Metabolism and Artificial Nutrition in the Critically Ill

  • G. Guarnieri
  • F. Iscra

Part of the Topics in Anaesthesia and Critical Care book series (TIACC)

Table of contents

  1. Front Matter
    Pages I-XIV
  2. Basics and Methods

    1. Front Matter
      Pages 1-1
    2. S. J. S. Ryde
      Pages 11-27
    3. J. P. Flatt
      Pages 29-45
  3. Local and Systemic Effects on Metabolism

    1. Front Matter
      Pages 59-59
    2. R. Chiolero, F. Pralong, R. Gaillard
      Pages 61-70
    3. G. L. Carlson, R. A. Little
      Pages 71-83
    4. G. Sganga, I. Giovannini, C. Chiarla, M. Castagneto
      Pages 85-92
    5. J. Wernerman, J.-L. Luo, F. Hammarqvist
      Pages 93-100
  4. TPN vs ENT Nutrition Cost and Benefits

    1. Front Matter
      Pages 113-113
  5. New Strategies on Metabolism and Nutrition

    1. Front Matter
      Pages 123-123
    2. G. Iapichino, A. Pezzi, D. Radrizzani, S. Marzorati
      Pages 133-145
    3. M. Braga, O. Gentilini, L. Gianotti, A. Vignali
      Pages 147-160

About this book


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 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 consump­ tion of principal energy substrates. Many experimental and clinical studies have investigated the metabolic aspects of individual organs or organ systems. However, for a correct evaluation of such metabolic events, in addition to studying the roles of metabolic enzymes, active metabolites, and the glutathione system, it is interesting to consider the use of indirect calorimetry as a valid and important investigative technique. The critically ill patient with major alterations in nutritional status may require artificial nutritive support administered through either parenteral or enteral routes.


Enteral nutrition Insulin Parenteral nutrition Sepsis Trauma artificial nutrition body composition carbohydrate cells growth factor nutrition pathophysiology physiology prevention surgery

Editors and affiliations

  • G. Guarnieri
    • 1
  • F. Iscra
    • 2
  1. 1.Institute of General Clinical MedicineCattinara HospitalTriesteItaly
  2. 2.Department of Anaesthesia, Intensive Care and Pain TherapyCattinara HospitalTriesteItaly

Bibliographic information

  • DOI
  • Copyright Information Springer-Verlag Milan 1999
  • Publisher Name Springer, Milano
  • eBook Packages Springer Book Archive
  • Print ISBN 978-88-470-0042-1
  • Online ISBN 978-88-470-2901-9
  • About this book