PA3AEN 1 HAPYLWEHMA MUTAHMA 41 Tranwe: o6uyne nonoxeHnn . TpeGosaiia k nitaHio .. Tirranine 8 kninHnecKon mennuyHe Bsawmonelicrane nutarenbHeix BeulecTs c MenMkaMeHTaMn. Tivwestie n06aekn v npwmecn 2 Henocrarowocte nwranua ...... 12 Benkoso-aepretmueckant HEQOCTATOYHOCTb Aedvuyt kapHuTiia. . Aednuyt ocHopnenx (accenynansiin) AMPHBEK KAGHOT eos eeee es 24 3 Wexyccrsennoe nuranne........ 25 Tate c nomoulbio ‘sHTepanbHoro 3OHMa. ......... 26 Nontioe napeTepanbuoe nianne Tirratine ymparousyx WnauweHToB c TAXENLIM cna6oymvem 4 Tanoewramnnos! TanepeMTamaHoset BHTaMMHHaR SaBMCHMOCTE Burn. onar.... Sonar ranosnTaMnno3. Haun Tanosnraunnos. . Tanepanramnnoa (mroxcnnaws) 38 MlawroTeHosan kcnoTa ......... 39 PuGornaavn ...... Tunosuramnios. . Twamin : Tunosnraunnos. . BuraMnnA........ FinnosuraMnnos. Tanepanramnioa (mnsroxcuKauis) ... 2.0... 43 Buramnn B, Md [nosuTamMuHo3 W3ABVCUMOCTD............. 45 TnepeuramnHo3- (maroKcnKaws) - 46 Byram B,, .... - 46 Tunosmramnnos. 46 Burammn C. 49 Fnnogmrannnos. 249 WxToKcuKayna . .51 Burawmn D. .. 51 TnnoguTamnnos W3aBMCMMOCTD............. 51 Tunepanramnnos (WHTOKCHKAUIA) «2. 54 ButamvHE...... wee TWNOBHTaMUHOS... . . Tinepamramntos (mHToxcuxauyen) . 56 Butamu K...... . 57 [nosuramunos. 57 Tunepamramnno3 (weToxcuxauya)...... 0.2... 59 Aetbnunr u Toxcnunocrs Munepansibix Beujecra . 59 XPOM. eee e eee + 59 Men 62 NonoOperentoih neduusr..... 62 HacnegcreexHbii ge@uunt .... 63 Tiowobperentian uToKcunaua Hace dcTaeHan MHTORCMNGLIS DIOP eee eeeeeeee eee ees 66 Hon... eee eee e cece ee es 66 Kenes0 . 67 Maprarieu ... : 68 Monw6nen ... : 68 Cenex - 68 Uk. a) Oxnperne m mera6onnuecknit cnnapom . 70 Oxrpenve . 70 MeraGonmeckuii cHHApOM 762 PAMEN 1. HAPYLIEHMIS| TMTAHMA 41 NMTAHME: OBLME nono KEHMA Hyrpuuwronorua — Wayka o niue v ee BAMAHMM Ha 3f;opoBbe 4enoBexa. MutaTenb- HbIe BELLIECTBA ABNIAIOTCA XAMMYECKMMM CO- eAMHeHMsMM, COnepKAUIMMNCA B nMUe M MCNONb3YEMbIMA OpraHM3MOM {A pocTa, OGecneveHnA xnaHEAeRTENLHOCTA M SHEp- run, MuratenbHble seulectsa (KyTpHeHTH), KOTOpbie He CMHTesMpyloTcA OpraHi3MoM, BnmoToA HaMGonee YeHHBIMM (HesaMeHH- Muimi) HW nosTOMy LOMKHb! GbiTb NomyHeHet eMecte c nnuielt. K HMM OTHOCATCA BHTaMM- Hb, MMHEPasibl, HEKOTOPbIe AMMHOKMC/IOTEI WKMpHBIe KcHoTEI. HyTPMeHTbI, KOTOPbIE CviTesMpyioTca opraHWaMoM M3 APyr¥x co- eAMHeHMi, aK HECMOTPA Ha TO, 4TO OH MOryT GbiTb NonyyeHbI C NMUIeH, He ABNAOT- cs HegaMeHMMbimn. MaKpoHyTpHeHTb! He- OGxopMMEl oprakWaMy B OTHOCHTeNBHO Gonbuiom KoniiuecTBe, MKpoosieMeHTbI He- OGxoAMMbI 8 HeGonbuOM KonH¥ecTBe. Hemocratok onpegenenhbix nuTaTenbHbix BeLECTB MOXeT BECTH K pasnM4HbIM 3a60- nesannsm (HanpnMep, KBauMOpKop, nen- arpa), a Takxe apyrum HapyweHnam (cM. ra. 2 Ha crp. 12). Manmwek notpeGneHna MaKPOHYTPHeHTOB BeseT K OKMPEHMIO (CM. cp. 70), a wanmuek norpeGneHWA MixKpO- HYTPMEHTOB MOXeT BbISbIBATE TOKCHYECKHE nponsnenna, MakPouyTPHEHTE! B OcHoBHOM nua CocToHT M3 MaKpo- HyTPMeHTOB, KOTOpbIe cnyxaT MCTOYHM- KOM OHEprMM WM MHOrWX HesaMeHMMbIX HyTpneHToB. Yrnesopbl, Genki (akmiovan He3aMeHMMbIe AMMHOKMCAOTEI), MPL! (Bknio4aA SCCeHUMaNbHbIe XMPHbIe KMC- noTbl), MakpOS/eMeHTHI M BOAa ABAAIOTCA makposnementamn. Kak MCTOMHMKH SHEp- THM yrneBoAbl, KMPbI M Genkn BaMMogza- MeHReMbl; XWpbI_NpoMsBOgAT 9 KKan/r (37,8 kax/r); Genkn m yrneson — 4 xkan/r (16,8 Kax/r). Yrnesopei. Yrnesonbi nmwm pacujenna- JoTos|¢ 06pag0BaHMeM rmlOKOSbI M APYrHx MO Hocaxapngos. Yrnesopbl nosBIa‘oT ypoBeHb TAHOKO3bI B KPOBH M NlonoAHAIOT sanac SHEp- Tan, MpocTole yrneBoasl, 8 OCHOBHOM MOHO- caxapngbl Win ANCaxapHpb!, COCTOAT 13 He- Gori Mosiekyn W ABNsIOTCA HMSKOMONeKy- JADHEIMM COBAKHEHMAMM, KOTOPHIe BbICTPO BcacbiBaioTcA. CnoxKHbie yrneBopb! ABNAIOTCA BEICOKOMONIEKY/IAPHBIMM COBLIMHEHMAIMM, MO Aeky/t| KOTOpbIX NPM paciyervieHvn OGpasy- oT MoHocaxapabl. Croxble yrneBon! nO- BILIAIOT YPOBEHb FmKOKOSbI B KPOBM MeLNEH- Ho, Ho Gone sywmTenbH, ['mioKosa i caxaposa sag /sHOTOR MPOCTEIMH yrneBonaMn; KpaXMaN A kneTaTka (Wesmon0sa) — ChOKHBIMA yrne- Bogan (nonHcaxapwaaMn). Tankemuyecknit nHgeKc nokaabiBaer, Kak 6bicTpO yrnesogbl NoBLIWAIOT ypoBeHb F710- Ko3bI B KpOBM. SHANeHNA PAA BbIPaKAIOTCA ‘oT 1 (camoe MeppeHHoe nosbiwieHne) {40 100 (caMoe 6ticTpoe noBbieHHe, okB/IBa- JIHTHO HACTOH rmioKose — om. Ta6A, 1-1). Ognako B AevCTBMTeEMbHOCTH CKOPOCTE NO- BBILIEHMA YPOBHA F/N0KO3bI B KDOBM TaKKe ‘SaBMouT OT XapakTepa yrneBOAOB B NMULe. Yrnesofb| G BbICOKMM rivKeMMYeCKMM VQ{eKCOM 6bICTPO NOBbILUAIOT YPOBEHb F110 KO3bI 8 KPOBM 10 BbICOKMX LMbp. Kak pe- SyNbTaT, BOSPACTAeT yPOBeHb MHCyAMHA, TO BbiabiBAeT rMNOr/MKeMMIO M nosBNeHne uyscTea ronofa, KoTopbie cnoco6crByioT notpeGneHnio ua6ITKa Kanopnii, a cnego- BaTenbHO, yBenmMeHMi0 Beca. YrneBOnbl C HVSKMM THVKeMHYECKHM MHAIeKCOM nOBbI- WAIOT YPOBEHb TNOKO3bI 8 KPOBM MeAeH- Hee, B peaynbrate Yero nocTnpaHaNanbHbiit YPOBeHb MHCYsINHa B KPOBM HiDKe H YYBCTBO Tonofia MeHee Bbipaxexo. Bneactane sTo- ro coggaetca Gonee GnaronpmsTHBil mM TMgHBI Npodwn Mv, cnegoBatenbHo, YMeHBUaeTCA PUCK PasBHTHA OXMPeHHA, GaxapHoro AMaGeTa M ero OCROXHEHHi Benkn. Mnuwjesbie Genkn pacujennsiorca ¢ O6pas0BaHveM nenTHZOB M AMMHOKHCAOT. Benkn HeoGxoammbi na noapepxaHns x13 HefesTenbHocTn, O6HOBNeHMA, yHKL!MO- HvpoBaHis M pocta TkaHeli. OaHaKo ecan ‘Oprakwam He nonyyaeT AOCTaTOXHO KaNo- pvt wa geno (ocoGeHHo xupos) WAM M3 nM uu, Genlok MoxeT GbiTb Mcnonb30BaH Kak MCTOMHMK 3HeprMn, * Mpocrsie yrnesoni (MoHOcaxapnatl) He pacwien- -AmioToA npHt raRpontse. Choxniie (anmrocaxapnat): Awcaxapnats, TpNCaXapMAL MT.2, rANpOAMEyOTER 10 mowocaxapnjoe, KoTopsie W BcacEaIOTCA1, MMTAHME: OBUIME NONOKEHMA 3 Tasnaua 1-1. FAvKEMMYECKHI HHDEKC HEKOTOPbIX NPOAYKTOB Kareropwa| — Hanmenosanwe | Magexc Bobs ‘acon 33 Kpacwas veveamua 27 Xne6 Con 4 Xne6 pxanoii Xne6 Sensi 69 Vs uensHoh nueHnuss ‘Snaxn Bce orpy6n 54 Kyxypyatbie xnonia 83 scan myxa 53 Bosnyiil ne 90 Tlwenmanbie xnonts 70 Monostisie | MonoKo, mopoxenoe, | 34—38 nponykret | Horypr @pycrs | AG oKn Bananes 61 Anenscni 43 Anenscioabil cox Kny6unKa 32 SepHo Samet Kopmsessilt pic 66 Benwii pac Maxapowst - Kaprospens | Pacrsopuwoe niope (Se- noe) 86 Tope (6enoe) Cnankniixaptodens | 50 Saxyon | Kykypyahiie wines Oscatoe neveHbe 57 Kaprodensroiewnnes! | 56 Caxap ‘pyxtosa Frokosa 100 Mea a1 Pacbunnposannsti caxap| 64 Venonbaoaanne opraHiamom Genka ni- uv ain opmmpoaHnn TkaHeM s|enieTCA awcrbiM noTpeGneHmem Genka (nonoxn- TemibHbih azoTwcTall Ganake). Mph KaTa6o- ssecknx cocToaHtsx (HanpHMeD, ronofa- Hie, MHeKUMN, OXOTH), CBRSAHHbIX C NOB- pexneHvem TkaHie opraHvama, GenkoB MoXeT GbITb Mcronsa0oBaHo Gonbule, Hem TonyyeHo 13 NHL, 4TO NPHBOAMT K 4UCTOR notepe enka (oTpHUaTeNbHbIl asoTMCTHIA 6anaiic). AgoTHcTallt Gananc AanaeToA ny4 Wn onpenensioume cbakTopoM pasHiibt Mexny KonM4eCTBOM noTpeGnseMoro agora W KonMecTBOM a30Ta, BbyJenAeMoro opra- HM3MOM C MONOii Vi KasIOM. Vis 20 amuvokucnot 9 aBnsioTca Hesa- MeHVMBIMM 2MMHOKMCNOTAMM; OHM He CMH TeSMpyIOTCA B OPraHHMe M AOMXHbI GbITb, nonyyeHbi v3 niu. Bapocniie Hyxnaloros B Haun B AMMHOKMCAOT, a AeTAM OT 0.0 1 roga AononHwTenbHO TpebyeTca rcTH- ANH. Tpv HopManbHom sece notpe6HocTb B nuuwesbix Genkax B3aMMOcBAsaHa C TeMnOM pocta, KoTOPbI yMeHbWaeTCA OT MnaneH- YecKoro Bospacta AO Bspocnoro. Nope6- HocTe B GenKax cHinKaeTon oT 2,2 r/xr y 3-mecauHbK MnageHues 10 1,2 kr/ry 5-net- uuwx pete 1 0,8 Kr/r y BspocnbKxX. NoTpe6- HocTb 8 Genkax cooTseTcTayeT norpe6HoC- TM_B He3aMeHVMbK AMMHOKMoNOTaX (CM. Ta6n. 1-2). Bapocnbie, Kenaiouwe YMeHb- UMTS MbIMIeHHYIO Maccy, HyKQaIOTCA B Mit- HuManbHoM KonMecTBe GenkoB. AmmioKncnoTHbili cocTas Genkos Wwrpo- Ko Bapbypyet. Buonormyeckan \eHHOCTb OTpaxaeT CXO/CTBO AMMHOKMGNOTHOTO CO- cTapa Genka c Genkamu TkaHei XMBOTHbIX. HanGonee rapMoHM4HbiM ABNIAeTCA AMYHbIA Genok, 6vonormueckan YeHHOCTS KOTOpOrO npwisata ga 100. KneoTHie Genk monoKa 4 aca MMel0T BbICOKyIO