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, a 3-in-1 delivery offers advantages over separate lipid, dextrose, and amino acid infusions. In North America, 38% of TPN is administered as 3-in-l admixtures, and the proportion is expected to increase. The constituents of the bag can be tailored to the individual patients (changing) requirements without changing lines and bottles. A central pharmaceutical facility for compounding the admixtures ensures a high standard of sterility and quality control.
No advantage is gained by supplying more calories than the basal metabolic requirement, which is calculated as a function of the patient*s weight, height, age, degree of stress, and degree of activity. An average resting adult with a basal metabolic rate of 2,000 kcal/d will need 3,000 kcal only when in a severe septic state and will rarely, in severe burns, require up to 4,000 kcal.
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