Metabolism and Artificial Nutrition in the Critically Ill
The critically ill patient in intensive care may present with serious metabolic alterations caused directly by the illness or secondarily by complications (e.g. infections, organ failure or sepsis) developing within a few hours of hospitaliza tion or in
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G. Guarnieri F. Iscra (Eds)
Metabolism and Artificial Nutrition in the Critically Ill
Series edited by Antonino Gullo
Springer
G. GUARNIERI, MD
Institute of General Clinical Medicine Cattinara Hospital, Trieste - Italy
F. ISCRA,MD Department of Anaesthesia, Intensive Care and Pain Therapy Cattinara Hospital, Trieste - Italy Series of Topics in Anaesthesia and Critical Care edited by A.GULLO,MD
Department of Anaesthesia, Intensive Care and Pain Therapy University of Trieste, Cattinara Hospital, Trieste - Italy
© Springer-Verlag Italia, Milano 1999
ISBN 978-88-470-0042-1 ISBN 978-88-470-2901-9 (eBook) DOI 10.1007/978-88-470-2901-9 Library of Congress Cataloging-in-Publication Data: Applied for This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the Italian Copyright Law in its current version and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the Italian Copyright Law. The use of general descriptive names, registered names, trademarks, etc., in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: the publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Cover design: Simona Colombo, Milan Typesetting: Graphostudio, Milan
SPIN 10697760
Foreword
The critically ill patient in intensive care may present with serious metabolic alterations caused directly by the illness or secondarily by complications (e.g. infections, organ failure or sepsis) developing within a few hours of hospitalization or in the following days. Among the situations which maintain and further trigger rapidly evolving altered metabolism are complex hormonal reactions, particularly those of the hypothalamus-hypophysis-adrenal axis, and abnormal stimulation of the autonomic nervous system. In fact, the sympathetic nervous system is known to cause significant metabolic alterations. For example, a surgery patient afflicted by septic complications may become hypercatabolic and experience significant nitrogen loss; the altered protein metabolism may in turn heavily influence carbohydrate and lipid metabolism as well. Thus, it is apparent that for optimal care of patients with altered metabolic functions, further knowledge is necessary regarding the physiopathology of metabolism and the physiopathological mechanisms, which alter the consumption of principal