Gvonorv4eckyi0 YeH- Hoos (~90); Genkn anakos M Bower uMeIoT HUSK MokasaTenb Svonorm4ecKol UeH- HocTu (~40); HexoTopuie apyrne VCTONHIKH Gena (Hanpymep, xenaTHH) MMeloT 610N0- Fnveckylo UeHHOCTs, paskylo 0. AMMHOKHC- AOTHBI COCTAB OTAeNbHbIX GenkoB, CocTaB- TSIOWWX PAyMOH NMTaHMA, ONpPegenneT O6- wylo Gvonormyeckyio WeHHOCTb AMeTEI. Cornaco RDA [pexomexpogaHHan cyto4- Han noTpe6HocTb (q03a)] peKomexayerca cMewakHan aneTa, uMeWoUjan 6uonorM4ec- kyl0 YeHHOCTD, paBHyto 70. Kup. Xupbi pacujennaiorea c o6pas0- BaHMeM XVIPHBIX KMCNOT MW rnMUepMHa. Ki- Pbi HEOGXOAMMb! Asn pocTa TKaHel 4 npo- AYKUAM rOpMOHOB. HaCbIUeHHBIe XKMPHBIE KVIGAOTbI, BXOARLIME B COCTAB KMBOTHBIX XH PoB, CoxpaHsioT TBepADe COcToRHMe npM KOMHaTHOl Temnepatype. PactuTenbHble >Xvpbl, CKMIONAA NanbMOBOe M KOKOCOBOe macna, np KoMHaTHOi Temnepatype MMe- 1oT KMAKOe COCTORHME; OHM COpePKaT BbI- COKNe KOHUeHTPALIMM MOHOHEHACbILLeHHbIxPAMEN 1. HAPYLIEHMIS| TMTAHMA Tasnvya 1-2. MotPesHocTh OCHOBHBIX AMMHOKHCHOTAX r/kt Macce! TENA Maanenupt Aen Tlorpestocrs (4-6 mecmues (10-12 nex | BaPocabte Treranmn 29 = = Visonetiunn 88 10 Jeu 150 4 Sinsnet 99 49 12 Mernonni w unotenn 72 esnnananny vw THposnt 120 Tpeown 4 30 7 Tpantopan 19 4 3 Bann 93 Boero Hesamennwsnx amnvoKnenoT (c+ 715 231 86 ksowaa rMoTAAMH) XMpHEIK KMCKOT WM NOMMHEHACKILIEHHEIX >XxPHBIX KUCNOT. Mpn YacTH4HOH rMgpore- HGaLIM HeHACDILIeHHBIX XP KACHOT o6pasyioTcA TpaHCxvpHbIe KMCNOTEI. Baxveliummn (acceHuvanbHbiMi) xKMp- HbIMM KncnoTamn (BXXK) aBnatoTca -6 (n-6) nuHonepan M ~3 (n-3) NMHONeHOBAA KHCSIO- tol. pyre -6 Kncnorel (Hanpumep apaxn- AoHOBaA KMcnOTa) M Apyrve -3 xMpHBIE kucnote! [aiikosaneHTeHosan (3iKosaneH- TaeHopan) KvcnoTa, 0KOsarexcoHoBan kvonoTa] TaKKe Heo6xopMMbl opraHvamy, HO OHM MoryT cvTesMposaTbcA 13 BKK. BXK Heo6xogmel ANA opmupoBaHKA PASNYHBIX HEHACBILIEHHEIX XPHBIX KMGHOT (oiiKosaHomnos), BKnIOYaA _NpocTarnaHay- Hbl, TPOMGokcaHbI, NPOcTALMKAMHE! H Nel- KOTpMeHI (cM. TakKe CTP. 24). 0-3 KMpHBIe KVCHIOTbI CHIDKAIOT PUCK NlopaxKeHVA KOPO- HapHoix aptepii. Nlotpe6HocTs 8 OCHOBHbIX XKMPHbIX KHC- norax pasnui4Ha B 3aBMCMMOCTH OT BOSpaC~ Ta. Bapocntim TpeGyetca konm4ecTBO NMHO- sieBoW KVCNOTHI, SkKBMBANeHTHOE NO KpaitHeii mepe 2 % ower norpeGHoCTH B kanopyAx, 4 AMHONeHOBOM KUCNOT! COOTBETCTBEHHO 0,5 %, PactuTenbHbie macna Goratbl IMHO FeBO MW MMHONeHOBON KncnoTamn. Macna, npowsseneHHble “3 wadpata, nonconHey- Huka, Kykypy3bl, COM, NIpMynbi, TbIKBbI Mt 3a~ PonbWWel MWeHMYbI, GoraTbl GonbWMM KO- AWHECTBOM sVHONeBO KuGHOTHL. >KMpEI MopcKolt ppi6bl v Macna, npovaBeneHHBIe 3 IbHAHOTO CEMeHH, TbIKBbI, COMM KOHON- 1M, 6oraTbl BONbLIMM KONMYeCTBOM /IMHONIe- HOBO KMCNOTbI. XKupbI MOPCKO! PbIObI TAK xe CHaGKAIOT OpraliaM B GONbUIOM KOsM- YecTBe HEKOTOPBIMM ApyTHM -3>KMPHDIMIA kvcnoramn. B CLUA rashum niujestim vcTOsHMKOM TPaHOAUDHEK KMCHOT sanHeTCR pacTTeN- Hoe Maco, nonyyeHHoe 8 pesynbTare rMapo- TeHUgauyin. TpaHOknpHble KMCHOTB! noBbILIA- loTxonecrepHk JIIH v noHioKaIOT xOMeCTEpMH JIMIB; oH TaKKe HesaBviCHMO yaennneaioT pIcK nopaxkeHia KOPOHApHEE apTepinih Maxpoanementsl. Na, Cl, K, Ca, Pu Mg Tpe6yloToA opraHvsMy 6 OTHOCHTeNbHO Gonbuix KonMuecTBax exefHEBHO (CM. TaGn. 1-3, 1-4 15-2), Boga. Bony otHocat k makponuratenb- HoMy BeulecTBy, TaK Kak e@ NoTpeOHOCTs MpM pacxone sHeprin coctasnaeT 1 Mn/ xexan (0,24 man/kaox), win npnGsinanTenbHo 2500 mn/nerb. Motpe6HocTs 8 Bone vsMe- HaeTOR NPM AMXopaKe; B TennOM Wn xO- SOBHOM KAVMATE; NPM BEICOKOH Mi HUSKOHt snaxHocm. MikPosneEMeEHTbI BuTamvioi M MMHepanbi Kak Mikpoane- MeHTbI TpeGyloTcA B HeGoNbWIOM KONMueCT- Be (cm. rs. 45) Bonopactsopumbimn BuTaMMHaMn 8- nmotca BYTaMVH C (acKop6MHOBAA KMCNO- Ta) M BOGEMb anleMeHTOB KOMMNeKca BHTa- nia B: Tani (auTaMne B,), puSodnaanH (ayant B,), HnkoTHHOBAA KucnoTa, npn AOKcnH (BuTaMMH B,), onneBaa KucnoTa, koGanamuu (BuTamuH B ), 6noOTHH M NaHTO- TeHoBaA KvCNOTa. K xmpopacTaopmmbim BMTaMMHaM OT- HocsToa peTHHon (sitTaMMl A), xoneKaNbuM- epon wn aprokanbumdepon (BuTaMMH D), a-ToKodepon (BuTAMMH E) M UNNOXMHOH 1 MeHaXvHOH (BMTaMMIH K), TOMbKO BATaMVHbL A,EWB akkymynpyiroa Ha cnyyaii shaun ‘TeNbHbIX VaMeHeHMi B OpraHnaMe.1, MIMTAHME: OBIE NONOKEHAA 5 Tasnnya 1-3, Maxpoanemenet (MMHEPATH) TintatenbHoe nets Wicrossinkn nonycnns yaxynn Ca Monoxo v npoayirit wonosHoro npo- | ‘opwuposanne KocTel u ay608, wexoxnenina, WACO, pba, Alta, Cpeproibakine Kposiy, HeFipoMycKynsp- xne6nbie snakn, 606%, pyKTbl, 080- | Has YyaCTEMTeNLHOCTS, MUILIEYHO® wa Coxpauierne, nposonMocr’ cepnes- Hot MouuUbt cl Bonbwmrorao ninuessxnponykros, | KncnoTHo-uwenosHoli Ganavo, ooMo- OCHOBHOM xnBOTHOTO NpOMCKOX- | TiRVeCKOe AaBneHMe, PH KpOBIK, (bYHIK- ‘eHMA, OnHAKO BCTpevaeTcA Ha He- | UMSITIONEK KoTOpHX oBoUIax; akanorimiHo Na K Bonbwnkorso ninwessxnponyxros, | MuiuesHar axTasHocTs, nepenava kniOvas UenbHOe H cHATOE MonOKO, | MMynbCa, BHYTPHKNETONHBI KACAOT Ganaitl, 4epHocns, MOM, Maco | ‘HO-WYeno¥HoH GanaHc, sanepxxa 80- Bt Mg Senene, opexn, xnebHbre anaKn, sep- | Dopmnposanne ay6os n KocTel, ne- a, Mopexas nia emava mMmynsca, MBIWeNHOe COKpa- eHne, akTHBaUne depMmeHTOB Na Bonbwnicrao nmuessxnponykros, | KycnoTHO-ulenosHoli Banal, ooMO- ‘aknovas rosAnMKy, CAM, Capny- | TiHeCKoe AaBneHe, PH KpOBIA, Mbt- Hb, CuIp, 3eneHbie OnMBHi, KyKypy3- | wesHoe CoKpameHNe, nepenata HM Hullxne6, Kaprodensibie ynncss, | nynbea, nonnepxaHne rpanveHTos: kpalwenyio kanycTy KNeTOUHO! MeMOpaH P Monoxo, ciip, waco, nomauunas nm | ‘opmnposaine syGos m KocTel, xc- a, poi6a, xieGiule snaKn, opexn, | OTHO-WMeno“HOM anak, BuipaGoTKa 60681 snepran OcHosHbie MnkpoonemenTeI BKIONaI0T oken€30, Hof, UMHK, XpoM, CeneH, MapraHeLl, Mosm6peH W Memb. Kpome xpoma, Kaxabilt W3 HWX BXOAMT B COCTAB cepMeHTOB MK TOPMOHOB, y4aCTAYIOUIWX B MeTaGonMaMe. 3a ncKnioyeHvem xkenesa M UMHKa, ReduyMT MvkpoMMHepasios B ripOMbILUNeHHO pagBhn- ‘TbiX CTpaHaX ABNEETCA PepKOCTHIO (cM. rN 4na orp. 32 urn. 5 Ha crp. 59). SvayeHne Apyrvx MuHepaviog ANA niopen (Hanpymep, anoMMHMii, MBIbAK, 6op, KO- Ganbt, Top, HuKenb, KpeMHMi, Baan) He goKasaHo. Drop, XoTA M He ABNAETCA OC- HOBHBIM MMKpooNeMeHTOM, yHacTByeT 6 npodwnaktuke Kapneca, opmupya KoMno- ant ¢ Ca, KoTOpsl cra6minampyeT MMHe- Panbryio Matpmuy sy608. Boe muKpoane- MeHTbI 6 OONbUMX KONMYECTBAX TOKCHHHbI, a HeKOTOpBIE M3 HX (MBILUBAK, HiKeNb M XpoM) MOTYT BbISBIBATb paK. AAPYrVE NIMWEBBIE CYECTAHLMK TunwyHbii cocTas nMuM, exesHEBHO: notpe6naemoi YenoBeKom, conepxut Go- nee 100 000 xmmi4eckd akTHBHBX BeLeCTE (Hanpumep, Kode conepxnt 1000). Ma HAx Tonbko 300 ABNAIOTCA NMTaTeNbHbIMM Be- lecteamn (HyTpHeHTaMi) M TosIBKO HeKO- Topble u3 HM HesaMeHMMI. Ho MHorMe BeuecTBa, He MMeIoUMe NuTaTenbHOH YeH- HOCTH, CONepxaLIMecA B NMUWeEBbIxX NPOAyK- Tax, MonesHbl. Hanpnmep, nnujesbie 10- Gaskn (KOHCepBaHTbI, SMynbraTopbl, aHTH- oxcupaHTbl, cTa6wnugaTopel) ynyswaior KaNeCTBO MPOAYKTOB MW Mx CTaOMNbHOCTS. Muxpoxomnoventst (HanpyMep, cneuvn, MHpMdepenTHbIe BeU\eECTBa, WaMeHAIO- ume sanax m akyc, apomar, Ber, xAMMYeC- KA akTMBHBIe BeUlecTBa pacTMTenbHOFO NponcxoxneHHA M MHOrve Apyrne ecTecT- BeHHble NpOnykTbl) ynyHwaioT BHEWHHi BM BKC NM. Kneryatka, BcTpevaioulaaca 8 pasni4- Hex dopmax (HanpuMmep, YeNmonosa, re- Muuennionosa, neKTHH, cMona), yonnnBaer nepuctanbtiky KKT, npenotapauaer 3a- Mop w yny4waeT TeveHWe AMBepTHKynesa. Mpennonarawr, 470 KneTuaTka yeennunsa- eT CKOpOCTb SAMMMHALIMA BeLIECTB, NpOAy- umpyembx GakTepuamn ToncToro KMWweY- Huka Cnoco6cTByIOWIMx pasBMTHiIO paka. Snupemmonornuecknmn MccnepoBaHiaMn6 PAMEN 1. HAPYLIEHMIS| TMTAHMA TaGnuya 1-4. PExoMEHAYEMOE COAEPKAHME’ B NMIJE HEKOTOPbIX MMTATEMIbHBIX MAKPOBEWJECTE (YNPABJIEHME NMTAHMA W MIMUJEBLIX NPOAYKTOB, HAUMOHANHAR AKADEMMS) ‘SuePrerH- Boaract | Benox | — veckas ansuna | @ocoor | Marina ATETOPHM Toa, 7 UEHHOCTE / 7 Mr/ kKan/ Hosopoxpex- 0,0—0,5 2,2 108,3 50,0 Hole 0,5—1,0 1,6 94,4 dem 1-3 100,0 