it is not advisable to try to give additional electrolytes like sodium, potassium but let the variety in diet balance out the ratio naturally.

Dr. Yogindra Vasavada :

Because diet is such an important part of treatment, the dietitian will review a person’s lab work results and recommend a meal plan individualized for their needs. Eating a proper diet can help preserve kidney function and overall health. See link : http://www.davita.com/kidney-disease/overview/stages-of-kidney-disease/stage-3-of-chronic-kidney-disease/e/4749

Dr. Yogindra Vasavada :

Normal upper level of potassium is 5.5 so his level is within normal range.

JACUSTOMER-g15zm0mc- :

thank you again

JACUSTOMER-g15zm0mc- :

can you help me further by advising me on the normal safe level for sodium, magnesium, phosporus as well please?

JACUSTOMER-g15zm0mc- :

He was told by a coach that he suffers cramps because his magnesium is low.

JACUSTOMER-g15zm0mc- :

is it safe for him to use a multi vitamins? if so which would be best?

JACUSTOMER-g15zm0mc- :

He has been put on Alphacalcidol 0.75mg/day

JACUSTOMER-g15zm0mc- :

Amnopidine o.5mg in the morning and Losartan 0.25mg before bed.

JACUSTOMER-g15zm0mc- :

his blood pressure reading at last clinic a week ago is 110/79. is this normal for age 15?

JACUSTOMER-g15zm0mc- :

I mean amlodipine 20mg in the morning and Losartan potassium 25mg at night before bed.

JACUSTOMER-g15zm0mc- :

they said its because his blood pressure could be high sometimes. And his vitamin D is low.

JACUSTOMER-g15zm0mc- :

he looks health and strong. and all of this is confusing for him. He has been quite unhappy lately.

JACUSTOMER-g15zm0mc- :

can you suggest how I can support him emotionally? can integrating natural health theraphy help such as homeopathy or acupuncture help? A friend suggested this.

JACUSTOMER-g15zm0mc- :

She said that some of the natural health practitioners work with doctors to help patients with good results.

Dr. Yogindra Vasavada :

Normal sodium is 135-145 mEg/L, magnesium is 1.6-3.0 mg/dL, potassium is 3-4.5 mg/dL. Different labs may have other slightly different norms. All vitamins may be taken in normal physiologic supplement amounts. Vitamin D could be low due to lack of sunlight exposure over whole body during noon hours. B.P reading mentioned is normal for his age, could be due to good control with drug.

Dr. Yogindra Vasavada :

Please consult a psychiatrist for helping him emotions. Homeopathy or acupuncture may not help any, while deep breathing exercises and naturopathy may be of help.

Dr. Yogindra Vasavada :

Good luck to him.

JACUSTOMER-g15zm0mc- :

Thank you very much.

JACUSTOMER-g15zm0mc- :

What level is safe for phosphorous please?

Dr. Yogindra Vasavada :

Value between 2.4 and 4.1 mg per 100cc considered normal. Above 4.5 is considered unsafe.

JACUSTOMER-g15zm0mc- :

what is the current medical position for early transplant? eg predialysis or at stage 3?

JACUSTOMER-g15zm0mc- :

will this benefit a patient on the longer run?

JACUSTOMER-g15zm0mc- :

how long does a transpant organ last? or when will another transplant be necessary?

JACUSTOMER-g15zm0mc- :

can dialysis be used at early stage eg infrequently/occassionally to ensure safety and reduce waste build up? If possible what are the likely implications for health and quality of life?

Dr. Yogindra Vasavada :

Transplant early is current policy, being beneficial to recipient avoiding damage to other organs due to toxic metabolites. Depends upon availability of donor kidney. If there is no active condition the new organ can last lifetime. Till transplant is done, dialysis at regular and frequent interval is beneficial.

JACUSTOMER-g15zm0mc- :

what do you mean by 'active condition' please?

JACUSTOMER-g15zm0mc- :

Also do you mean transpant can be done at stage 3?

JACUSTOMER-g15zm0mc- :

will this affect level of activity the patient can do? I ask this because he is a National level champion sprinter and full of hope. Will he be abe to continue following recovery if he was to have a transplant?

JACUSTOMER-g15zm0mc- :

will the level of toxic metabolite likely to affect orther organs at stage 3? which organs are at most risk at stage 3?

JACUSTOMER-g15zm0mc- :

sorry I keep asking questions. I know very little and very worried. He is just 15 and a lovely, very fine young man. Loves people and well mannered, level headed and very respectful.

Dr. Y. Vasavada and other Paediatrics Specialists are ready to help you
Customer: replied 2 years ago.

please could you respond to my last set of questions? they are important please.

Many thanks.

Customer: replied 2 years ago.

I have just been told that his Ferritin level is 40.9. What is this measure? Does it mean his is almost aenemic?

Expert:  Dr. Y. Vasavada replied 2 years ago.
Active condition means the disease process which resulted in ckd. This process, if active, can affect donor organ too.
Transplant can be done for all persons fit for surgery. Post transplant, physical activity can be resumed to pre-op level after a short period of rest and recuperation. He can undertake all activities his cardiac and lung function allows.
Liver, intestines, brain, bones and joints etc are affected on long standing ckd. There is no clear-cut level for toxic metabolites, only long exposure is responsible.
Ferritin is protein carrying iron in blood. Normal reading is 12-300 so he is in normal range. Results are considered along with hemoglobin and other parameters. 14-15 gm hemoglobin per 100 ml is normal value.
Customer: replied 2 years ago.

His Heamoglobin reading is 137g/l (13.7 per 100ml?)

Is this ok? Not sure of the conversion. Is my interpretation of the figure correct?

Urea reading is 9.5

What is the normal range please? Is this a toxic metabolite you mentioned? what are the others please?

He is told to aim at 2800calories/day now. And of this between 54-67g of protein and that timing of his protein intake is important. Is this reasonable?

In February measurment : His height is 175.5cm (75th -91st centile)

His weight 67.2kg (75th -91th centile). Are these ok for his age. does it mean he is taller for his age?

He has an athletic figure, not fat or built, but appears leaner in recent weeks complaining his diet change is making him unwell at times. I reduced his protien intake following the news, before getting in touch with you to understand the condition. could this be the reason for these changes in him?

Tiredness - he is tired first thing in the morning for the 1st hour or so now for the past year or so. Is there a likely link to his ckd at stage 3b? in other words does it make the person with stage 3b tired?

Water - He drinks alot of water, about 4/5liters daily and wakes up to a glass of water at night too. frequently visit the toilet.

Is this ok?

Urine colour is lemon like. Is this ok?

Expert:  Dr. Y. Vasavada replied 2 years ago.
Hemoglobin is adequate. Urea is normal upto 40 mg, and height, weight are normal for his age (height determined by genes). Urine color may be due to bile degradation pigment from gut, being excreted by urine. B complex vitamin Riboflav also gives this urine color soon after dose.
Tired feeling soon on waking may be due to calcium deficit, so give calcium supplement also along with vitamin D. Ckd causing tiredness will last whole day.