The Metabolic Management of the Critically Ill

HOW DO I USE THIS BOOK? This book is organized to answer specific questions about the metabolic and nutritional problems of critically ill patients. Thc questions are listed under five chapter headings in the Contents. Each question is self-contained with its own charts, tables, and references, although, in some instances, you may be referred to another section of the book for additional information. A detailed subject outline appears on the first page of each chapter, and there is an index for cross-reference to specific subjects. A metabolic support plan and accompanying metabolic and nutritional worksheet are locatcd in the Appendix. This plan pro vides the best estimates available for predicting the metabolic requirements of patients, and outlines approaches to feeding the hospitalized patient which will satisfy these nutritional needs. Clin ical cases are presented in this section to help you get started using the support plan. This volume is a handbook organized for frequent use - place the appropriate tables and nomograms on the bulletin board of the intensive care unit or in your office for convenient reference. Use the metabolic and nutritional support plan and establish the habit of assessing the metabolic requirements of your patients. Refer to the references cited to explore in further detail specific questions or areas of interest. By applying our knowledge of the metabolic and nutritional alterations which occur following disease, we can improve our care of the critically ill.

Contenu

1. Energy and Energy Balance.- 2. Control of Body Temperature: Relationships with Metabolic Control.- 3. Hormonal Control of Body Fuels.- 4. Alterations in Intermediary Metabolism.- 5. Feeding the Patient.- Appendix: Metabolic Support Plan Using the Metabolic and Nutritional Worksheet.- 1. Peritonitis in a patient with inflammatory bowel disease.- 2. Multiple trauma in a young, healthy male.- 3. A small burn injury in a depleted woman.- 4. Intraabdominal postoperative complications: Edematous patient referred to your service after 2 weeks of semistarvation.- 5. Parenteral nutrition following injury and renal failure.- 6. Hepatic dysfunction in a patient with an enterocutaneous fistula receiving intravenous feedings.- 7. Bacteremia in a patient with severe peritonitis: Managing nutritional requirements, hyperglycemia, the intravenous catheter, and fever.- 8. Edema, hypoproteinemia, and malnutrition following blunt abdominal trauma and small bowel resection.