61,5 61,5 62 46 90,0 40,0 7-10 714 28,6 28,6 Myxuittbt 11-14 26,7 26,7 0,9 45,5 18,2 18,2 40,3 16,7 16,7 49 36,7 10,1 10,1 29,9 10,4 10,4 45 OKeHUMHbE 11-14 47,8 26,1 26,1 21,8 218 55 37,9 20,7 20,7 48 34,9 12,7 12,7 29,2 12,3 12,3 43 Tipu Gepemen- 0,9 46 18,5 18,5 49 ocra Tip xopmine- tron, 1,0 79 19,0 19,0 54 wan ryt *PexomeHnyeMoe cyrowoe noTpeGneHe, supaNehioe KaK cPpenHEcyTO¥HOe noTpeGneHHe BTeYeHME ‘AawremsHoro BpeMeH n npenHasHa¥eHHoe fnR OBecreveHMA MHAMBHAYATEHOTO NMTAHMA Cpemy HaHOO- ‘nee snopoBux nonel, xHayuIMx 8 CLUA 8 OSH aKONOTMHECKAX yCnOBHEX. AOkaszaHa TeCHAA B3aMMOCBASb Mes pas- BuTHeM paka TONCTOMA KMLLKM M HIKSKHM rOT- pe6newmem KkneTaarkn, GnaronprsTHoe Boagelictene KneTuarkn Ha dyHKyMOHANb~ Hble paccTpolicTaa KMWe4HMKa, GonesHb Kpora (8 nepion pemuccni), oxnpeHie 1 remoppoii. Mepesapnsaeman KkneTuarka (Haxonutcn 80 pykrax, oBOUIaX, OBCe, AH MeHe GoGax) cHixkaeT nocTnpaHananb- Hoe TIOBBILIEHMe TniOKOSH M MHCyAMHa B KPOBM M CrOco6cTBYeT CHINKeHMIO ypoBHA xonecTepnna. Tunmsnbit paynon sananhix crpay npe- AycmarpueaeT HnaKoe NloTpeGneHHe KneT- 4arku (nipHGnnanTenbHo 12 r/cyr) na-3a Bbi- COKorO NoTpeGneHMA BbICOKOOHMUIeHHOM Myki, NWeHMUbI, HitgKoTO —noTpeGneHMA pykros 1 oBower. HactortenbHo peKo- MeHpyeTca yBenu4eHnve noTpeGnexna KneT- ark npuGnuaHTenbHo 0 30 r/cyT, 3a cHeT niotpe6newma Gonbwero KonmMvecTBa OB0- wel, pykroe m xneGHbKX 3naKOB C BbICOKHM COMepxKaHieM KeTYATKM. TPEBOBAHMA K NM TAHMIO Hannexaujee nuranne HanpaaneHo Ha AOCTMxXeHHe WM NOAAepxaHHe KENAaTesbHO- ro COCTaBa OpraHv3ama, a Take NOAeEpKa- Hive BbICOKOrO noTeHuMana ANA busM4ec- Koi MW yMcTBeHHOM paGoTbI. CGanaHcupo- BaHHOCTb nomy¥aemMo 9HeprMM = C Pacxonyemoii sHeprneit HeoGxogvma Ana Noggepxakna Maccei Tena. Pacxon sHep- TMM 3aBMeMT OT BospacTa, NoNOBOM npMHa- Anexnocta, seca (cM. Ta6n. 1-4), MeTa6o- muveckoi w guanueckoi aktaskocTa, Eon Nonyaemaa SHepria npeBbILIaeT pacxo- AYeMylO, TO NPOMCXOAMT yBerIM4eHMe BeCa. Ec notpeGnee sHeprMa MeHbule pac- xona, HaSmonaetca norepa aeca. Cyrouiie noTpe6HOCTH B OCHOBHENX nit TaTe/bHbIX BELCCTBAX TaKKE 3aBMCAT OT sospacta, NoNOBOM NpMHAReXHOCTH, Be- ca, MeTaGonm4ecKon m usn4ecKol aKTHB- HocTu. Kaxapie 5 net Ynpasnexve nuTaHna WnmuyeBbix npogykToB HaunoHanbHol aka-1, MIMTAHME: OBIE NONOKEHAA 7 nemvn Hayk/HauoHanbHoro wecnenoBa- Tembckoro coBeTa MuHMcTepcTaa CembckO- ro xoasiictea CLUA (USDA) abinycKaior pe- KOMeHAAUMK NO NMTAHMIO, BKOYaIOWMe PeKoMeHAyEMBIe —HOPMBI noTpeCneHAA Genkos, SHEPriH, HEKOTOPLIX BUTAMMHOB 1 miepanos (RDAs — cm. TaGn. 1-4, 4-2 4 5-2). JIA MeHee V3BeCTHBIX BUTAMMHOB 1 Miwepamios ykasaHa mx Gegonachaa 1 agexeatan cyTouHan notpeHocTe (cM rn. 4 ta6n. 5-2). Bepemenibie (CM. cTp. 2796) v mnageH- Upt (CM. CTp. 2892) vmetoT oco6Ie noTpe6- HOCTM B NMTATEMbHbIX BELUECTBAX. USDA nyGninxyet CrpasosHink rio nta- Ho, 8 KOTOPOM ykagaHO KoMMMeCTBO PeKO- MeHayeMoro e@xepHeBHOrO nocTynieHnA pasnv4HiKX rpynn nvweBbx Bewecrs (cM TaGn. 1-5 1-6). HekoToptie averonom pe- KomeHayior noTpeOnsT» Gonsuee KonMNeC Tao ébpykroe v oBowiel. Ans NoKUABIX s10- Tasnvua 1-5. PasMeP noPunit Tawesas tonne PasmeP noPunn Xne6,xne6- | 1 nownmxxne6a Hie anakh, 1 yas" roroasixx ynoTpe6- pve wwaxapo- | neHiio xneGHBXx anakos Hes 1/2 4auikia npuroToaneHHeNx xneGubnx anakoa, puca win maKapou ‘Opycres ‘3/4 vauukn ébpyxtosoro coxa ‘ cpentee aGnoKo, Ganat wna anensowt 1/2 vauikn py6neHbix, npAro- ‘TOBNEHHbX HiMM KOHCEPSHpO- BaHHbIx bpYKTOB: Maco, nomau- | 1/2 wauKu npnroTosnesib Has Tua, ‘oywienix 60608 pui6a,avua, | 2-3 yHUAM npHroToBNeHHOrO ‘eyweiie 6o- | nocTHoro waca, gomawiiedt 6uinopexn — | nTmubi nnn puibeL (1 ayo wan 2 cr. 1. apaxnco- Boro waCna COOTBETCTEYIOT 11 yaa nocTHorO Maca) Monoxo, fio | 1 waka monoka wnn HorypTa ryprn cup 41,5 yuna HaTypansHoro Cupa 2ysumn nnaaneHoro csipa sou ‘3/4 vauKn oBoulHOrO coKa ‘Yaka CBeXMx NACTBEHHX onowett ‘/2sawKn npyrix oBowel, 82- eHbixnnn cBeKeHapesAHHEN *1 yuu — 28,349 r, (Mommeu. peg.) net, na KoTopbix cyulecTayior oTAeNbHBIe ninwjeebie TpeSoeaHis, Guia coanara oTZe- moka cnpasosHas nixpamnga nin (CM. pic. 1-1). AnekaaTHbil npieM xuaKOCTH s8- JIAGTCA OCHOBON STO NupaMVyAl. Kupbl AOMKHE! COCTABNATe oKONO 30 % o6ueh xKanopviiHoctn, HacbiMjeHHbIe ‘TpaHOKMpHble KuUCHOTEI — MeHee 10%. JIAu- Hee noTpeGneHve xnpos, 8 TOM Hine HacbI- UIeHHi, NOBEaeT prick pasBHTUA aTepocK- neposa. SameHa HaCBIU|eHHEDX XMpo8 ont- HeHACbILICHHBIMM §XVIPHBIMM—KMACAIOTAaMIA MOXET YMeHbILMTS BEDOATHOCTS BOSHHKHO- selva aTepockneposa. OGbHHOe HCTon30- Bale NMLYeBbIK AOGAEOK He sianeTCR HEOO- XOBMMBIM ATMA ONESHBIM; HEKOTOpBIE 0- GaeKn moryr ObiTb BpenHbiMn, NTAHME B KSIMHMYECKOM MEAMUMHE Aednuvt nuratenbiix Beujecta MoxeT BUISHIBATH YXYAWEHNE 3AOpOBb (Ha HOHE sa6oneBaHins Win 6e3 Hero), B CBOIO O4e- Peab HeKoTopbie naTonormHeckne cocToA- hus (HanpaMep, Manba6cop6una) Moryt BUBBATS AEHVIIMT NMTATENbHEK BEUIeCTB. Kpome Toro, mHorme nauexTb! (HanpyMep, NOXMNbIe NayWeHTel Mp OKCTPEHHO! roc nivTanwsauy) He NoAospeBAIOT O AedHUN- Te numTaTenbHbx BeWYeCTB, TpeByIOW\eM He- oGxonMoro neveHNa. MHorve MenMuWHC- kve UeHTps pacnonaraioT —rpynnama NloproTOBNeHHEK cneyaNnoToS — epavei, mencectep, spaveli-aneronoros u dapma- WeBT08 ANA NOMOUIM KMMHMYNCTAM B NpO- qunaxrnke, qarHOCTHKe WM seNeHMN CKpbi- Tox AedMUMTOB NVTATENbHbIX BELIECTS. VannwHee notpeGnenne nium Moxer npwgecti K xpoHnueckw sa6onesaHnam, TakviM ak pak, rMnepTOHNA, OxMPEHMe, Ca- XapHiili qMaGeT M NopaxeHiNe KOPOHApHbIX aprepiii. Avemyeckne orpannuennn Heo6- XOQMMBI Np MHOTMX HAGHeACTBHHBK Me- TaGonnueckyx saGonesaHvx (Hanpvmep, ranakTosemns, (beHAnKeTOHYpIA). QUeEHKA nMTAHMA Tokaganiin aia OueHKM xapakTepa niuTa- HMal BKTIONAIOT HEXENATENHYIO Maccy WAM opmy Tena, nogospeHne Ha onpeneneH- Hbllt Ae MUMT WN TOKCHYHOCT OCHOBHEIX TIMTaTeNbHbIX BELYECTB, a TaKKE y HOBOPOX-8 PAMEN 1. HAPYLIEHMIS| TMTAHMA Tasnnuya 1-6. KonmvecTB0 EXEAHEBHO HEOBXOAMMbIX NOPLMit h Yous KANOPMi (xan) MMERAS rPyTIA ‘oxono 1600 coxono 2200 oxono 2800 Xne6 6 9 ch ‘Opyxrot 2 3 4 Monoxo 2-3 Maco. 2 (o6wee, 5 yHunii) 2 (o6wee, 6 yHunid) 3 (o6wee, 7 yHuni4) Osown 3 4 5 Bepemenitie, KopMaUIMe rpyAbiO XEHUIMHEs, NOAPOCTKH M KOHOWH (0 24 net) HyKAAIOTOR B 3 nop- yuan. AeHHUK M AeTel sanePXxKy pocTa HK pas- syrua. B TO Xe BpeMs xapakTep nvTaHKA AOMKeH ObIT OUEHEH KaK 4aCTS KAMHMHeC- koro o6cnefoBava MilaneHues MM peel, NOXMAbKx Monel, a TaKKe JMU, NPMHMMAIO~ Ux HECKONBKO BHAOB MeKapCTB, monet c TicMxnuecKMMM paccTpoiicTeaMn M NayMeH- TOB C CVCTeMHbIMM 3a6oneBaHnAMn, ANA- umes Gonbule, 4eM HECKOMbKO QHei. Ouerka o6wero xapaktepa nuraHna BKNOYaeT aHAMHes, usvkanbHoe o6cre- AOBaHve, a MHOrAa HeKoTOpHe TecTbI. Ec wmeeTcA nopospeHne Ha HenocTaTouHOe NMTaHve, To NPOBO_ATCA NaGopaTOpHbIe Mc- cnenosakns w onpenenexne Typropa KOxM (om. crp. 13). OyenKa opmsi Tena ucnonb- 3yeTCR ANA OUHKM cTeneHA M KaYeCTBa oxnpeHns. ‘AvamHes Bknio¥aeT onpoc o notpeGne- HAM NpoAYKTOB NuTaHMA, MIMeHEHMN BeCa, aktopax pucka AedvuyyrTa nMweseix npo- AykToB 4 O6wero ocMoTpa No opraHam W ‘cuctemam (oM. Ta6n. 2-1 Ha orp. 16). Qive- Tonor MoxeT nony4wTb Gonee AeTanbHBIe cpeeHia No aHaMHesy nvTaHi. AHaMHeS OBbIYHO BKAIOYAeT CNUCOK NPOLYKTOB nuTa- Hus, CbeneHHbXX 3a NocnenHHe 24 Yaca, M @HKeTHBIA ONPOC NayneHTa O noTpebnAe- Mbix nponykrax nisTaHisl. MoxkHO Vicniomb3o- BaTb CheyMabHbii AHEBHMK, 4TOObI AeNaTb 3anvicn 060 BCex CbeDeHHEK NMUleBbIx NpO- ykrax. CaMbIM TOHHbIM OTHETOM JIA OUCH kv paunova nvTaHMA ABNAETCA BSBEWEHHAA cBo6onHan aveTa, npn KoTOpol nayveHT ‘ganncbiBaeT Bec M BCe NoTpeGnAeMbIe Npo- AykToI nuTaHAA Donxto 6tiTb BbinonHeHo NonHoe uan- kanbHoe O6cnenoBaHMe, KOTOpOE BKMIOYAeT onpenenexve pocta, seca u pacnpenene- He xXvpoBol TkaH, MHeKc Maccbl Tena (AMT) — sec (kr) / poct (m)* onpenenser ‘OTHOWeHMe Beca K pocTy (om. Ta6n. 6-1 Ha Tp. 73) Gone TONHO, Ye Ta6nMUp! pocTa M seca. CyujecTeyloT