I

Reprioritization of Entercocyte Protein Synthesis

Î Acute Phase Protein Synthesis

Reprioritization of Entercocyte Protein Synthesis

Î Acute Phase Protein Synthesis

FIGURE 6.6 Implications of impaired intestinal amino acid absorption. From Gardiner, K. and Barbul, A. Intestinal amino acid absorption during sepsis. J. Parent. Enternal Nutr. 17, 280, 1993.

Experimental sepsis, induced by either cecal ligation and puncture or intraperitoneal injection of lipopolysaccharide, showed a significant decrease in intestinal absorption of amino acids. Furthermore, the utilization of arginine may be decreased, and its biosynthesis may be impaired during sepsis as suggested by the significantly decreased plasma arginine levels in septic patients (Figure 6.6).1719

Enteral feeding in comparison with parenteral feeding has been shown to improve outcome in burned children and in adults after trauma. It also has been demonstrated that enteral feeding improves survival in animals after hemorrhage and sepsis. A reversal of the alteration in T-cell function associated with trauma or surgery has been demonstrated in patients fed enteral diets rich in arginine. Additionally, moderately stressed intensive care unit patients given an enteral argininerich diet show enhancement of T-cell blastogenesis. This suggests that enteral feeding, to supply the amino acid nutrients, may impart a benefit during septic illness.20-22

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