Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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Polytraumatism usually presents in previously healthy patients with a good nutritional status. However, metabolic changes derived from the traumatic injury put these patients in a nutritional risk situation. Specialized nutritional support should be started if it is foreseeable that nutritional requirements will not be met p.o. within the 5-10 days period from admission. ⋯ However, the presence of head trauma leads to gastrointestinal motility impairments that hinder tolerance to enteral nutrition. Patients with abdominal trauma also present difficulties for the onset and tolerance of enteral diet. The insertion of transpyloric tubes or jejunostomy catheters allows early use of enteral nutrition in these patients.
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Nutritional and metabolic support in patients with liver failure should be able to adequately provide the nutritional requirements and, at the same time, to contribute in patients' recovery by controlling or reverting the metabolic impairments observed. However, in spite of the pathophysiologic basis described by some authors considering amino acids unbalance as a triggering and maintaining factor for encephalopathy, there are no sufficient data to recommend the use of "specific" solutions (branched amino acids-enriched and low on aromatic amino acids) as part of the nutritional support of patients with acute liver failure. Its routinary use is neither recommended for preventing complications in patients submitted to liver transplantation. ⋯ In patients requiring parenteral nutrition, there is no contraindication to the use of lipid infusions. An increase in vitamins and micronutrients intake is recommended. In patients submitted to liver transplantation, nutrients intake should be started early in the postoperative period through a transpyloric route of access.