onpenenenHbie craH- AapTbl yBenMeHHA pocTa M Bea MNaneH- ues, AeTelt v nlonpoctkos (om. ctp. 2934). Baxxo yunTbiBaTb pacnpegeneHve xVpO- Bolt TKaHM B Tene. J\vcnponopynoHanbHoe ‘oxupeHime TynoBMula (T. @. OTHOWeHKE Ta- svs/6enpo > 0,8) accounmpoBaHo c cep- AesHO-COcyAVCTRIMN Mv YepeBpanbHO-Bac- KYAAPHbIMM paccTpolicTBamM, runepToHnelt v caxapHbim nva6eTOM Naule, 4eM oTNlOXxe- Hive XMPoBO! TkaHM, PacnonOxeHHOM B Apy- Tux Mectax Tena. CyuectayioT onpeneneH- Hble MeTonbI OUeHKN PacnpeneneHiA xMpO- Bolt TkaHHM B Tene: TOMLIHa KOXHOM CKNAAKM Monpenenenne 6noaneKTpHYecKoro conpo- ‘TwpneHina (OM. Crp. 73). B3AMMOPEWCTBME NMTATESIbHbIX BEWECTB C MEAMKAMEHTAMM Mutatenbiibie BeuecTea MOryT V3aMeHsT ‘acbdekr nekapcreeHitinx npenaparoe; M, Ha- oGopor, nexapcrseHibie npenaparei oKasbi- BaioT envsHine Ha nitTaHve. MvujeBbie Npo- AYKTH MOryT yBenMuNTe, aanepxate Win YMeHbITS BCaCbIBaHKe eKapcTBeHHOTO npenapara. Mmwesbie nponykrst yraeTait a6cop6ymo MHOrMKX aHTH6KMOTHKOB. OHM MOTYT W3MeHMTb MeTaGONIN3M NeKapCTB; Ha- npnmep, 6orarbie GenkaMn nvueable Mpo- AYKTHI MoryT YCKOpHITb meraGonnaM onpe- AeneHHLKX NeKapCTe, CTAMymMpYA WIATOXDOM P-450. Notpe6neHne rpelinhpytoe MOKeT wura6poBate ynToxpoM P-450, samen mera6onvam Texxe /ekapCTBeHHby npena- patos. MutatenbHble BeUlecTBa, KOTOpbIE aniaioT Ha GakTepvanbHyio ¢iopy, Moryt1, NMTAHVE: OBLIME NO/OXEHMA Kapropen Bens puc Bani xne6 >kupioe msico Kopiesnepsil pc SE Osorawienrtie xnebHe LE ma Pwo. 1-1. Exeqnestas nupamina nM Ans nOKHTEKX mone.10 PAMEN 1. HAPYLIEHMIS| TMTAHMA SHA4MTENbHO BAMSITb Ha O6LM MeTaGOnIM3M onpeneneHHbx neKapcTBeHHbix npenapa- Tos. HeKoTopbie onpepeneHHble NPOpyKTel NuMTaHMA BAMAIOT Ha AelicTBHe NeKapcTBeH- Hex npenaparos, Hanpmmep, THpamni, KOMNOHEHT Cbipa M MOUHIM BASOKOHCTPUK- TOP, MOXET BbISBATb FMnePTOHHYECKMAH KPMS y HeKoTOpbKX nauMeHTOB, KOTOpHIe NPM Mal0T MHTMGMTOpEI MOHOaMMHOOKCHa3bI M ynoTpeGnsior B NMUy Chip. edu HytpveHTos MoxeT nosnwaTe Ha BCacbiBaHe M MeTa6onM3M nexapc- TeeHHOrO Npenapata. Taxenbii DednunT ‘Heprni H Genka yMeHbWaeT KOHYeHTpA- MIO TeaHeBbx epMeHToB M MOxeT Hera~ TWBHO NOBAMATS Ha NelicTBHe NeKapCTBeH- bx npenapaTos, Hapywan aGcop6ynio MM arperausio Genkos, BbIsbIBaA AUCYHKLWIO nevenn. Vamenexua 8 XKT moryt Hapy- WaTb a6copG6ynio u yrHeTaTb AevicTBMe Me- aAvkamerta. Leduynt Ca, Mg wan unHKa HeraTuBHo BniaaeT Ha MeTa6onnaM neKapc- TBeHHBX npenaparos. DeduuytT BMTaMHHa CC yruetaer aktveHoctb epmextos, meTa- Gonnanpyiouwx MennKaMeHTsl, OCOBeHHO Y MOxunbIx monet. BonbwmHcTBo siekapcTBeHHbx npenapa- TOB BAWIOT Ha anneTMT, BCacbIBaHMe NMTa- TeNbHbIX BELECTS M TKaHeBbI MeTa6ONM3M (cm. Ta6a. 1-7). HeKoTopsie npenapato! (Hanpymep, MeToKnonpamua) ycunneaioT nepnctanbtuky XKKT, yMeHbuan a6cop6- uWio nuraTenbHbX BeulecTs. Apyrue npe- Napatel (HanpHMep, OnvaTbl, aHTHxonM- Hepruyeckwe Nnpenapatbl) yrHeTaioT ne- pucranbriaky XKKT. Hexotoptie npenapatel BrnaioT Ha Me Ta6on“3m MuHepanos. Hanpumep, Mo4e- FOHHbIe Npeniaparbl (B nepayio O¥epenb, TMa3MpbI) HM FHIOKOKOPTHKOMAbI yMeHbWuA- oT conepxate K B opraHname, ysenH4n- Basi BOCNPHMMMHBOCT K AMFOKCHH-HHAY- UMpOBaHHbIM = CepgesHbiM apuTMusM. MuoroxpatHoe wcnonbsoBaHne cna6u- TeMbHbIX Take YMeHbWaeT COnepKaHHE K 8 opranuame. Koptuson, AesoKcnkop- TMKOCTeDOH H afibgoCTepOH yBenM4nBaioT cogepxanue Na m 3agepxky BOAb! B Opra- HigMe, no KpaiiHelt Mepe, BDeMeHHO; 3a- Aepxka Bont! HaGniopaeTcA sHaNMTeNBHO MeHbUJe pM NPMMeHeHHM NpeAHHsONOHA W HeKOTOPBIX APyrMx aHanoros rMlOKOKOP- Tukongos. KoMGuHmposanible acTporeH- nporectepoHoable opanbHbie KOHTpayen- TMBBI TaKKe YBENMHNBAIOT KOHUEHTPALWO Na m 3anepxky Bob! 8 opraHnane. Mpe- Tasnmua 1-7. Brwave MEQMKAMEHTOB HA MMTAHME Sooext MequKaMenT Tloswenne annerara ‘AnKOrOnb, AHTMTMCTAMMAHIe, THOKOKOPTHKOHAL, ApOHAOMHON, MHCYTIH, erecTpona aueTar, MMpTaanitH,ncwxoTpontile npenapars, Cynbibo- HMnMo4esnia, ropMOHL LIFTOBAAHOM Kernestt Chvoxerie annerara ‘ArTMBnoTinK#, cuinysne peareHTel (eTHnYennionosa, cwona ryapO- Baa), unknodbocrpann, AMTOKCHH, rnioKarOH, METHAZION, MOpIMI, sbniooxceTm Cioxenne aGoop6unnxn- | Opnnctat OB Yeennvenve yposisrnoxo- | OxtpeoTmg, onvaTs, cbeHOTHASHHE, bEHMTOMH, NPOBeHEUMA, THAINA- ‘3618 xpoan ule QuypeTuKu, rmOKOKOPTAKOMAL, Bapm>apHH Chioxenine ypost rmokoasi | Acnuptn, Gap6uryparts, B-GnoxaTopsi, wiruOuTopsi MoHOaMMHOKCH- 8 xpoBH ‘hast (MAO), opanbHble aktmnaneprnvkemmueckve npenapattl, dena YeTHH, beHAn6ytasoH, cynscboHUnaMiab! Ciioxene ypostxvpos 8 | Acnupwn v 5-amwiocannuvnosas xvcnoTa, L-acnaparwHasa, xnopTeT- nnaswe aUKMiH, KOMAMUMAH, AeKCTDaHL, rmIOKATOH, HYKOTHHOBAR KhcnOTa, exnnoyion, crarHH, cynednHnitpasok, TpMKdnonepAAON Yaenmvenve yposr xnpoB 8 | HafmnovesHAKOBLIe rmiOKOKOPTHKOMAS|, NOPNPOMASHH. STSHON, FOP nnaame MoH pocTa, opanbibie KOHTpaLIenTMBHl (KOMOMHMpoBAHHBie acTporeH- porecrepows)), Thoypaunn, BxTamint D Cunxenne weTa6onvama | Xnopamcbenkon, TeTpaunKnini Genoa1, MIMTAHME: OBIE NONOKEHAA " Napatbl cyAbOHMNMONEBMHbI WM AMTHR MOryT yrHeTaTb HaKoneHMe M peanusa- unio Tioga WwHTOBMAHON xenesoi. Opanb- Hble KOHTpaulentTHBbI MOYT CHIDKATb YPO- BeHb UMHKa B TIa3Me M NOBBILIATS YpO- BeHb Mea. Onpeneneniie npenapatel snusiot Ha a6cop6umio u MeTaGonv3M BuTaMMHOB. ‘StaHon wHrMGupyeT yTHnMsayni0 THaMn- Ha, HapyWaeT COeqMHeHHe W30HMasHAA C HuKOTHHOBOM KucnoTOM mM MeTa6onvam NMpMAOKCHHA. StaHON M OpaNbHble KOHT- Payentueb! GnoKupyioT abcop6unio dona- Toe. ¥ GonbwHcTea nayneHToB, NPM MajOUlMx eHMTOMH, deHOGapGuTan, npn- MMOH Wim deHOTHaSHHBI, pasBuBaeTcA Aeduynt donara, BbiaBanHblli, BepOATHO, NOBPEXAEHMEM MIMKPOCOMANbHbX neve- HOMHBIX epMeHToB, MeTabonnsmpyloUynx AavHele npenapatsl. Jo6asKn, conepxa- ume onarbl, MOryT GHUKaTe adceKTHB- HOCT NPOTHBOCYAOPOXHBIX Npenapatos, HO BeWeCTBa, BXOAALMe B COCTAB APOx- >keBbIX Npenapatos, No-BMAMMoMy, yBe- AMNMBaIOT ypOBHH donata Ges CHWKEHHS addextusHoct. —MpotusocynopoxHbie Npeniaparel MOryT BbIsBaTS NEDMUMT BATA minha D. CHikeHie BCacbIBaHA BATAMMHa B,, MOxeT HaOniogareca npM npmMeHeHnn AMMHOCANMUMNOBO KMCNOTbI, MezeHHO BcacbiBaloweroca HogMcToro K, KONXMU- Ha, TpadsoonMposnHa, aTaKONa M Opanb- Hbmx KoHTpayentHBoB. Opanbible KOHTpa- UenTMBbI ¢ BBICOKHM COnePKaHHeM mpo- TecToreHoB MOryT abiaBaTS nenpeccHto, BepOATHO, W3-3a AeduunTa TpuNnTodaKa, pagevsaiowleroca npn meta6onname npe- napatos. Ha metaGonvam nuTatenbHbix BeLeCTB Takxe MOTYT BhMsTS M Apyrue AMETHHECKHE cyGcraymm. Hanpwmep, Ha BcacbiBaHne >xemiega, He BXOAALIerO B COCTaB reMa, OKa~ SbIBaIOT BIMAKME MHOTMe NMTATeNbHbIe BE- ujecTaa, cnoco6cTayioue cHiDkeHHIO WM, HaoGopor, nosbiWweHHio a6cop6ynn (cm. orp. 1322). TIMLJEBbIE JOBABKM WnPMMECK Ao6aakn — xnmuieckne seulectsa, CMewaHHBIe C nMuleBbIMM nponykKTaMM C uenbio o6serHeHis O6paGorKi, xpaHeHia wn noBbieHHs ux opraHonentHyecKHx csolicts. Tonbko Te no6askm, KoTopbie Npownm onpenenenibie na6opatopHbe wccneposakna, paspewenb! K HCnONb3O- BaHMIO B KaYECTBE MIMULeBLIK. CooTHoulenne BbironHOCTH no6aBoK (Ha- NpMMep, YMeHbUIeHKe OTXoROB, yBennue- Hue pasHooOpasna nMUeBbX npopyKToB, npodwnaxtnka nMujeBbxX OTpasneHHi) w PUCKOB OeHHTb AOCTATONHO cAOXHO. Ha~ NpMep, HUTpHT, KOTOPbIA MCnOAbayeTCA B KoHCepsHpoBaHHoM Msice, npenoTapaujaeT oct Clostridium botulinum v ynysuiaer apo- Mar. OgHaKO HIMTpHtT KOHBEpTHpYeTCA B HAT- PosaMMHBI, KOTOPHe sIBNAIOTCA KaHUepO- TeHHbIMM BeU\eCTBAMM AA xMBOTHEIK. C Apyroii cToponts, KonMYecTBO HHTPHMTa, 1O- GaaneHHoro K KOHCepBMpOBAHHOMy Macy, BNAETOA HEOONBLIMM M0 CPaBHEHMIO G KO- AMHeCTBOM HUTPATOB, CONePXALIINXCA B eC- TeCTBeHHEIX npOAYKTaX UM NpeBpALYaiowUMxcA 8 HMTHT Nog AeiICTBMEM CHOHHEX Kens. Buramun C nvm MoxeT yMeHBUMTb O6pa- soBaHve HMTpHTa BOKKT. Penko HeKoTopLIe poGaakn (HanpuMep, cynbOvTbi) BbIabIBaIOT TwnepsyscranTenbHble peaKumn (nMUeayIO annepriio). BONbwMHGTBO peaKuiAi BbIaBa- Ho OBBINHbIMM NHUeBLIMM nponykTaMl (CM. orp. 1751). Tpumecu wxorga