Consequences of Nutrient Deficiency or Excess

Nutrient Deficiency

• Decreased respiratory muscle strength, hypoventilation, failure to wean from mechanical ventilation

• Immunosuppression, increased risk of nosocomial infection

• Poor wound healing: decreased fibroblast proliferation, diminished collagen synthesis, remodeling of previously healed wounds, development of decubitus ulcers

• Risk of refeeding syndrome

• Reduction in lean body mass, increased mortality Nutrient Excess

• Failure to wean from mechanical ventilation, hyperventilation

• Hyperglycemia

• Metabolic acidosis

• Hypertriglyceridemia

• Hepatic steatosis

• Hypertonic dehydration

• Overfeeding of previously malnourished patients can lead to refeeding syndrome

Meeting nutritional requirements in burn patients is important; however, additional nutritional support beyond requirements will not prevent the marked hypermetabolism and elevation in energy expenditure that remains for 40 to 50 d following injury [86]. In critically ill patients, it is important to monitor actual energy intake as a percentage of goal requirements to ensure that requirements are being met while avoiding the complications associated with under- and overfeeding (Table 11.3).

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