Der Internist
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A concept for combined enteral and parenteral nutrition for critically ill patients is described in which endogenous substrate production during the acute phase of illness is taken into consideration and hyperalimentation is avoided. The nutritional goal is defined by multiplication of the base rate, i.e. body weight (BW) in kg as delivery rate in ml/h (wedge 24 kcal/kg BW/24 h), with a target factor, which varies between 0.2 and 1.8. An equivalent composition of enteral and parenteral nutrition allows a transition between both forms without problems. Simultaneously, immunologic aspects of nutrition are considered as well and both forms of nutrition are complemented by immune-modulating substrates such as glutamine and antioxidants.
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Cerebral lesions may contribute to a transient left ventricular ballooning syndrome that can mimic acute myocardial infarction. Fibrinolytic therapy or GP IIb/IIIa antagonists should be withheld in cases of neurologic disorder or unconsciousness even in the presence of ST-elevation. ECG transmission by telemetry and myocardial infarction alarm networks allow correct diagnosis and catheter treatment within required time limits.
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Inadequate oral food intake and impending or manifest malnutrition are an indication for artificial nutrition. Regarding the course of the disease and quality of life this can improve the prognosis and also prolong the life span. ⋯ Prerequisites for any nutritional concept are careful evaluation of the nutritional status and specification of the nutritional concept adapted to any disease-specific changes in digestive capacity and metabolism. Enteral nutrition, if possible as volitional nutritional support, should be preferred to parenteral nutrition.