He Moryt 6biT® nonko- cTbIO ynanenbl Ges paspyweHna nHweBbix nponyktos; Takum o6pasom, orpaHnueH- ble Wx KonMYeCTBa paspeLieHts. OCHOBHEI- MM NIpMMeCEMM sBnAoToR — necTMUMpE!, Taxenble MeTaiibl (CBMHeU, KanMii, PTYTE), HimTpaTts (B SeneHbIX NMCTEAK OBO- weit), anaroKcnes (B opexax M moroKe), POCTCTHMyAUpyIOU\Me TOPMOHE! (B MONOY- HbUx NPOAYKTAX M M*—IGE), BONOGEI KABOTHEIX w dekanin, a Takxe 4acru HaceKoMBIX. Yn- pasnenme no nMujestim nponykTam H Me- Aukamentam CUA (FDA) paspa6orano Gesonackbie ypoBH npMMecelt, He abiabi- Balouyyx sa6onesaHna unm KeGnaronpusT- Hele BrinsHMA Ha miomel. OAK, KaK 6biN0 NloKasaHo, COOTHOWeHMe MexKAY YpesBbi- aitHo HnaKMM ypoBHeM BospeiicTavA M He- GnaronpuatHuimn addexraMn pocTaTosHO CAOXHO OYeHMTe; HONrOcpoYHbIe NO6O4- Hole odepexTbl MX, XOTA HEXeNATENbHBI, HO BoaMOxHbI. Besonachble ypoBHH YacTo on- PefensioTCA KOHCeHCYCOM, a He BeCKMMA AoxagatenbcTeamn.12 PAMEN 1. HAPYLIEHMIS| TMTAHMA 2 - HEAOCTATOYHOCTb NMTAHMA Henocrarouxocts nutaHus — ofHa Ws opm Hapywenna nutans. Hepocta- TouHoe nMTaHMe MOXeT SBNATECA pe- synbTaToM HeageKBaTHOro noTpeGne- HVS NMTaTeNbHbIx BewecTB, Manba6cop- Gum, HapywexHoro MmetaGonusma, noTepH HyTpHeHTos NpM NoHOCe MnM npH YBenn4eHnn notpe6HocTH B nue (KaK GbipaeT npu pake unv MHdeKuMn). Hepo- CTaTo4HocTs nMTaHwA nporpeccupyer MocteneHHO; OGbiMHO KaKan cTaqMA SaHMMaeT MpoAOMxHTeNbHOe BpeMA, 4To6bI pasBuTbcA. CHayana MsMeHsIOT- GH YPOBHM HYTPHEHTOB B KPOBM M TKAHAX, 3aTeM MPONCXOAAT BHYTPHKNeTOYHBIE VSMeHeHHa B GHOXAMMYECKMX yHKYWAX w cTpykrype. B KOHe4HOM cyeTe, nos: ASKOTCA NPMSHAKM M CHMNTOMBI @axtorbl PCKA HegocratosHoe nvTaxne accoynmposa- Ho co MHoruMn paccTpolicreamn v o6cToR- TeNbCTBAMM, BKsOYaA GeAHOCT M COUMalb- Hble GepcTema. Puck ero BOSHMKHOBeHMS Take Gombe 8 OnpefeneHHble Nepvoptt BpemeHn (8 mnageHvecTBe, pakHem fe- ToTse, nyGepratom nepvone, npn 6epe- MeHHOCTH, KOpMneHHMn rpyAbio, B CTapyec- kom Boapacte). Mnagensectao u AetcTao. MnageHubt MW feTH OcOGeHHO 4yBCTBMTeNbHbI K HEAO- CTATONHOCTH NMTAHMA 3-34 MK BLICOKMK NotpeSHocTeli 8 akeprin n HeoBxoAMMbKx numarenbHbx BeulecTax. Mpv aednuwre ByTamniia K y HOBOPOXAeHHEIX MOXET pas~ ByTbcA remMopparMyeckan GonesHb HOBO- POXAEHHEIX, ONacHoe ANA XxM3HH pac crpoiicrso (cm. orp. 57). Y mnageHua, ‘BCKapM/IMBABLUCTOCA TONbKO rpyAHBIM MO JIOKOM, MOXET PasBUTbCH AeDMUMT BHTAMM- Ha B,,, ECM Mats — crpori perevapvaneu, Hegoctato4Ho 4 HenOnHOUeHHO NMTaIOWWY- cA M/ayleHUbl M eT NoABepraloTCA PUcKY BOSHMKHOBEHK'A Y HX GenkKOBO-sHeprem- YecKoii HeocTarounocTy, nedvunTa xene- 3a, onvesol KucnoTE, BATaMMHOB A uC, Mea v unika. B TeveHne nyGeptatHoro ne- pvoga yeenmuneawTca noTpeGHOCTH B niM- le noTomy, 470 Temn pocra Bcero opraHva- ma yoKopseToa, HenocTato4HocTs nMTaHiiA Yy AeBONeK M IOHbIX AeBYLWeK MOXeT GbITb ‘o6ycnosnexa xapakrepHoii Aa HX HeBpO- reHolt aHopeKcneli (cm. crp. 2206). Bepemenvocts 4 Kopmnenve rpyabio. Tlotpe6Hoc™ 8 nwTaTenbHbIK BeLecTBAX yeenmuneaioroa 8 nepnon GepemeHHOCTH 1 KOpMneHvA rpyabio. B TeyeHve GepemeH- HOCTM MOryT BCTPe4aTBCA OTKNOHEHMA OT HOpMambHOM AMeTEI, Bkniovan VaBpaUyeH- Hoi annetuT (noTpeOneHve HENMleBbIx Be- wecTs THNa riMHbl M aKTMBMpOBAHHOrO yr- na). Dloctarosno pacnpoctpaxera xene3o- AednuntHaa aHeMinA, Tak xe Kak MM onnesoneduutHan aHemua, ocoGeHHO pean >xXeHUIMH, KOTOpBIe —NpHHMMarM ‘opanblble KOHTpalerTvBbl. Crapyeckuit sospacr. Crapexne — naxe Kora Gonestb win pedvuyrr nutTaHiia oTCyTC~ TByIOT — NpMBOAMT K GapKoneHHn (nporpec- ‘cnpyioueli noTepe MbIe4HOH Macc Tera), KoTopas Haunvaercs nocne 40.ner u, BKOHeY- HOM ceTe, BbIPaKaeTCA B NoTepe npH6nVsn- TenbHo 10 kr (22 ¢ynTa) MbIeHHOM Maccel y Myxuni 5 kr (11 yHTOB) yKeHLLMH. TDMA HbI 3TOrO 3akmIONAIOTCA B YMEHLILEHHA Va eCKOMi aKTMBHOCTH H noTpeGneHVA NMUY HB YBeNIMEHMIM YPOBHA UATOKMHOB (OcoGeHHO viTepnevixnna-6). ¥ MyxaMH NpVMHOIA cap- KONeHMM sIBAETCA TaKKe Mi yMeHBIeHHE yposHa aH~porevos. MIpn crapeHin cHWKa~ foTCA VHTeHCMBHOCTh OcHOBHOrO o6MmeHa (rnapHbim 06pa30M, 13-3 CHMKEHKI HEXM= oso! MaccbI Tena), Guan Macca Tena, pocT, Macca ckeneTa noBbiWaeToA cpepHAA Mac ‘ca xvpa (8 npoueHTHOM ConepxaHIM oT Mac- col Tena) npvGnvavTensHo Ha 20—30 % y Mypkun 1 27—40 % y KeHUI Haynnas c 20 net w ennotb A 80, cHwKa- eTcA rloTpeGneHne NMUyA, OCOBRHHO y Myx uw. AHOpexci™ 3-34 camoro npoyecca CTapeHif MMeeT MHOTO MIpM¥MH: CHMKAeTCA apartveHoe paccna6neHne aHa xenyAKa, YyBeNM4NBaIOTCA CeKPELIMA M AKTBHOCT XO- JIRUACTOKMHWIHA, KOTOPbIM BLISLIBACT 4YBCTBO HaCbiLeHHA, M yBenHuMBAeTCA BbiAeneHHE mentiva (aHopeKcureHHBili rOpMoH, BbIpa- Gareipaemei”i apynountamn). MoHiMKeHHbIe OGOHAHMe Mi BKYC YMeHbUIAIOT YAOBONBCTBMe OTNIpMeMa NMWM, HO OBbIHHO sb HesHait~2. HEMOCTATOYHOCTE NMTAHMA 13 ‘TenbHO CHWDKaIOT KONIMNECTBO NoTPeBnAEMON TMU. AHOpeKcHs MOXET MMeTb APYTHE NPM “Hb (HaNPMMep, OAMHOYECTBO, HEBOSMOK- HOCTb KyNWiTl NPOAYKTE! M NPMTOTOBMTb eAY, AeMeHUMA, HeKOTOpIe XPOHMHeCKMe pac- Ctpolictsa, ynotpeGnexwe HeKoTopeK npe- naparos). THnw4Han npH4nHa HepocTaTON- Horo miraHisa — fenpeccna. Mnorna ene NpensTcTayior HesporeHHan aHopeKcHA, Na- PaHoliA WAM MaHMakanbHbIe COCTORHIA. [pO Gnembi c ay6amn orpaHvuneaioT cnoco6- HOCTe XeBaTe M BNocNeACTENN nepeBapn- BaTb MM yCBaMBaTb Ny. PacnpocTpakeHHon TIPMMHO! ABNAIOTCA M TPYDHOCTH C rnoTaHH- em (Hanpumep, 13-3 npvnaaKoB, HHCY! ToB, Apyrix HeBpoNorMyeckMx paccTpolicTs, KaHpMAosa NMUeBOAA WM KCepocToMM). Benpocts uni dbyHKuMoHanbHble HapyLieHiss orpaHitweaioT gocTynHocTe noTpeGneHna NMTATeMbHEIX BELIECTB. TlomewenHbie 8 Joma Ana npectapenbix ocoBeHHO nopBepxeHH PUCKY PAsBMTUA y wx cHHApoMa GenkoBO-sHepreTu4ecKon Hemoctato4Hocrn (BSH). OHM YacTo 1e30- PWeHTHPOBaHbI M He CrOCOGHE! BbIpasHT., TO romogHil Wn Kakve NMUJeBbIe NPOAYKTe! OHM npeANONTaIOT. OHH MoryT BbiTb (busH- eCKM He CnlOCOOHbI NPMHMMaTe nMLly CaMo- crosTenbHo. XKesanne win roraHne y HAX MOTYT 6biTb O4€Hb MeATeHHEIMN, M ANA ADY- FOr YenOBeKA CTaHOBHTOA YTOMMTeNbHbIM HaKOPMMTb WX OCTATOYHBIM KONMYECTEOM nu. HegocTatouHoe norpeGneHMe um cHH- >keHHOe BCACHIBaHHe BHTAMMHa D, a TaKKe Hepoctaro4Hoe npeGbiBaHve Ha cONHYe npwBogat k OcTeomManauMn (CM. cTp. 49). Paanwunble paccrpoiicrsa 4 MeaN- umHcKwe npouenypel. JMaGer, HeKoTOpEIe xpoHieckwe pacctpolicraa KKT, pesex- Ui KKH, HeKOTODEIe APyTHe xupyprH4eC- kne sMewiaTenbcTBa Ha KKT BefyT K Hapy- WeHIIO BCACbIBaHMA XmpopacTBopAMbx ByTaMMHos, B4TaMMHa B , Ka/ibuMa HM xKeNIe- 3a, [nioTeHogaa sHTeponaria, HepocTaToH- HOCTb NOgKeNyAOYHON KeNesbI WM ApyrVe Pacctpolicrsa Moryt npusecth K Manba6- cop6unn. CHWKeHHOe BCaCLIBaHMe MoXeT cnoco6ctaosats xenesopeduumy M ocTe- onoposy. MopaxeHns neveHn ocna6nsioT HakonneHve BuTaMvHoB Av Bu npenato- TeyioT MeTaGonvamy Genka 4 MCTOYHMKOB ‘oHeprnn. MoyesHas HenOCTATONHOCTe ABIA- eTca npeppacnonaraiowmm akTopom Ae- cbvura Genka, xenesa m sitamuna D. Mot- peGnenve HeaneKsaTHbIX KONMYeCTB NM MOXET SIBTBCA PesysibTaTOM aHOpeKHH y GonbHbix pakom, Aenpeccueli, CriMflom. Vinebexuwm, Tpaema, runeprupeos, oGwnp- Hele OXOTM M ANIMTeNbHaS NHxXOpapKa yaen- unpaioT MeTaGonmueckve notpe6HoCTH. Bererapmanckue aversl. Jlednunt xe- sega MOXeT BCTPEYATBCA y «sIMYHO-MONOY- Hoi» BereTapnaHues (XOTA Takan AMeTa MO- er 6bitb saiorom xopowero sqoposts). ¥ cTpornx BereTapwaHUes MOXeT PasBUTRCA AedvuyT BuTamnna B,,, @CIM OHM He NOT PeGnaloT ApOxKeBbIe SKCTPAKTEI WM NHUIe- BbIe MPOAYKTBI, CDePMeHTHPOBAHHBIe B aSH- ATCKOM CTMNe. Y HX CHIKEHO TaKKe NOT- peGnenne kanbuyna, xevesa, UAHKA, TONKO ¢bpyktopas AMeTa He peKOMeHAyeTCA, NOTO- My TO OHa ednunTHa no Genky, NaH MHO- TMM MinkpoanemeHTam. Hogomonbie aveTsi. HeKoTopsie Moa- Hole AMeTSI NPHBOAST K HEdMuMTY BHTAMH- HOB, MMHepanbHbix BeLWeCTB M Genka, Cep- Ae4HbIM, NOYeYHLIM, MeTaGONMHECKMM Ha- pyweHnam vm wHorna K cMepTH. OveHb HuaKoKanopniineie pMeTb! (<400 Kxan/cyt) He MoryT nloggepxneats 3fopoBbe syIM- TenbHoe BpeMs. Jlexapcrsenusie npenapars! m nuuwe- Bble AoGaBKu. MHorve npenaparel (HanpH- mep, opeqcTea, nonasnaiowme annetuT, AWOKCHH) yMeHbwaloT annerwr, spyrne yxyawaioT BcacbigaHne nMTatenbHbix Be- wecTe uv MetaGonmam. HekoToptie npe- napatbl (HanpuMep, CTMMyssITOpbl anneTH- 7a) OKasbiBaloT KaTaGOAMHECKHe odpdexTbl. Onpegenenntie npenapatei moryt ocnaGuTb BCACLIBAHMe MHOTMX nMTaTeNbHbIX BeLIeCTB, HanpHMep NPOTMBOCyAOPOXHbIe cpeacTBa Moryt ocnaGiTb BCacbIBaHMe BUTAMMHOB. AnkoronbHas WM neKapcTBeHHas 3a- BUCMMOCTS. [ayeHTEI c ANKOTOMbHO! Mn AeKAPCTBEHHOM 3aBMCMMOCTbIO MoryT Npe- HeGperats CBOMMM nMWeBbIMM noTpeGHOC- Tamu. BeacbipaHve 1 meta6onnaM nuTa- TeNbHbIX BeLLECTB Takxe MOTYT 6bITb Oca6- ‘eH. «BHYTPHBEHHBIe® HapKOMAHE! O6bI4HO (CTAHOBATCA ICTOLICHHBIMM, TAK Ke Kak M all- Koronnkn, KoTOpbIe NoTpeOnHOT Gone oA- Horo IMTPa KPENKAX CNMPTHbIX HANMTKOB B AeHb. ANKOrOsIM3M MOXET BbISBATE DEQMYMT MarHiMA, UMHKa Wi HeKOTOPBIX BHTaMMHOB, BKMONAA THAMMH.14 PAMEN 1. HAPYLIEHMIS| TMTAHMA Toxpyxocrs cepenwnts npennnessa (cm) ~ (3,14 x TKCT cm)? 