Current opinion in clinical nutrition and metabolic care
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Curr Opin Clin Nutr Metab Care · May 2006
ReviewCauses and consequences of inadequate substrate supply to pediatric ICU patients.
The prevalence of malnutrition among children admitted to a pediatric intensive care unit is still high. Assessment of nutrient supply is essential in the care of critically ill children because inadequate nutrition can increase morbidity and mortality. This review covers the causes and consequences of inadequate nutrient supply to critically ill children. ⋯ In the majority of children admitted to a pediatric intensive care unit, nutritional problems--both underfeeding and overfeeding--occur during admission due to poor estimation of nutritional needs, under-prescribing and problems in the delivery of the nutrients. Recommendations are made in order to prevent inadequate nutritional supply and its potentially harmful consequences in critically ill children.
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Curr Opin Clin Nutr Metab Care · May 2006
ReviewPracticalities of selenium supplementation in critically ill patients.
To review the reason for and clinical effects of selenium supplementation in critically ill patients. ⋯ The available evidence suggests that selenoproteins play an important role in the immunomodulation of critically ill patients and a sodium selenite supplementation upregulates these selenoenzymes. The intervention trials with sodium selenite performed to date are small and therefore only a tendency in reduction of morbidity and mortality could be demonstrated. Larger trials are necessary to show the supposed benefits and risks of selenite supplementation in critically ill patients.
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Curr Opin Clin Nutr Metab Care · May 2006
ReviewGlutamine: the first clinically relevant pharmacological regulator of heat shock protein expression?
It is well known that enhanced heat shock protein expression protects organisms against morbidity and mortality following experimental injury/illness. Presently, chemical/gene therapy based laboratory methods of enhancing heat shock protein expression are impractical for clinical application. Our laboratory has shown glutamine enhances heat shock protein expression following models of experimental illness/injury. The purpose of this review is to examine recent data supporting the use of glutamine as a clinically relevant enhancer of heat shock protein expression. ⋯ Currently, extensive data support glutamine as a gene level regulator of heat shock protein expression. Glutamine depletion, following critical illness/injury, is likely to lead to a state in which organisms are unable to induce heat shock proteins appropriately. Further, pharmacologic supplementation of glutamine potentiates the heat shock protein response prior to and following a stress. Pharmacologic trials utilizing glutamine to enhance heat shock proteins in humans are indicated.