Daily Nutritional Requirements
Daily Nutritional Requirements
Poor Nutrition in ICU
Poor Nutrition in ICU: the establishment of enteral feeding is considered an important goal
Scleroderma
Scleroderma = autoimmune mediated widespread collagenous deposition. Limited form: Calcinosis, Raynauds, Esophageal dysfunction, Sclerodacytaly and Telangiectasia (CREST syndrome)
Systemic Lupus Erythematosus
Systemic Lupus Erythematosus (SLE) = chronic, multi-system disease commonest in young females; wide spread antibodies -> produce tissue damage
Polyangiitis – MPA, GPA, EGPA
Polyangiitis - MPA, GPA, EGPA: similar but different diseases; positive Antineutrophil cytopasmic antibiodies (ANCA); renal histology (focal necrotizing, pauci-immune glomerulonephritis)
Pulmonary Artery Catheter
Pulmonary Artery Catheter aka Swan-Ganz catheter (or 'the yellow snake'); continuous cardiac output monitoring; pulmonary artery pressure and more...
Lactate Clearance versus ScvO2 Monitoring in Severe Sepsis
Resuscitation targets in severe sepsis include: preload, e.g. CVP; afterload, e.g. MAP; tissue oxygen delivery; end point controversial: ScvO2 vs lactate clearance
Procalcitonin
Procalcitonin is the propeptide of calcitonin, a 116-peptide molecule with a molecular weight of 13 kDa. Procalcitonin has been studied as a sepsis biomarker, to help with diagnosing/ ruling out sepsis and to guide the initiation and cessation of antibiotics
Enteral Nutrition vs Parenteral Nutrition
Enteral Nutrition vs Parenteral Nutrition: controversial issue; at present best recommendations are to optimize oral/enteral nutrition, avoid forced starvation if at all possible, and judiciously use supplemental parenteral nutrition.
Folate Deficiency
Folate Deficiency: 500-20,000 mcg stored in body; required 50-100mcg/day; required for DNA, RNA and protein synthesis (purine, thymidine and amino acid synthesis)
Glucose Control in the Critically Ill
Routine management in ICU involves avoiding complications of hyperglycaemia (infections) and hypoglycaemia (arrhythmias, neurological damage, cardiac events). Traditional goals have varied
Immunonutrition
Immunonutrition involves feeding (enteral or TPN) enriched with various nutrients (arginine, glutamine, omega-3-fatty acids, nucleotides and anti-oxidants: copper, selenium, zinc, vitamins B, C and E) to improve immune responses and modulate inflammatory responses