Cover

Nutrition in Intensive Care Medicine: Beyond Physiology

Editor(s): Singer P. (Petah Tikva) 
Table of Contents
Vol. 105, 2013
Section title: Requirements, Routes of Administration and Prescription
Singer P (ed): Nutrition in Intensive Care Medicine: Beyond Physiology. World Rev Nutr Diet. Basel, Karger, 2013, vol 105, pp 12–20
(DOI:10.1159/000341545)

Protein Metabolism and Requirements

Biolo G.
Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy

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Article / Publication Details

First-Page Preview
Abstract of Requirements, Routes of Administration and Prescription

Published online: 10/12/2012
Cover Date: 2013

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 0

ISBN: 978-3-318-02227-8 (Print)
eISBN: 978-3-318-02228-5 (Online)

Abstract

Skeletal muscle adaptation to critical illness includes insulin resistance, accelerated proteolysis, and increased release of glutamine and the other amino acids. Such amino acid efflux from skeletal muscle provides precursors for protein synthesis and energy fuel to the liver and to the rapidly dividing cells of the intestinal mucosa and the immune system. From these adaptation mechanisms, severe muscle wasting, glutamine depletion, and hyperglycemia, with increased patient morbidity and mortality, may ensue. Protein/amino acid nutrition, through either enteral or parenteral routes, plays a pivotal role in treatment of metabolic abnormalities in critical illness. In contrast to energy requirement, which can be accurately assessed by indirect calorimetry, methods to determine individual protein/amino acid needs are not currently available. In critical illness, a decreased ability of protein/amino acid intake to promote body protein synthesis is defined as anabolic resistance. This abnormality leads to increased protein/amino acid requirement and relative inefficiency of nutritional interventions. In addition to stress mediators, immobility and physical inactivity are key determinants of anabolic resistance. The development of mobility protocols in the intensive care unit should be encouraged to enhance the efficacy of nutrition. In critical illness, protein/amino acid requirement has been defined as the intake level associated with the lowest rate of catabolism. The optimal protein-sparing effects in patients receiving adequate energy are achieved when protein/amino acids are administered at rates between 1.3 and 1.5 g/kg/day. Extra glutamine supplementation is required in conditions of severe systemic inflammatory response. Protein requirement increases during hypocaloric feeding and in patients with acute renal failure on continuous renal replacement therapy. Evidence suggests that receiving adequate protein/amino acid intake may be more important than achieving the target energy requirement in order to maintain nitrogen balance and, possibly, improve patient outcome.


Article / Publication Details

First-Page Preview
Abstract of Requirements, Routes of Administration and Prescription

Published online: 10/12/2012
Cover Date: 2013

Number of Print Pages: 9
Number of Figures: 2
Number of Tables: 0

ISBN: 978-3-318-02227-8 (Print)
eISBN: 978-3-318-02228-5 (Online)


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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