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.

This book is a guide for clinicians seeking to use metabolic approaches in the care of hospitalized patients. Since a nutritional component exists for practically any disease process managed, it is important to properly address the macro- and micronutrient issues that can help facilitate a favourable clinical outcome. Metabolic medicine is a newly recognized speciality that applies proven nutritional approaches to support hospitalized patients within existing standards of care. Optimizing Metabolic Status for the Hospitalized Patient: The Role of Macro- and Micronutrition on Disease Management addresses the gap of nutrition knowledge among physicians who generally care for patients without addressing the nutritional and metabolic perspective. Features: State-of-the-art guidelines for practicing metabolic medicine in the hospital setting “Hands on” guide for day-to-day metabolic management of hospitalized patients Personal insights from one of the field’s leading practitioners, drawing upon decades of experience Historical reviews of key scientific developments This book is written by Dr Michael M. Rothkopf, Clinical Professor of Medicine at Rutgers/New Jersey Medical School. Dr Rothkopf founded the Metabolic Medicine Center at Morristown Medical Center and is the current Metabolic Medicine Consultant for the Heart Transplant, Lung Transplant, Cardiac Surgery and Wound Care Programs at RWJBH/Newark Beth Israel Medical Center. This book is directed at the physician level of hospital care. It provides value to a broad range of physicians regardless of their medical specialty or subspecialty. It will also be useful for medical students and resident physicians in training as well as nurse practitioners and physician assistants working in hospital settings.

Malnutrition and obesity are both common among Americans over age 65. There are also a host of other medical conditions from which older people and other Medicare beneficiaries suffer that could be improved with appropriate nutritional intervention. Despite that, access to a nutrition professional is very limited. Do nutrition services benefit older people in terms of morbidity, mortality, or quality of life? Which health professionals are best qualified to provide such services? What would be the cost to Medicare of such services? Would the cost be offset by reduced illness in this population? This book addresses these questions, provides recommendations for nutrition services for the elderly, and considers how the coverage policy should be approached and practiced. The book discusses the role of nutrition therapy in the management of a number of diseases. It also examines what the elderly receive in the way of nutrition services along the continuum of care settings and addresses the areas of expertise needed by health professionals to provide appropriate nutrition services and therapy.

The new 3rd Edition of this definitive reference on parenteral nutrition has been completely revised and updated to cover some of the significant advances in the field. This new edition is also multiauthored with several international contributors to broaden its appealT urermore, a number of new chapters have been added to cover some of the latest advances such as Metabolic Response to Illness and Its Medications; Transplantation; Nutritional Pharmacotherapy with PN and Peripheral PN; and many more. Thoroughly revised and updated to provide the most current information in the field. International authors broaden readership appeal. Parenteral feeding modalities in both the hospital and at home are included.

This Surgical Clinics issue is Part 2 of a special two part issue on nutrition and metabolism of the surgical patient, co-guest edited by Dr. Stanley Dudrick, a pioneer in total parenteral nutrition. Part 2, guest edited by Dr. Dudrick and Dr. Juan Sanchez present topics on nutrition and metabolism for the chronically ill patient. Topics will include: nutrition management of acute and chronic pancreatitis, surgical treatment of patients with diabetes mellitus, nutrition management of geriatric surgical patients, nutrients, routes of delivery and immunocompetence, immunologic functions and aspects of the alimentary tract related to feeding, overview of enteral and parenteral feeding access techniques, dietary, metabolic and surgical management of obese patients, historical highlights of the development of total parenteral nutrition, nutrition support of patients with cardiovascular disease, genomic and epigenomic aspects of nutrition and metabolism in surgical patients, nutrition support of patients with inflammatory bowel disorders of the small intestine, colon and rectum, nutrition support of patients with cancer, home parenteral nutrition for intestinal failure, and more.

