In the fluid-restricted patient, the high caloric density of fat allows TPN to be delivered in volumes of 1 L without resorting to high osmolarity dextrose infusions. Full consideration of the individual patient and his or her needs can be aided by a case management approach.’
The proportion of carbohydrate, amino acid, and fat is dictated by a few basic principles. Dextrose provided at a rate of 7 mg/kg/min, once glycogen stores have been repleted, engenders a lipogenic response. This is evidenced by a respiratory quotient of greater than 1, development of fatty liver, and excess carbon dioxide production. An infusion […]
Furthermore, direct delivery of glutamine, the small bowel enterocytes preferred oxidative fuel, can preserve the barrier function of the mucosa and reduce endotoxin leakage into the circulation. Short-chain fatty acids are the preferred substrate of the colonic enterocyte, and their intracolonic infusion has improved diversion colitis in humans. When total parenteral nutrition (TPN) is indicated, […]
The reduction in lactic acidosis following an infusion of a fish oil structured lipid in an endotoxemia model (see Fig 1) is also relevant in this context as it implies improved oxygen delivery, and presumably flow, to the tissues. The data suggest that if an increase in flow can be induced, some compensation of the […]
During sepsis, cardiac output often rises, with between 17% and 28% going to the splanchnic region. The oxygen extraction of the liver, however, increases dramatically to over 40% of total body oxygen consumption, compared to 30% in injured but nonseptic patients. With the high oxygen extraction required, the hepatocyte may be vulnerable to ischemic injury; […]
The trace elements and essential minerals, including zinc, copper, chromium, selenium, and iron, are required for important coenzymes in nucleic acid metabolism and for protein synthesis. Zinc deficiency has been associated with impaired antibody-mediated responses to T-lympho-cytes, impaired natural killer cell activity, defective chemo-taxis of leukocytes, and delayed wound healing. The importance of these factors […]
Glutamine is the preferred oxidative fuel for the small bowel endothelium, and enteral administration of a glutamine-supplemented diet has been shown to preserve mucosal cellularity, to promote recovery, and to improve nitrogen balance in animal studies. Finally, branched-chain amino acids are used as energy sources during the acute phase of injury. When given alone or […]
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