Laboratory support of the clinical nutrition service

This article critically reviews the role of the laboratory services in assessment, monitoring and management of complications in patients requiring nutritional support. It has broadly been divided into three sections. (i) Assessment of protein and energy status: whilst it is stressed that clinical judgement and anthropometric measurements are the most effective methods of evaluation of nutritional requirements, laboratory tests which can be of use in assessment of protein energy status are discussed in detail, including an appraisal of the value of each test in various clinical situations. (ii) Assessment of micronutrient and electrolyte status: the clinical justification for assessment of the various micronutrients and electrolytes is considered. A few selected examples are discussed in detail including an evaluation of the tests of status available and examples of situations where measurement may be clinically helpful. (iii) Effective use of the laboratory: this section attempts to guide the clinician in the most appropriate use of laboratory tests, firstly in the assessment of requirement for aspects of nutritional support, secondly in the continued monitoring and evaluation of the support provided, and thirdly in prevention and treatment of metabolic complications. It is emphasised that clinical nutrition is a multidisciplinary topic requiring input from the laboratory in conjunction with other specialities to provide the best available patient care.