Parenteral nutrition in the critically ill patient

E. B. Cochran, C. A. Kamper, Stephanie Phelps, R. O. Brown

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

The metabolic alterations, nutritional and metabolic assessment, and nutritional requirements of critically ill patients are discussed, and parenteral nutrition support therapies are reviewed. Physiological alterations in the metabolism of the injured or septic patient are mediated through the interactions of neuroendocrine, cardiovascular, toxic, and starvation responses. These responses cause mobilization of nutritional substrates in an effort to maintain vital organ function and immune defenses. A patient's nutritional status can be determined from anthropometric measurements, creatinine excretion rate, and evaluations of protein stores and immune reserves and function; body weight is a poor indicator. Nitrogen-balance calculations are also useful for determining the adequacy of nutritional intake and the degree of metabolic stress. Early assessments of nutritional status may assist in identifying those patients for whom nutritional support interventions are needed. Nutritional requirements are altered by the metabolic responses to injury and sepsis. Studies suggest that use of nutrient solutions enriched for branched-chain amino acids may enhance nitrogen retention and that energy expenditures in injured or septic patients are only moderately elevated. Most nonprotein calories in parenteral nutrient solutions are provided as glucose, but lipids are an important source of energy in the critically ill patient who has high energy requirements or carbohydrate intolerance; however, clearance of lipids may be decreased. Fluid, electrolyte, and mineral status must be evaluated frequently. Critically ill patients have unique nutritional requirements, and parenteral nutrition support therapies for these patients are being investigated and refined.

Original languageEnglish (US)
Pages (from-to)783-799
Number of pages17
JournalClinical Pharmacy
Volume8
Issue number11
StatePublished - 1989
Externally publishedYes

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Parenteral Nutrition
Critical Illness
Nutritional Requirements
Nutrition Therapy
Nutritional Status
Nitrogen
Lipids
Branched Chain Amino Acids
Nutrition Assessment
Physiological Stress
Nutritional Support
Poisons
Starvation
Energy Metabolism
Electrolytes
Minerals
Creatinine
Sepsis
Body Weight
Glucose

All Science Journal Classification (ASJC) codes

  • Pharmaceutical Science

Cite this

Cochran, E. B., Kamper, C. A., Phelps, S., & Brown, R. O. (1989). Parenteral nutrition in the critically ill patient. Clinical Pharmacy, 8(11), 783-799.

Parenteral nutrition in the critically ill patient. / Cochran, E. B.; Kamper, C. A.; Phelps, Stephanie; Brown, R. O.

In: Clinical Pharmacy, Vol. 8, No. 11, 1989, p. 783-799.

Research output: Contribution to journalReview article

Cochran, EB, Kamper, CA, Phelps, S & Brown, RO 1989, 'Parenteral nutrition in the critically ill patient', Clinical Pharmacy, vol. 8, no. 11, pp. 783-799.
Cochran EB, Kamper CA, Phelps S, Brown RO. Parenteral nutrition in the critically ill patient. Clinical Pharmacy. 1989;8(11):783-799.
Cochran, E. B. ; Kamper, C. A. ; Phelps, Stephanie ; Brown, R. O. / Parenteral nutrition in the critically ill patient. In: Clinical Pharmacy. 1989 ; Vol. 8, No. 11. pp. 783-799.
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