4x Crmntomel 4 anarHos Cvmntombl BapbvpyioT B 3aBVCMMOCTH OT MIMHVHbI M THNIa HefOCTATONHOGTH NMTaHHS (cm. c1p. 17 urn. 4a Crp. 32). Avarvos ockosbisaeToa Ha pesynbTarax kak MexMUWHCKOrO aHaMHesa, Tak M PexH- Ma nuTaHua, O6weKTuBHOro ObcnepoBaHiA, aHannga cTpykrypbl Tenia (GM. cTp. 72) n u3- GupatensHtx maGoparopHbx ccneposa- Hn. Awamnes. AHaMHes fomxeH Bkmi04aTb Bonpocs! 0 otpe6neHWN niMWK (cM. pyc. 2-1), HenaBHMe H3MeHEHMS B BeCe MI cbaKTO- pax pvcka HegocTaTo4HOCTH niMTaHHMA, BKmlovas ynoTpe6neHMe neKapcTs M ankoro- aa. HenpegHamepedHas notepa Gonee 10% OGbI4HOrO BeCa B TeYeHVe Tpex MeCALIER YykaablBaeT Ha BbICOKYIO BEPOATHOCTS HEAO- CTaTOYHOCTH nuTaHMs. CoumanbHbili aHaM- He3 JOMKEH BKNIOYATS BONPOCEI O TOM, LO- CTYNHBI NM AeHETH AAA en! M MOXeT JM Na~ UWeHT KynltTb €€ M NpHrOTOBHTE. pv o6cnenosarinn nayyeHTa no opra- Ham Mi CucTemMaM HeEOGxogMMo CoKycupo- BaTb BHYMaHMe Ha CMMNTOMAX ednuvTa rumratenbHbx BeujecTs (om. Ta6n. 2-1). Ha~ npumep, ronosxas Gon, TowHOTAa M AMnO- TMA MOTYT yka3bIBaTb Ha MHTOKGHKALIMIO BM Tamuiom A. O6vexrusHoe oGcnegoBanne. O6beK- TBHOe OGCNeAOBAaHVe AOMKHO BKMIOYaTb vamepeHne pocta v seca, pacnpeneneHne >xvpa v aHTponoMeTpHHeCKOe OnpeneneHne MpbILWe4HOM MaccbI Tena. VHQeKC MaCCbI Te- sia [MT = Bec (kr) / poct (m) ] yperynupyer Bec poctom (oM. Ta6n. 6-1 Ha crp. 73). Ec- 1M Bec naumeHTa <80 % fomKHOrO, CooT- BercTBylowero pocty, Min eon MMT < 18, To HOMKHa GbiTb sanonospeHa HenocTaToH- HOCTb niwTaHina. XOTA STM HaHHbIe NONESHbI B AwarWocTuKe HegocTaTo4HocTH nuTaHHA, OHM Mano CreuMv4Hbl. To nnowapy MbiWesHO oBnactm cepe- AWHbI BepXHeH YacTM NpenNeYeA OYCHVBA- JOT MbWeYHyIO Maccy Tena, Sta nnowanb PaCcHMTBIBAETCA VCXOA V3 TONLMHbI KOK- Holt cknapkn Tpauenca (TKCT) v oKpyKHoC~ TH cepepmnel npepnnesba. O6a vamepeHna nposopstca Ha ONHOM Mt TOM xe y4acTKe, npasas pyka nayjeHTa — 8 paccna6neHHoM = 10 (Myxcannts) Hn ~ 6,5 (eHUYMHEY) nonoxexun. CpenHas oKpyKHOCTb cepenn- HbI BepxHei YacTH npegnnesbsa npuGanan- TenbHo 32 + 5 cM ana Myxuni 1 28 + 6 cM Ana xKeHUWMH. Dopmyna ANA pacsera nno- UIaAM MBILIeNHOH OGnacTh CepenMHbl Bepx- Heli 4acTH npennnesba B CaHTMMeTpaX 8 keanpare npencrasneva BbiLe. Sra opmyna Koppexrupyer nnouazb MpluiesHoii oGnacTh BepxHeli vacTa npen- Tie4ba C yYeToM xvpa M KocTH. CpeqHne sHa4eHMA MIOWWaAM MbIWeSHOH OBnacTH ce- PenMHE! BePXHel YacTH npeznneybA cO- crapnsiot — 54 +11 om ana myxunn 1 30 + 7 CM DJA >KeHUWMH, SHaYeHMe MeHee 75 % Toro crangapta (B 3aBvcMMOCTM OT B03 acta) ykasbiBaeT Ha VICTOLWeHVe MbILe4- Holi maccbI Tena (OM. Ta6n., 2-2). Ha 910 v3 MepeHie BNMsIOT (bu3aMYeCKaA AKTMBHOCTE, reHeTHHeckve dakTopbi u BospacTHas noTe- Ps MBILeYHOM Macc. OGvexrusHoe oGcnenoBakne fOKHO GbiTe cboKycuposaHo Ha cneundnuecKnx cuMNTOMaX HeOCTaTKa NMTATeNbHbX Be- ects. Heo6xoAMMO BbIRBNSTs CMMMTOMb! BH (Hanpymep, oTex, KaxeKcns, cbinb). O6cnenoBane TaKKe AOMKHO cocpenoTO- uwmTeca Ha NPM3HaKaX COCTORHMI, KOTOPLIE Moran npenpacnonaratb K Henoctatky n= TaTeNbHbIX BeW\eCTB, HANpHMep CTOMATO- normueckne npo6nembi. [ovxnvecKnii cra- TyC AOMKeH BbiTe OUeHEH, NoTOMy 4TO De- Mpeccva Mi yxynUIeHNe — KOTHMITHBHBIK cnoco6HocTeli MoryT NpuBOAMTS K NoTepe Beca. Wnpoko § pacnpoctpaHeHHas Tonxas ‘oueHKa coctosHia nitaHus (MOCN) vc- TonbsyeT MH>opMaLWiO M3 aHaMHesA NaLWA- edTa (HanpyMep, noTepa Beca, H3MeHEHMA B NPVEMe NMULM, TaCTPOMHTECTHHANbHbIE CVMNTOMB!), AaHHbxX OBReKTHBHOrO OBcne: AoBaHna (HanpvMep, noTepA MbILIeSHOH MaCCbI M nlozKOxHOrO xMpa, OTeK, aClMT) M BpaveSHol OMeHKM COCTORHMA niMTaHWA ra- uwexa. Vicnonbayerca yrsepxneHHan Mv HM-UIKas1a OWIGHKM COCTORHWA —nMTaHNA (MOCT1) naynexta, KoTopan Takxke WMpoKO NpMeHseTCA npn OWeHKe cTaTyca NMTaHAA ANS nloxmnbx nayveHTos (cM. pc. 2-1). Amartoctuxa. O6bem Heo6xoquMbIx na- GoparopHbix vccnenoBaHiit HeRCeH M MO-2. HEJOCTATOMHOCT® MMTAHMA 15 BS coyxca nuranus kommanns NESTLE amar, Via, Boopact___Bec (xr) Poor (ca) Orvecra0, ron__para. Bubepure nantonee nanaaRuuNl sapkaNT OTBETH W sarmuunTe ero HoweD 8 evel. Crummpyire Bann no Bceu naaiestM. cr cya mete wna pas 11, npwcrynaltre« cneouteny STaNY ys Onpensnehve NOKESATEN HENOCTETEOFD RHR. A. Yeeruenne ofvema norpetniemoR nm 28 ochesnine 3 Mecsila BcneACTAMO cHioKDHus af nerwra urn pacerpovicTsa cvcrema MAllesape- a, xeaaTesksiol wu rmovarenisol| GyHKWaH 0 —‘cunsnan norepa annerara ‘1—cpeanan novepnannersTa 2—wnesxod novepi snnerara B. Chioeatve wacci1 Tana a nocnenywe 3 Mecsia O— cxoxere Gomive, vena Sir 1— He snaer 2— chnnene 13 «¢ 3 — winaxoro cHvoKo HAR K. BuSpantiue mapreps norpeGne-is Genes + He menee 1 Groza ws Monowisxcnponycies Baeie fa ; asian once anc oaounwn ven sihuawn a HeceMo “hse, pus ve Buna TAB exearen0 0 0,0 cam 0 una 1 oraor «nae —ecam 2 oraera sna 1,0 —ecmu $ ormera ena L YhorpeGnewre nayx uv Gonee Enon se onpTos wenouel exazonNa Her C. Pogaiaciocrs (0—npyosah xnoctenn wna kpecry 1 — woxer ecranaTs © KposaTu/xpeca, HO He Bu oar wa yay 2—aonyr ns yoy . Mewrononieci” crpece uni ocrpoe saGoneea- we sa nocnenmnive $ wecsUa om 2—Her E, Temonesponorwecire npoGnew (0 —raxenas dopua neve F. Wanexo maces Tena (MMT) ar /at OW ueten 18 twwriona 2 mur 21—23 = MMT Gores 23 ‘yrmaapal Gann (onepaauy Tan vaxoanaTene 14 6annos) oo 12Gancen — Cocromue vas ou, cores cc Teyterayer ne eb otaicom a snetan Ganon SobubnengeraromceTe ‘ae ‘ram nNOS. Sworn cuchy G. Mposuaaer ovaansno (Ho 8 AoMe npecrapansx ru Son Her Tne He Npeowaer Coven 3 vaavevewinx pata ne- oe L Tponexem wy xoxoiwe assis 0-1 Her Her «J. Konmvecteo nonHouehisx npveMos Miu 8 eH> 01 mpwone 1 2npwewa — Snpwena, M. Kanwecrao aunveaeMol xnaKocTH (Bona, ox, Kobe, MonoKo, sah WT. 2.) 8 ens 0,0 wees 3 craxavoa: 05—3-Scracaios 1,0 —Conee § craranos N. Choco mara One maxer ects cowocromrensio 11 —wensmrasaer TpyayocTa np amocTonTanshou nvraHian 2— ect camocroRTenHo ©. Cavoouam cocrom ae rea — OWTaeT, #70 COCTOSHiVe nTaHHE NEKO He seer 2 — creer, sro npotne ¢ rurasateu ner P. Camoouetna cocTostae saopoeta w opasnenmn ‘apyrman nom.ann Toro xe BospacTa 0,0—He Taxoe xopowee 05 —we anaer 1,0 —Toxoe xe xopawes 20— mye QO oo eres 0,5—ON 21-22 4 MM 22 # anes: oo RL Oxppaiocrs apis (OM) 0—Ovnenee 31 ou 031 u6anee 1s Bana no sropomy srany oust ‘Cywmepi pouy ran) axcauamo 18 ooo april Gant No nepeoMy aTany axes 14 600). cero no sy stare (waxevamato 30 Gannos) o. TloxasaTens WegocraTownocTn nMTarin ‘17—23,5 Ganna pHCK Tmnorpobwa ence 17 Gamos covenant rwnerpodie Puc. 2-116 PADEN 1. HAPYLIEHMIS TMTAHAA Puc. 2-1. Munn-ukana oyeHKn cocToaHma nitania. Guigoz Y and Garry PJ 1994. Mini nutri- tional assessment. A practical assessment tool for grading the nutritional status of elderly patients. Facts and Research in Gerontology. Supplement 2:15-59. Rubenstein LZ, Jarker J, Guigoz Y, and Vellas B. Comprehensive geriatric assessment (CGA) and the MINA: An overview of the CGA, nutri- tional assessment and development of a shortened version of the MINA. In “Mini nutritional assess- ment (MINA): Research and practice in the elderly.” Vellas B, Garry PJ, and Guigoz Y, editors. Nestle Nutrition Workshop Series. Clinical & Performance Programme, vol. 1, Karger, Bale, 1997. © So« des Produits Nestle S.A., Vevey, Switzerland, trademark owners. Hanevarako c paspeweHia. Tasnnua 2-1. TlPH3HAKH W CMMNTOMbI HEQOCTATOYHOCTH NMTAHHA Osnacto/ CucTEMA (Crmntom ani nPHSHAK Aeonyar Bui erewnni enn | Kaxexcnn repr Koxibie noxposst Cunb MHorve BHTaMMH, UMHK, HesaMeni- ile xUpHE KHCNOTS! Cine Wa ysacrxax, oTxpaiTexxcom- | Haunt (nennarpa) uy: JlerkocT’ NOABNEHMIA «CMHAKOB» Butamunbt C mn K Bonoctl w HOT Victonyene wiv norepa Bonoc Benok Npexnespementoe nocenenne Cenen sonoc “Tloxroobpaakive» Horm >Kenes0 Taga «Kypwnas cnenoTa» Burama A Keparomannuya Brawn A Por ‘Xelinar n rnocent PuOodnasil, HMaunl, nMpAgOKCHH, >xeneso KposoToansocre aecex Burammu C, prGodnasnn KoHesHoc™n Orexn Benok Hepanan cvctewa Tlapecteannw oHewenwe cron | TwaMni acre Cynoporn Ca, Mg KorHiTvBHbie HW CeHCOpHEIe pac- | Tvamun (Gepn-Gepn), Hay (nen cTpoiicrea arpa), NMPHAOKCHH, BATAMMH B Aemenuna Twamni, HMaAH, BATAMMH Bo CreneTHo-mewesnan | ToTepA waiwesHOh wacos! Benox oncrea. ‘Desopwaunn xocreii(«O-o6pas- | Buran D, Ca Hble> Horn, nedopMupoBaHiie oneHible GyCTaRES, McKPHBNEHHE mogsoHouHMka) Xpynkocts KocTet Buramun D Bonesienvocte mnpnyxiocrs | BurammnC cycTaBoB KT ‘Draper Benox, wvaunt, donnesa wicnoTa, ByTaMaH B Avaper w waspaueHie Bkyca Usk Dvebarva Gon npn rnoraknn | >Kenes0 (cinpoM Nnammepa—Bricona) ‘SwmoKpMHHAR YaenmieHme wyrToBnQHOM xeness| | Vion2. HEMOCTATOYHOCTb NMTAHMA 7 TasnMua 2-2. Mowat MBILIENHOA OBNACTH CEPEZMHbI BEPXHEA YACTM MIPEAMIEYA ¥ BSPOCNBIX Crangarr (%) Mrcunn —) Keune) Mswenan Macca 100+ 20 54211 3027 AnexpaTHan ri) 40 22 Aonyctwman 60 2 8 Wcrowenne 50 a 15 Kaxexonst Cents mbiuesHas macca cepenmiel BepxHei 4acTa npennnevs + 1 cTaHnapTHoe oTknoHeHMe. [lo ‘paniiin | Il HauoHanoits nporpamM vay¥eHHs SAOpOBbA M niTaHiAR, X€T 3aBNCETb OT MaTephanbHOro nonoxKe- Hua nauvexTa. Ecnn npnunta o4esMaHa 1 Moxer 6biTb OTKoppeKTupoBaka (HanpMMep, ‘ovTyauna Ha rpaHi BboKMBaHMA), uccneAO- BaHMa AaioT Mano nonbabi. Apyrme nayneH- Tel Hy>kalOTCA” B Gone AeTANbHO! OUeHKe. Yaue ecero ucnoneayembili naGopatop- Hbiii TecT — vsMepeHve Genka CbIBOpOTKM. YMeHbweHA KONVHeCTBa anbGyMMHOB M Apyrvx 6enkos [Hanpnmep, npeanb6ymuHa (Tpanctupetmna), TpaHcdheppuna, petv- HONICBASBIBAIOLYerO Genka] MOTT yKaabIBaTb Ha Aednunt Genka win BSH. Mpn nporpec- ‘CMpOBaHMA HEpOCTATONHOrO niMTaHHA ypo- BeHb amb6yMMHa CHMKAeTOA MesyIeHKO; ypoBHv npeanb6ymvxa, TpaHcdeppuHa, pe- ‘THONCBRSEIBAIOWIeTO Oeska YMeHbUIaIOTCA 6bicrpo. Onpenenexie ypoBHa anb6ymuHa AOcTaTONHO AeWeBO M nosBOnAeT NpOrHO- ‘S\POBATb PUCK OCNOKHEHHIM, CMEPTHOCTS M JeTa/lbHOCT Nysie, Hem VEMepeHne ZApy- Tux 6enkos. OpHaKo Koppensuva ypoBHa anb6yMiHa C PHCKOM OCNOXHeHMi CMepT- HOCTbIO MOXeT BbiTb CBASAHA Kak C HENMLe- BbIMM, Tak MG MMWeBEIMM cbakTopaMM. [pH BoCcnaneHHn OGpasyloTcA UMTOKMHEI, KOTO- ble BbIHYXNAIOT anbGyMnH M Apyre niMe- ble GesIKOBbIe MapKePbI BbIXOAMTb M3 KPO BeHOCHOrO pycna B TkaHM, YMeHbIUAA Vx YPOBHM B CbiBOPOTKe. MocKoneKy npeanb6y- Mul, Tpakod@eppi M peTiHoncessbisai- uit Genok yMeHbuiatoTca 8 npoUecce rono- Aakva Obicrpee, 4eM anb6yMMnH, Hx u3Mepe- Hve MHOrAa Mcnonb3yeTcA Ana AMarHOCTHKA WAN OUBHKN TAXECTA OCTpOrO romogaHHA. OpHako oKOHYaTeNbHO He ACHO, ABIAIOTOR aM OHM Gonee 4yBCTBHTeNbHEIMK WK cne- UM>vHBIMI, eM anbOyMVAH. Moxer 6biTb nogcumTaHo o6uee KoNM- YecTBO AMMMOUWNTOB, KOTOPOE 4aCTO CH >aeTCA Np nporpeccnpoBaHnn HeAOCTa~ TouHocTH nuraHia. HegocraTo4Hoe nura~ Hve BefeT K SHAYMTENLHOMY CHMOKEHINIO CD4* T-nvaouros, ostomy onpeaene- Hve aTOro NoKagaTena NonesHO y nayneH- Tos, KoTOpEle He GonbHeI ClIVjom. Koxsbie npo6si c MonontsoBaHVeM aHTH- FeHos nomoraioT BbInBMTb OCnaGneHne Kie- TouHOrO HMMyHWMTeTa npv BQH 4 npn HeKO- TOpbx APYTMK HaPyWEHHAX, CBAIAHHBIX C Hepoctaro4Hbim nuTaHveM (cM. cTp. 1724). Apyrne na6oparopHeie Tecra (wamepe- HVA ypoBHeli BATAMMHOB VM. MMHEpaNbHbIx Beulecte) UCnombsyloTCA BbIGOPO4HO, 4T0- 6bi AvarhocTHpoBaTe wx cneumdnueckne PaSHOBMAHOCTH COCTORHKi, CBASAHHEK C AeduuNTOM Toro WAM MHOrO KOMNOHEHTa. BESIKOBO- ‘SHEPFETMYECKAR HEAOCTATOYHOCTS Benxoso-svepretmyeckan Hemocta- ‘TouHocTs (BSH), wk GenkoBo-Kanopuii- Has HeAOCTaTOMHOCTH, — STO AEdMUMT ‘SHEPrHn M3-3a XPOHM4ECKOrO AeduynTa BCeX MakpOHyTpHeHTOB. OHa OGbI4HO BKMOYAeT AEDMUNTE! M MHOTMX MMKpO- Hyrpuentos. BSH Moxer 6niTb BHesan- Holi M ToTanbHO!l (ronogaHMe) Maw noc- TeneHHO. TaKecT BapbMpyeT OT cy6- KNMHMHECKMX NpORBNeHM AO sBHOH kaxexcnn (¢ OTeKOM, noTepeli Bono M atpodweii Koxn), Ha6miopaetcs Mynb- ‘TMopraHian M MyNbTHCKCTeMHaA HepO- craTouHocte. fia AMarHOCTHKM OG6bIHHO: wcnonbsyioTca naGopatopHbie uccne- OBaHHA, B TOM YnCNe OUeHKa CbIBOPO- ‘TouHoro anbGymuna. JleveHne BKnio¥aeT Koppexywio Ae@uunTa >%KMAKOCTH KM ‘SNEKTPONMTOR NyTeM BHYTPMBEHHOrO BAMBaHWA PacTBopoB, a saTeM nocTe-18 PAMEN 1. HAPYLIEHMIS| TMTAHMA NeHHOe BOSMeLeHMe NMTATeNbHBIX Be- uecTB NepopanbHo, ecnM BOSMOXKHO. B passvtbix cTpakax BSH senaetca co- cTosHMeM, pacnpocTpaHeHHbiM cpenn no- MeUeHHbX B 2oMa npecTapentix (KOTA 4aC~ TO OHM 06 3TOM He nopospeBaioT) M cpenn nayweHToB paccrpolictsamm, KoTOpEIe cHWKaIoT anneTwT wan yxynuaIoT nepesa- Pwpatve, BcacbiBaHne M MeTa6OsM3M nTa~ TenbHbix BeULeCTB. B pasBMBalOU\MKCA CTpa~ vax BOH xapakrepra ana jeTeii, KoTopble He notpe6nsioT BocTaToYHOe KONMNeCTBO kanopwii wiv Genka, Knaccvonkayna atTvonorma 59H Gbisaer nerkoii, yMepeHHo win TA- >xenoli CreneHy. Crapynio yoTaHaBnneaicr ny- TeM onpenleneHMsl PasHMUbl B NpoUeHTaX pe- @nbHOrO M pacyeTHOro (MMeabHOrO) BeCa NayveHTa, CooTBETCTBYIOW\eFO ero POcTy, WC~ Tlonbsya MexAYHAPOAHbIe CTaHfapTbl (HOP ma, 90—110 %; nerkan BH, 85—90 %; yme- PeHHas, 75—85 %; TwKenaA, MeHee 75 %). BOH moxer 6biTb nepsiuHol win BTO- pwsHoi. Nepsmunas BOH o6ycnosneva Hea- AeKBaTHLIM mlOCTyneHVeM niMTaTenbHbX BewjecTs, a sTopw4Han BOH sBneTca cnencTenem pasnvHeKX paccTpovicTs win nipvema nekapcTseHHblx npenapatos, KOTO Pole NenaTcTEyIOT McnonsoBAHNIO nMuTa~ TeNbHbIX BELIECTB. Nlepsmunaa BSH. Bo scem mupe nep- swan BOH BcrpevaeTca rnasHbim o6pa- 30M y AeTei M NOXMNIX NM, T. €. y TeX, ¥ KOTO OrpaHvHeHb! BOSMOKHOCTH 1OBbiBATb Npogyktbl, xoTA HavGonee yactan npwwHa B NOXMNOM BOspacTe — AeNpeccns. STO MoxeT ObiTb TakKe ChepcTsem co6moge- Hv noctos, neyeGHoro ronopakna wnw aHo- pexcnn. TakKe npuunHOl MoKeT 6biTS nn0- xoe (xecToKoe) OGpauieHve ¢ AeTbMM Mn nOxWniMN. Y pete xpoumveckan nepsiunan BSH meer Tp opel: MapasM, KBaLUMOpKOp copa, VMeloUlaA xapakrepHble ocoGeH- HOCTH O6enx (MapasmaTM4eckii KBaLMop- kop). Popma BSH 3asnont oT cOoTHOWeHHA 8 paumoHe nuTakna HeGenkoBbiX M Genko- BbIX VCTOYHUKOB SHEPIMM. FonopaHne — oc ‘pas Taxenan bopma nepsnuHol BSH. Mapasm (Tate HasbiBaeTca CyXoit op- moi BOH) BbisbigaeT noTepiO BeCa ui MCTO- ujeHve MBL. xMPOBOrO sanaca. B pasBH- BaIOWYMKCA CTpaHax MapasM — caMan 4ac- Tas cbopma BSH y fereli. Keawimopxop (Takke HasbiBaeMbilt BnaXxk- Holi, OAyTOBaTO MAK OTeYHO! opMoii) CBASAH C NPEXNEBPEMEHHEIM OTHATHEM crapwero peGeHKa oT rpygm, KoTopoe O6bINHO BCTpevaeTcA, KONA poxKnaeTcA mnanwnit peGeHox, «oTTecHsIs™ cTapwiero peGeHka oT rpyav. Takvm o6pa3zom, neTH c KBaLUMOPKOPOM OGBIYHO CTapWe, 4eM ¢ Ma- pasmom. KBalMOpKop MOXeT TaKKe ABUT Ga pesynbTaTom ocTpo GonesHn, 4acTo FacTposHTepura wiv Apyrol MHeKUNM (Be- PORTHO, BTOPMMHO!, 13-3 BuIPABOTKM UM ToKvHHOB) y NeTelt, KOTOpEIe yKe MMeIT BSH. Avera, KoTopan asnetca Gonee nednunT- Holi no Genky, 4em no sHeprin, MOxeT C Gonbwelt seposTHocToio BbiaeaTb KBaLuMOp- Kop, ¥eM mapasm, MeHee 4acTo, 4eM Ma- PaaM, KBaLUMOPKOp VMeeT TEHAHUMNIO ObITe OrpaHveHHbim