1/20. anorexia nervosa with severe liver dysfunction and subsequent critical complications.A twenty-year-old woman with anorexia nervosa (body mass index=11) suffered from severe liver dysfunction (aspartate aminotransferase 5,000 IU/l, alanine aminotransferase 3,980 IU/l, prothrombin time 32%), hypoglycemia (serum glucose 27 mg/dl), and pancreatic dysfunction (amylase 820 IU/l, lipase 558 IU/l). She fell into a depressive state with irritability, which was not improved by intravenous glucose. Despite treatment with plasmapheresis for the liver dysfunction, she subsequently developed pulmonary edema, acute renal failure, gastrointestinal bleeding, and disseminated intravascular coagulation. Hemodialysis, mechanical ventilation and drug therapy including prednisolone, prostaglandin E1, and branched-chain amino acid, improved her critical condition. In this case, malnutrition may have been the cause for the liver dysfunction and subsequent complications.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
2/20. Perforated duodenal ulcer associated with ovarian hyperstimulation syndrome: Case Report.ovarian hyperstimulation syndrome (OHSS) remains the most serious medical complication of controlled ovarian stimulation. An unusual case of perforated duodenal ulcer following critical OHSS is presented. A 29 year old nulligravid woman with polycystic ovarian syndrome underwent her first attempt at in-vitro fertilization. She was admitted to the hospital with critical OHSS and subsequently found to have a perforated posterior duodenal ulcer. She underwent exploratory laparotomy, antrectomy and gastrojejunostomy. Pathological analysis of her gastric antrum confirmed chronic gastritis and helicobacter pylori. She required prolonged assisted ventilation, vasopressor support, multiple i.v. antibiotics, blood product replacement and nutritional support. The patient was hospitalized for a total of 47 days and then transferred to a rehabilitation facility for an additional 30 days before being discharged to home. In this critically ill patient with OHSS, severe stress associated with invasive monitoring and multiple medical therapies in the intensive care unit as well as H. pylori infection appear to be the most probable causative factors of her perforated viscus. Prompt recognition of potential complications and proper medical intervention are essential in the management of patients with OHSS. Avoidance strategies are still needed.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
3/20. A method for the measurement of glucose oxidation using the constant infusion of stable isotope.We developed a method to measure the oxidation of glucose using the primed constant infusion of [U-13C] glucose in critically ill patients fed by total parenteral nutrition. The results obtained from the isotopic method were compared to those from indirect calorimetry in the critically ill patients. A patient with esophageal carcinoma was used for the preliminary study. The study was performed on the third postoperative day, assuming severely stressed state. Priming doses of NaH13CO3 at a dosage of 0.32 mg/kg and D-[U-13C] glucose at a dosage of 0.32 mg/kg were injected. D-[U-13C] glucose was then infused at an infusion rate of 0.004 mg/kg/min. It was revealed that the time required for an isotopic plateau was approximately 45 min in plasma glucose and 120 min in an expired air in highly stressed state. Isotopic measurement and indirect calorimetry were performed simultaneously pre- and postoperatively on three patients who underwent surgery for esophageal carcinoma. Increased fat oxidation was obtained by the isotopic method, whereas indirect calorimetry indicated nonprotein RQ above 1.0. Isotopic measurement offered a useful information that cannot be obtained from indirect calorimetry concerning the energy metabolism in the critical illness. Thus our method for the measurement of glucose oxidation is both simple and useful in investigating the energy metabolism in critically ill patients.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
4/20. Special feature: exploring the benefits and myths of enteral feeding in the critically ill.patients in the intensive care unit setting have been nutritionally deprived for various reasons. Many patients who are critically ill cannot absorb nourishment by traditional routes. Enteral feeding should be considered for all patients who cannot meet caloric needs. There are many benefits to enteral feeding such as decreased infection, rapid wound healing, and decreased length of stay and mortality. Many critical care nurses subscribe to myths for not feeding their patients. The myths for not feeding critically ill patients involve gut motility, feeding residuals, and patient positioning. There is significant evidence both to support nutrition as integral to recovery from a critical illness and to suggest that enteral feeding is efficient and effective at providing nutrition.- - - - - - - - - - ranking = 3keywords = nutrition (Clic here for more details about this article) |
5/20. Toxicity of food Drug and Cosmetic Blue No. 1 dye in critically ill patients.food Drug and Cosmetic Blue No. 1 dye (FD&C Blue No. 1) is commonly added to enteral nutrition formulations in order to facilitate the detection of gastric aspirate in tracheal secretions of critically ill patients. However, reports of systemic blue dye absorption and associated adverse outcomes are emerging. We report two cases of abnormal systemic absorption of FD&C Blue No. 1 in critically ill patients who subsequently died of refractory shock and metabolic acidosis. risk factors and mechanisms of FD&C Blue No. 1 toxicity are discussed, and alternate approaches to gastric aspiration detection in critically ill patients are considered.- - - - - - - - - - ranking = 1keywords = nutrition (Clic here for more details about this article) |
