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 cannot be overemphasized if the optimum environment for cellular and immunologic function is to be achieved. However, care must be taken when administering iron to the patient who also has low levels of plasma protein, since increased levels of free iron in conjunction with low concentrations of serum transferrin can increase susceptibility to bacterial pathogens.
Cellular Nutritional Support for Perfusion Deficit
Deranged tissue perfusion occurs early in sepsis. Possible causes include altered distribution of cardiac output between systems, constriction of the microvasculature, and a metabolic block in oxygen utilization at the cellular level,73/74 but dysfunction and loss of endothelium are probably the principal causes. The damaged endothelium produces less prostacyclin, which may contribute to the flow^dependent oxygen delivery seen in multiple organ failure.
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