This Surgical Clinics issue is Part 1 of a special two part issue on nutrition and metabolism of the surgical patient, co-guest edited by Dr. Stanley Dudrick, a pioneer in total parenteral nutrition. Part 1, guest edited by Dr. Dudrick and Dr. Juan Sanchez present topics on nutrition and metabolism for the acutely ill patient. Topics will include: metabolic considerations in management of surgical patients, sepsis associated with nutrition support of surgical patients, parenteral nutrition and nutrition support of surgical patients, cachexia and refeeding Syndrome, prevention and treatment of intestinal failure associated liver disease (IFALD) in neonates and children, adjuvant nutrition management of patients with liver failure, comprehensive management of patients with enteric fistulas, nutrition management of patients with malignancies of the head and neck , nutrition support of pediatric surgical patients, management of the short bowel syndrome, what, how and how much should burn patients be fed?, nutrition support in trauma and critically ill patients, and nutrition as an adjunct to management of patients with pulmonary failure.

J. E. Fischer, M.D. Professor Greep, ladies and gentlemen. It is a great pleasure for me and the participants to be present at this International Meeting of Parenteral Nutri tion. This meeting would not have been possible five years ago. At that time we were still arguing about central vs. peripheral routes, efficacy of the tech nique, and still getting accustomed to our ability to support patients nutri tionally. Within the last five years these discussions, which seem almost futile in retrospect, have been put aside. Both techniques, we know how, work quite well and have their own indications. Having become comfortable with the technique, it is now time to enter the second phase of parenteral nutrition, and that is the differentiation of the technique for the benefit of different patients. Over the next two days we will be discussing several problems which at the present time are central to the entire subject of parenteral nutrition. Is a fat calorie the same as a carbo hydrate calorie? What is the effect on protein metabolism of the fat calorie as opposed to the carbohydrate calorie? Are they equivalent? Are'there situations in which one is superior to the other? Perhaps we will find out tomorrow in the panel.

Nearly all medical specialities treat patients whose illnesses necessitate a means of nutrition which bypasses the gastrointestinal tract. Parenteral nutrition consequent ly means the administration of nutrient and building materials in qualitatively utilizable form and in quantitatively adequate amount by the intravenous route. This guarantees the requirements for energy and building materials under a variety of conditions, and compensates for any losses that might occur. The basis for any parenteral nutrition is the knowledge of the biochemical processes of intermediary metabolism under physiological and pathophysiological conditions (e. g. , starvation, post-stress metabolism, hypoxia, microcirculatory disturbances, etc. ). Only taken in these contexts can nutrient and bodybuilding sub stances be combined, measured out, and administered in such a way as to be definitively useful to the body. Research into the biochemistry and the patho biochemistry of intermediary metabolism has demonstrated possibilities, by means of which we may be able to "outwit" (to some extent) disturbances in utilization of certain nutrients under defined pathologic conditions. If the body receives and transforms substrate-precursors (e. g. , sorbitol), it can maintain an adequate level of nutrient and life-support substances; this slow rate of transformation to the substrate makes allowance for the limited utilization capacity, and covers the needs of the body by roundabout means. Some of the problems can now be considered solved, but a great many are still in the very early stages of elucidation, or await basic research.

Lipids have been in clinical use as components of intravenous nutrition for over 50 years. Over the last 15 years, new and improved lipids that include olive oil and/or fish oil have replaced the more traditional ones. These new lipids offer the opportunity to deliver high amounts of fatty acids and possess different functional properties: in particular, they can influence inflammatory processes, immune responses and hepatic metabolism. This book brings together articles written by leading international authorities in the area of intravenous lipids. Contributions discuss the latest findings in the field, ranging from pre-clinical research to the most recent clinical trials. Lipid functionality and utility in pediatric, adult surgical and critically ill patients are covered, as is the use of lipids in long-term home parenteral nutrition. Addressing a broad spectrum of topics, this publication provides a wealth of information for basic scientists, clinical researchers and clinical practitioners alike.