• Nutrition on ITU
    • Total energy expenditure can be 25-30kcal/day in the first few days up to 45-60kcal/day in the second week on ITU.
    • Complications
      • Impaired wound healing
      • Reduced muscle strength
      • Difficulty weaning
      • Increased risk of respiratory infection
    • Routes/considerations
      • Enteral route preferred
      • Post-pyloric feeding might be better in pancreatitis
      • Post pyloric feeding otherwise not particularly beneficial
      • Consider nj feeding, jejunostomy etc
    • Problems with TPN
      Link:ceaccp.oxfordjournals.org/content/early/2012/11/21/bjaceaccp.mks056.full.pdf
      • Hyperglycaemia
      • Acidosis
      • Sepsis
      • Dehydration
      • Fatty liver
      • Can be given peripherally using lower molar load or via a PICC
      • Electrolyte imbalance
      • Uraemia
    • Calculating requirements
      • Can be difficult
      • Vary daily
      • ?24 hr urea collection
      • Volume depends on disease eg ARDS, CRF.
    • Immunomodulation
      • Various additives tried
        • Glutamine
        • Arginine
        • Omega-3 fatty acids
        • Ribonucleotides
        • Taurine
        • Phospholipids
        • Probiotics
      • Glutamine may help in PN for ITU patients
    • Daily requirements
      • Energy
        • 25-40kcal/kg/day
      • Fluid
        • 25-35ml/kg
      • Protein/nitrogen
        • 0.5g/kg/day
      • Carbohydrate
        • 4 kcal/gram
        • 7g/kg/day
      • Fat
        • 9 kcal/gram
        • ~1g/kg/day
      • Minerals
        • Calcium
          • 0.1mmol/kg
        • Magnesium
          • 1mmol/kg
        • Phosphate
          • 0.5mmol/kg
        • Zinc
          • 0.3mcg/kg
      • Vitamins/trace elements
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/1/1/21.full.pdf
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/7/6/199.full.pdf