الفهرس 
Metabolism in Relation to Nutrition in Critically ill PatientsOnly 14 pages are availabe for public view
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Abstract
Nutrition is an important aspect of patient care in acute or chronic critical illness. Appropriate nutritional support during the acute phase of critical illness has the potential to reserve or mitigate adverse consequences of poor nutritional status.
An increasing nutritional deficit during a long ICU stay is associated with increased morbidity (infection rate, wound healing, mechanical ventilation, length of stay, duration of recovery, and costs).
Early nutritional support, provided within 24 hours of injury or intensive care unit (ICU) admission, is a key component in the treatment of critically ill patients and may reduce mortality by 8% to 13%.
The nutritional state of hospitalized patients reflects directly on their clinical course, even that there are greater rates of hospital-acquired diseases and greater risk of clinical complications among malnourished patients, increasing the hospital length of stay (LOS) and reducing quality of life. This leads to high hospital costs because these patients have a greater need for intensive care or specialized services.
Medical and surgical critically ill patients are subjected to stress, infection and impaired organ function, resulting in a hypercatabolic state, leading to metabolic dearangement and malnutrition.
The incidence of malnutrition worsens over time in patients who require prolonged hospitalization.
Critically ill patients are characterized by a number of alterations in carbohydrate, lipid, amino acid, protein and electrolytes metabolism.
It was recognized that ICU patients are unique with varying nutritional requirements during their stay and understanding the issues involved such as tight glycemic control, the effects of over- and underfeeding will ultimately lead to a reduction in morbidity and mortality.
Critically ill patient is performed to classify nutritional status, to identify nutritional risk and to serve as a baseline for monitoring nutrition support adequacy.
The nutritional status of a chronically critically ill patient depends on a part on the nutritional therapy given during acute critical illness and the primary function of the nutritional assessment is to identify pre-existing malnutrition in order to prevent or minimize further loss of body weight, particularly of cell mass, composition and function.
Both enteral nutrition (EN) and parenteral nutrition (PN) are associated with complications, so clear guidelines should be set,these guidelines may lead to more successful enteral feedings, earlier achievement of caloric goals, a lower rate of complications, and it is hoped a better outcome.
The enteral nutrition is the preferred route for delivering of nutritional support in critically ill patients and thought to offer several advantages over the PN; it is more physiological, may help restore or maintain normal gastrointestinal function, and was associated with a reduced risk of infectious complications and cost savings in ICU patients in relative to PN.
The timing for the initiation of EN appears to be a clinically important factor especially, in critically ill patients which was associated with improved outcomes,on the other hand PN has been associated with several complications and detrimental effects on the immune system to the extent that it has been called ”total poisonous nutrition”.
When gastroparesis appears to be the primary problem, parenteral nutrition should be started in a timely manner if the caloric goal cannot be reached or high residuals are present. The clinician should keep in mind that EN can have serious complications, such as aspiration and severe diarrhea.
As regard common side effects, parenteral nutrition is associated with increased infectious and noninfectious complications and increased length of hospital stay, enteral nutrition is associated with more episodes of diarrhea.