Download - Monitoring of Nutrition in ICU
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MONITORING OF NUTRITION IN
ICU
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A slender and restricted diet is always dangerous
in chronic and in acute diseases
Hippocrates 400 B.C.
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>40% of hospitalpatients malnourishedon
admission
McWhirter and Pennington 1994
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donotlet yourpatientsstarveand when you
offerthem nutritionsupport,doso by thesafest,
simplest, mosteffective route.
Dr Mike Stroud Feb 2006
Chairof NICE committee
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Monitoring
Shortterm
Blood
biochemistry
FeedvolumereceivedVs
Feedvolumeprescribed
Bowel motion & gastricaspirate
Any changesinstress/patientactivity
Longterm
Weight
Traceelements
Urinary urea
Urinary electrolyte
Anthropometric measurements
Indirectcalorimetry
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Physicalexamination
Examineregularly
Nutritionalstatus
Weightshould be measureddaily Hydrationstatus
Reasonablepredictorof body fatandcaloric
balance
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Functionalassessment
Repletionofproteinandenergy reservesis
associated with:
IMPROVEMENT IN FUNCTIONAL ABILITIES
Gripstrength
Activity level Physicalendurance
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Laboratory test
Useful for monitoring individual patient responses to
parenteral and enteral nutrition support
Metabolicstate
Protein energy balance
Micronutrition status
Fluidandelectrolyte
Acid base balance Organfunction
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Parenteral only
Chemsticks 6 hourly
iCa Every alternateday ( until
stable)
Alkaline Phosphatase Weekly
AST Weekly
Total Bilirubin Weekly
Triglyceride Asneeded
PT Asneeded
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Blood biochemistry
C-reactiveprotein
Bloodelectrolyte Na+,K+,
Blood Urea Nitrogen (BUN) LFT
Bloodglucose
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Nitrogen balance
Usefulindeterminingindividualproteinrequirement
Nitrogen Balance = Nitrogen Intake Nitrogen Output
Nitrogen intake =feedreceivedin 24 hours (enteral/parenteral/oral)
Nitrogen output=urinary urea/mmol/24 hoursx 0.033 +obligatory losses+
any extrarenallosses
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Protein Energy Balance
During periods of inadequate dietary protein or energy, a reduction
in hepatic synthesis and secretion of these proteins causes plasma
levels to fall.
Transthyretin
previously known as prealbumin
Half life of 2 days ( rapidly respond to nutrition balance)
Transferrin
Retinol binding protein
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Vitamins & Minerals
Micronutrientsin wound healingandimmune
function may needto be monitoredtoassurethe
adequacy ofsupplementation
Zinc
Vitamin C
Copper
Magnesium
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THANK YOU