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Severe Undernutrition

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The Stress Response of Critical Illness: Metabolic and Hormonal Aspects

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Abstract

Undernutrition in critically ill patients appears to be common, being encountered both at the time of admission and developing during the ICU stay. While many definition criteria for this state are available, loss of muscle mass and strength seem to be the most relevant signs. During the ICU stay, the main reason for undernutrition is underfeeding, a frequent occurrence in ICU practice, together with bed rest. Negative energy and nitrogen balance may result in an increase in morbidity and a prolonged rehabilitation period. While nutritional support is essential for these patients, it is important not to induce the refeeding syndrome. Enteral feeding is the preferred route for providing nutritional support but is not always achievable, usually the result of prolonged feeding interruptions. The calorie target should be reached progressively using the gastrointestinal route or the parenteral route if necessary. Indirect calorimetry remains the best guide for appropriately prescribing nutritional support. Protein administration should follow current guidelines. Careful monitoring of electrolytes (mainly phosphorus, magnesium, and potassium) is mandatory. Nutritional support is of extreme importance not only to provide enough nutrients in a deficiency condition but also to prevent prolonged rehabilitation periods for survivors.

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Author information

Authors and Affiliations

  1. Intensive Care Department, Rabin Medical Center, Jabotinsky Street 39, Petah Tikva, 49100, Israel

    Pierre Singer MD

  2. Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva, Israel

    Pierre Singer MD & Jonathan Cohen MD

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  1. Pierre Singer MD
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  2. Jonathan Cohen MD
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Correspondence to Pierre Singer MD .

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Editors and Affiliations

  1. Brussels, Belgium

    Jean-Charles Preiser

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Singer, P., Cohen, J. (2016). Severe Undernutrition. In: Preiser, JC. (eds) The Stress Response of Critical Illness: Metabolic and Hormonal Aspects. Springer, Cham. https://doi.org/10.1007/978-3-319-27687-8_15

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  • DOI: https://doi.org/10.1007/978-3-319-27687-8_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27685-4

  • Online ISBN: 978-3-319-27687-8

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