ABSTRACT
Introduction ........................................................................................................................................................................... 1159 Metabolic Response to Stress ............................................................................................................................................... 1159 Nutritional Intervention in Critical Illness ............................................................................................................................ 1161 Determination of Energy Requirements ............................................................................................................................... 1161
Protein Requirements ....................................................................................................................................................... 1162 Carbohydrate Requirements ............................................................................................................................................. 1163 Lipid Requirements .......................................................................................................................................................... 1163 Fluid and Electrolytes ...................................................................................................................................................... 1164 Vitamins, Trace Elements, and Minerals.......................................................................................................................... 1164
Route of Nutrient Delivery ................................................................................................................................................... 1165 Parenteral vs. Enteral Nutrition ........................................................................................................................................ 1165 Low-Flow States .............................................................................................................................................................. 1166
Nutrition Support in Trauma and Burns................................................................................................................................ 1167 Estimating Nutrient Requirements ........................................................................................................................................ 1167
Energy .............................................................................................................................................................................. 1167 Protein .............................................................................................................................................................................. 1168 Glutamine ......................................................................................................................................................................... 1169 Arginine ............................................................................................................................................................................ 1169 Lipid ................................................................................................................................................................................. 1170
Micronutrients ....................................................................................................................................................................... 1171 References ............................................................................................................................................................................. 1172
The human body constantly strives to maintain homeostasis even when challenged by physical, biological, chemical, or psychological forces. Hospitalized patients are routinely exposed to numerous factors that cause metabolic stress, in addition to the stress event that brought them to the intensive care unit (ICU). Some of these stresses include semistarvation, infection, trauma, surgery, and tissue ischemia. Malnutrition in hospitalized patient is surprisingly common.1 Malnutrition in the hospitalized patient occurs via either inadequate caloric delivery or from the hyperdynamic response to the metabolic insult.2 These two pathways resulting in malnutrition exhibit very different metabolic alterations (Table 69.1). The development of malnutrition in critically ill patients can occur very rapidly secondary to the hormonal, neuronal, and other molecular modulators of metabolic response that result in the complex response to stress which is observed.
