[Catabolism and artificial nutrition of the internal medicine intensive care patient]

Numerous investigations have been performed on catabolism in polytrauma and surgery. Comparable studies on the internal medical intensive-care patient are not available. Such patients have an increasing metabolism with a maximum attained on day 5, and the catabolic condition is associated with an increased muscle protein breakdown. Objective measurements of catabolism and nutritional status are important but difficult. The recovery of a patient after acute illness depends on the provision of sufficient and adequate nutrition in three steps: 1. quantity and quality of calories; 2. quantity and quality of protein; 3. vitamins and electrolytes. Glucose is one source of calories as are fructose, xylit, and fat. Quantity and quality of amino acids are relative to organ failure and disturbance of amino acid metabolism. Branched-chain amino acids may be helpful in hepatic failure and severe sepsis.