6/20. The metabolic response to stress: a case of complex nutrition support management.The ICU patient with burns, neurotrauma, sepsis, or major surgery typifies the classic hypermetabolic patient. These patients have increased energy and nutrient needs as a result of their injuries and require early nutrition support. Although these patients are likely to benefit from nutritional intervention, the complexity of the stress response to injury and subsequent changes in nutrient metabolism make the design and implementation of nutrition care challenging. This article reviews the pathophysiology of common hypermetabolic conditions and provides strategies to manage the complications associated with nutrition support.- - - - - - - - - - ranking = 8keywords = nutrition (Clic here for more details about this article) |
7/20. Meeting the nutritional needs of the bariatric patient in acute care.Meeting the nutritional needs of the bariatric (severely obese) patient in acute and critical care can be a challenge. Assessment of metabolic needs and energy expenditure is imperative to calculate nutritional needs. Achieving adequate nutrition is a result of multidisciplinary team collaboration, with the nurse providing important data for the dietitian to calculate needs. This article reviews aspects of nutritional support of the bariatric patient including assessment, planning, implementation, and evaluation.- - - - - - - - - - ranking = 8keywords = nutrition (Clic here for more details about this article) |
8/20. nutritional support in the critically injured.nutritional support must be an integral part of the management of trauma victims. This article compares the stress response, a maladaptive response, and starvation, an adaptive process, examines the clinical research regarding total parenteral nutrition and total enteral nutrition, provides an evidence-based approach to initiating nutritional support in critically injured patients, and discusses considerations in selecting nutritional formulas.- - - - - - - - - - ranking = 4keywords = nutrition (Clic here for more details about this article) |
9/20. Contemporary strategies for the prevention of stress-related mucosal bleeding.PURPOSE: The purpose of this review is to describe the clinical presentation and pathophysiology of stress-related mucosal bleeding and review the strategies to prevent bleeding. SUMMARY: The mortality rate associated with clinically significant stress-related mucosal bleeding is high. Respiratory failure requiring mechanical ventilation for more than 48 hours and coagulopathy are two strong, independent risk factors for bleeding. Splanchnic hypoperfusion is the underlying etiology of stress-related mucosal injury and bleeding. Mucosal damage typically manifests as multiple superficial lesions without perforation, and bleeding often originates in superficial capillaries after the patient is admitted to the intensive care unit. Providing adequate visceral perfusion is vital to preventing bleeding. Gastrointestinal function should be taken into consideration before using enteral nutrition, and enteral nutrition should not be the sole stress ulcer prophylactic therapy. Acid-suppression therapy should be used to raise the intragastric pH above 3.5 because it reduces the incidence of stress-related mucosal bleeding. proton pump inhibitors are at least as effective, and may be more effective than histamine H2-receptor antagonists in achieving this pH goal and preventing bleeding. CONCLUSION: The key to reducing mortality from stress-related bleeding in critically ill patients is to prevent mucosal damage. Providing adequate visceral perfusion and acid-suppression therapy can reduce the risk of stress-related mucosal damage and bleeding.- - - - - - - - - - ranking = 2keywords = nutrition (Clic here for more details about this article) |
10/20. The use of tegaserod in critically ill patients with impaired gastric motility.Studies have shown that early enteral nutrition in critically ill patients reduces the incidence of morbidity and death. Nonetheless, intolerance to gastric enteral nutrition is common in these patients as a result of gastroparesis. The use of prokinetic agents such as metoclopramide, domperidone, cisapride, and erythromycin can improve gastric emptying, but these agents are not without deleterious adverse effects. Tegaserod, a selective serotonin type 4 receptor partial agonist, was recently approved for treatment of women with irritable bowel syndrome. On the basis of tegaserod's mechanism of action, it was hypothesized that tegaserod may accelerate the return of gastric function in intensive care unit patients with gastroparesis. It would thus provide an additional agent for the management of gastroparesis with a more favorable safety profile. We present 3 case reports of the successful use of tegaserod in intensive care unit patients with impaired gastric motility. To our knowledge, the use of tegaserod in this setting has not been reported or studied previously.- - - - - - - - - - ranking = 2keywords = nutrition (Clic here for more details about this article) |
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