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.’
Knowledge of cellular metabolism will increasingly direct research efforts toward more precise targeting of nutritional requirements. Starvation denies the patient the substantial benefit of nutrient intake that can support many important aspects of metabolic function. We now seek nutrients that not only supply requisite energy and protein needs but also influence the aspects of cellular metabolism that affect regional blood flow, endothelial function, and cellular immune function. In the future, cellular nutritional support of early multiple organ failure using lipids such as fish oil may influence the prostaglandin milieu, while use of arginine may synergize these effects by increasing the production of endothelium-derived vasoactive substances. Cellular function in multiple organ failure will never be satisfactory in a starvation state. The challenge is to find the most beneficial nutrients and the most appropriate delivery options.
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