ABSTRACT
The term micronutrient includes vitamins and trace elements. Vitamins are substances not generally synthesized by the body and are cofactors for various enzymes. Trace elements are metals present in minute quantities that act as cofactors or as part of the structure of specic enzymes. Trace metals (selenium, zinc, manganese, iron, and copper) and 13 essential vitamins (4 fat soluble and 9 water soluble) are essential in stabilizing or catalyzing homeostatic reactions in the human organism.1-4
Absorption and Interactions ...........................................................................................................124 Vitamins ....................................................................................................................................124 Trace Elements .......................................................................................................................... 130
Effect of the Inammatory Response on Micronutrient Status ...................................................... 131 Vitamins .................................................................................................................................... 131 Trace Elements .......................................................................................................................... 131
Toxicity of Micronutients............................................................................................................... 132 Vitamins .................................................................................................................................... 132 Trace Elements .......................................................................................................................... 132
Role of Micronutrients in the Treatment of the Oxidative Stress State in Critical Illness ............. 132 Introduction ............................................................................................................................... 132 Oxidative Stress State ................................................................................................................ 132 Endogenous Antioxidant Activity ............................................................................................. 133 Micronutrient Replacement in Critical Illness .......................................................................... 133 Summary of Recent Recommendations and Review of Data ................................................... 133
Summary ........................................................................................................................................ 134 Recommendations for Supplementation ........................................................................................ 134
Who Needs Supplementation .................................................................................................... 134 Timing ....................................................................................................................................... 134 Route ......................................................................................................................................... 135 Dose........................................................................................................................................... 135 Monitoring................................................................................................................................. 135
Conclusion ..................................................................................................................................... 136 References ...................................................................................................................................... 136
ciency will be addressed individually, except in the tables listed. Otherwise, only the most crucial deciency states dealing with critical illness will be discussed. The second half of this chapter will be dedicated to past and current studies highlighting the increasingly important role antioxidant therapy plays in critically ill patients during the acute inammatory and oxidative stress states.
