With regards to nutrition in the critically ill patient
a) list the methods available to estimate energy expenditure in the critically ill patient
b) list the metabolic and clinical problems associated with overfeeding
c) list the clinical and biochemical features of the refeeding syndrome ?
a) list the methods available to estimate energy expenditure in the critically ill patient
Indirect calorimetry
Fick principle ( in patients with a PAFC)
Predictive equations
b) list the metabolic and clinical problems associated with overfeeding
Hepatic steatosis
Hyperglycemia
Hyperlipidemia
Hypercarbia
Hyperosmolarity and hypertonic dehydration (in patients fed excess nitrogen who have impaired urine concentrating ability)
Azotemia (due to excess nitrogen intake)
c) list the clinical and biochemical features of the refeeding syndrome ?
-seen when normal intake is resumed after a period of initial starvation
- Low PO4, Mg and K and thiamine deficiency
- Can presents with weakness, arrythmias and cardio-respiratory failure
The article linked below compares all three methods mentioned in the college answer. Specifically, for each mentioned topic the following rambling digressions are available:
In brief:
Method | Physiology | Advantages | Limitations |
Predictive Equations |
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Reverse Fick method |
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Indirect calorimetry |
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Indications may include:
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The complications of overfeeding the critically ill patient are discussed elsewhere.
In brief, they are as follows:
Refeeding syndrome is also discussed elsewhere, but - in brief point form - its features are as follows:
Flancbaum, Louis, et al. "Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients." The American journal of clinical nutrition 69.3 (1999): 461-466.
Klein, Catherine J., Gena S. Stanek, and CHARLES E. WILES III. "Overfeeding macronutrients to critically ill adults: metabolic complications." Journal of the American Dietetic Association 98.7 (1998): 795-806.
Hearing, Stephen D. "Refeeding syndrome." BMJ 328.7445 (2004): 908-909.
Stanga, Z., et al. "Nutrition in clinical practice—the refeeding syndrome: illustrative cases and guidelines for prevention and treatment." European journal of clinical nutrition 62.6 (2008): 687-694.
Kraft, Michael D., Imad F. Btaiche, and Gordon S. Sacks. "Review of the refeeding syndrome." Nutrition in Clinical Practice 20.6 (2005): 625-633.
Khan, Laeeq UR, et al. "Refeeding syndrome: a literature review."Gastroenterology research and practice 2011 (2010).