onpeseneHHbiMM pernoHa- MM Mupa, TaKMMM KaK CeNbCKHE PerMOHE! Agpnkn, Kapn6ckve TxooKeaHckne ocT- posa. B atx o6nacTsx OCHOBHEIe NPOAYKTE! TwTaMa (HanpMep, MaHMoKa, cnapKwit kapToenb, 3eneHble GaHaHbl) GeaHbi Gen- kam w 6orarel yrnesonamn. Mpn KBaLMop- Kope NOBbIL/aeTOA NPOHAUAeMOCTe KneTOY- HBX MeMBpaH, BbISbIBAA TPAHCCynAUWIO BHYTPMCOCYAMCTON xMpKOCTH M Genka, 40 TpMBOAMT K NepudepHyecKomy OTeKy. Mapasmatmeckuit KBauMopKop xapaK- TepnsyeTca CyMMapHbIMM OCOGeHHOCTAMY Mapagma Mi KBaluMopKopa, TlopaxeHHbie MM eT OTeXHbI M YMeIoT Gonbwe xVpa B CO- rage Tena, 4eM np Mapasme. Tonopake — nonHaa HenocraTo4HocT nuraTenbHbyx BewecTB. MHorna ronopaKne O6poBontbHoe (Kak B Nepviog penuArnosHo- To nocra wiv npH HesporeHHOH aHopeKcui), HO OGbI4HO OHO OGycnoBNeHO BHEWHMMM cbaxtopamn (Hanpymep, CTMXHiiHBIe O6cTO- siTenbCTBA, HaxOXNeHMe B NYCTBIHE).. Bropwuvas BQH. Stor Tun o6bINHO 9B- ssieTCA pesynbTaTOM paccTpoiicTs, KOTOpbIe BrwsioT Ha CyHKYWiO XKT, KaxeKTHHECKHX PaccTpolicrs m cocTosHiit, KoTopbie yeenl- 4npaioT MeTaGonv4eckne noTpeOHOCTH (Ha- npumep, nideKywn, rneptupeos, GonesH’ Anancova, deoxpomouyToma, Apyrue oH- AOKPVHHbIE HapyuleHHs, OXOrM, TPaBMbl, xupyprvveckne BMewaTenbcTea). Mpn Ka-2. HEMOCTATOYHOCTE NMTAHMA 19 xeKTH¥eckWx paccrpoiicrsax (Hanpumep, CTIMA, pak) " noyeuHoii HenocraTouHocTH Kara6onmueckve npouecce! npMBOnST K O6- pagoBatiio Wa6biTKa UATOKMHOB, TO B CBOIO Ovepenb BeneT K HenOcTaTOuHOCTH iMTa- nus. Cepneynan HenocTaro4HocTs TepMi- HanbHoii CTapWMn MOXeT BbISBaTe KAPAMANb~ Hylo KaxeKcio — Taxenyio bopmy HenocTa- TO¥HOGTH iMTaHINs, CMepTHOGTS OT KOTOPO! oco6eHHo BbicoKa. KaxexTvueckne pac- crpoiictaa moryt yMeHbuWTb annetaT wan yxyauiTs MeTa6onvaM niTaTenbHbX Be- ujects. Pacotpoyictsa, KoTopele BIMsIOT Ha yHkyio KKT, MoryT HapywaTb nepesapn- Bakve (HanpyMep, HenocTaToHHOCTs non >kerlyfo4Ho! Kenesb!), BCACHBAHMe (HANPM- Mep, aHTepiTei, sHTeponaTwn) anw MMda- ‘TwYecknit TpaHCnopT nvTaTeNbHbix BeUleCTS (Hanpnmep, sa6piowmnHHE dn6poa, Go- neat Munpos). Matoousvonorna HayanbHas MetaGonvueckan peaKuua — YMeHBUIeHe MHTeHCHBHOCTH OGMeHa Be- ects. Ana oGecneveHia aHeprvelt opra- Hv3M CHaNana «pacujennseT» xvpoByio ‘TkaHb. ODHAKO 3aTeM BHYTPeHHNe OpraHb! MbiUMbITakKe HAuMHaIOT paspywla4rboA, M VK Macca yMeHbluaeTon. Bonbille BCero «Tepa- OT» B BeCe NeNeHb M KMWEYHIK, npoMexy- TouHOe NonoxeHMe saHMMaloT Cepaue M TONKM, M MeHBUIe BCerO TepseT B BECE HE- paHas cvctema. Cumntomb! ¥ nPHSHAKH Cymntombl yMepeHHol BSH moryr Germ o6uymn (cvcTeMHbIM) waK saTparnBaTe onpenenexibie oprakbi M cncTemel. Xapak- ‘TepHbl anaTuav pagppaxvrenbHocT. [auyt- exT ocnaGneH, pa6oTocnoco6HOCT» CHinKe- Ha, HapyWeHbl KOrHTHBHBIe CnOCOGHOCTH, a wHorfa M COsHalNe. PasBvBaioTca BpeMeH- Hel nedmuyT naKrosbl M axnopraapia. Hac bi NOHOCEI, M OHM yoyryBnmIOToA eduUWTOM KvWeYHbIX Aucaxapnas, OcOGeHHO NaKTasbI (om. orp. 137). TkaHn roHap, aTpodMyHts OH Moxer Bbia8aTb aMeHOpe!O y XEHUIMH 1 TOTepIO AMGWNO y MyKUNH VM KEHLAH, Tlorepn xvpa Mt MbIWe4HOM Maccbl aaa JoTca O6uIMM npoABneHveM Ans BCex opm BSH. Y sapocnbix AOGpoBonbueB, KOTOpbIe ronogasm B TeyeHve 30—40 quel, noTepy Beca ObiiK aBHbIMM (25 % Ha4anbHoro Be- a). Eonu rononakne 6onee snmTenbHoe, TO motepw Beca MoryT focturHyTh 50 % y BAPOCNEIK 4, BOSMOXHO, Gonbue y AeTel. Kaxexcva y sapocnbx HanGonee ovesia- Ha B Tex OGnacTax, rae B HOpMe O6bI4HO VMeIOTCA BHQMBIE XUPOBLIE OTNOKEHI. Mbluiubi yMeHbuiaioTcA B OSbeMe, a KoCTH 3aMeTHO abicTynaloT. Koxa CTaHOBMITCA TOH- Koll, cyXoii, HeanacTM4Hol, GnepHOl M x0- nopHOH. Bonocts cyxve M /erko Bbinanalor, cTaHosAce penknmn. OcnaGieHo saxvane- ve pax. ¥ noxnnex naueHToB yeennuysa- eToA puck nepenomos Genpa, nponexsiel, TPOdmHeCKHK #38. Tp ocrpoit win xpornueckoit TaKenoii BH paamep cepaua m cepnesnaili BbiSpoc YyMeHbWwaIOTCR; nysibc zaMenAETCA, CHAKA eTca apTepvansHoe fasneHne. VHTeHCME- HOCTS AbKAHNA HXVBHEHHAA eMKOCTE er ux cHioxaioros. MagaeT Temneparypa Tena, vworga npwsona k CMepTH. MoryT pasBiTo- csi oTek, aHemus, xenTyxa 4 neTexiin. Mo- .xeT HaOmiogaTbcA neYyeHo4HaN, noyesHan wan cepnestan HenocTaTo4HocT. Kneroukbi vaimynnTer ocna6neH, yae- AMMBAETCA BOCKPMAMHUBOCTS K MHEEKYA= sm, Bakrepnanbibie wHdeKun (Hanpvmep, THeBMOHMA, racTpOSHTepHT, CpenHMli OMT, vubexun yporennTanbHoro Tpakra, cen- ove) sensioTCA XapakTepHEIMN AIA BCEX opm BGH. Micbexumm npwBopar K aKTuBa- Win NponyKUAM YMATOKVHOB, KOTOpbIe yoy Ty6nmW0T aHOpeKcMo, TO NpMBOAMT K eule Gonbuleli noTepe MuiWe4HO! MaccbI M sHa- YiTesIbHOMY YMeHBUEHIIO ypoBHA CbIBOPO- TouHoro anboymnta. Y mnajeHues Mapaam sbisbisaeT ¥yBCTBO Tonoma, noTepwo Beca, 3aflepxKy pocTa, No- Teplo NOAKOXHOM xMPOBOM KNeTHATK W Mb wesHolt Maccts. BbicTynaioT peGpa m minue- bie KocTv. [Ipa6nas, ToHKas,, «Gomrrarouan- os» KOxa BUCHT CknapKaMn, Keauopxop xapakrepwayeron nepube- Pywecknmn oTeKami. XKvBoT BBICTyNaeT, HO acura Her. Koxa cyxas, TOHKaA M CMOp- eHHaa; O#a CTaHoBMTcA ranepnurmeHTH- PosalHOW, TpecKaeToA, a noTOM passBa- eToA e€ rMnonnrMeHTauIVA, LUXNOCTE M aT= pods. Koxa pasniuibx nacre Tena MoxeT nopaxaTecA 8 pasiuHoe BpeMs. Bonocei craHossca ToHKumu, Gypimin rin ceppimn. Bonocts Ha ronose nerko sbinafa- 10T, BKOHENHOM CHeTe, CTAHOBACh PenKHM, 120 PASMEN 1. HAPYLI IEHMAL TIMTAHMAA Ho BosioceI pecHHl, MoryT axe YpesMepHO pactm. Yepenosave HenocraToNHOcTH nin TaHMA MW apeKBATHOrO NTaHMA| NPMBOAMT K Tomy, ¥TO BONOCEI WMeIOT BMA «nloflocaToro nara». Bonskbie eT Moryt Gere anatHs- HbIMH, HO CTaHOBRTCA PasnpaKNTeNbHEIMY, ecnn wx nbrraiotca pacuiesenvTb. Tlonkoe ronogakme cmeprenbHo, ecru agwon Gonee 8—12 Hegens. Takum o6pa- 30M, Xapakrepxbie Ans BOH cvMnomel He yonesaior paseuTeca. Qvartos Avartos ocHosbisaetcr Ha ucTOpHM Go- nesHn, Kora yoTaHaBlMBaeToA ABHO Hea~ nexsatHoe notpe6nenme nin. ZomKHa ObiTb MAeHTHd>vUuNpOBaHa NpMYMHa HeaseK- BaTHoro nuTakns, OcoGeHHO y feTeli. ¥ Ae- Tel M nogpoctkos HyXHO OGssaTenbHo VIMeTb B BUY BOSMOXHOCTb KeCTOKOrO O6- paUeHHA MH HepBHy!O aHOpeKcHNO. JanHble oOvextveHoro o6cnenosaHva MoryT O6BINHO nogTaepAWTe AMarHos. Lna wneHTunKauynn npwanHel BTopHYHOH BSH HeOGXopMMbl Na6opaTopHble MccnenoBa~ Hus. ViaMepeHve yposka anbOyMuHa nnas- Mbl, O6wero KonMueCcTBa nMMouMToB, CD4" T-numountos v peakuina Ha KOXHbIE aHTWreHbI NloMoraioT ONpenenMTs TAKECT BH (om. Ta6n. 2-3) wiv nonTsepayTs AMa- THOS NpH Norpaln4Hbix CocToAHMsX. [poBe- jeHve u3sMepeHns ypoBHs C-peaKTMBHOro 6enka wiv pacTsopmmoro peuentopa vH- TepmeliknHa-2 MoxeT NOMOYS OnpeseNvTb npwanky HefocTaTo4Horo niTaHWA npM ee HescHOCTH H NopTBepAMTS HapyWweHne po- AYKuMM UvTOKVHOB. MHorve RononHMTenb- Hble NokagaTenn MOryT OTAVHATECA OT HOP- MaNbHbix sHa4eHWis: HaNPMMep, XapaKTepHb! CHMDxKEHHBIe YPOBHH FOPMOHOB, BHTAMMHOB, summgos, xonecTepnia, npeans6ymmla, MHcynmHonogo6Horo akropa pocra-1, QuOpoxeKtmHa uw peTHHoncEssbiBaioUero npotenka. YposHn kpeaTnHvHa MeTMN- rucTMgHHa B Mo4e MOryT UcnonbsoBaTbCA Kak KpITepMiM OURHKH CTeneHM noTepé Mac CbI MBI. Mockonbky KaTaGonv3m Genka 3aMeQNAETCA, YPOBEH MOYEBHHEI B MONE TakKe yMeHbUZeTCA. OTH AaHHBIe PenKO yanmeipaioToa np BeiGope TaKTHKN ne4e- HVa C nomousio ApyrHx saGopatopHblx Tec- OB MOXHO BbIABMTb M COMyTCTBYIOUWMe OT- kKnoHeHA, KoTOpble TpebyioT neyeHva. Zlonxnes Gris onpeneneHe ypoBHH aneKT- POsITOB CbIBOPOTKM, NOKagaTeNM MO4EBAHD! Mi kpeatnHina, BUN, riioKo3bl, 803MOxKHO, Ca, Mg, ocdara nw Na. Yposin rioKosbi kposv 4 anektponmTos (ocoGeHHO K, Ca, Mg, ocdara, norma Na) o6bIvHo KuaKne. Tloxasarenn Mo¥esiibl v KpeaTvHiia, BUN 8 GOnbUMHCTBe Cny¥aeB COXpaHANOTCA Ha HMKMX SHAYEHMAK, 10 PASBHTHA NOYeYHOH HenocratouHocrM. BosMoXxHO BbiaBNeHHe Meta6onv4eckoro aumgosa. MposonuTca Gui atanns KpoBH; OObIHHO NpYicyTCTBY- eT HOPMOUMTapHas aHeMus (rnaBHbiM o6pa- 30M 13-4 edwuyTa Genka) ni MAKPOLW- TapHaa aHemma (v3-3a OfHOBpeMeHHOrO peduuna xenesa). Tasnmua 2-3. Moka3ATENM, MCNONbSYEMBIE ANIA OW|EHKM THKECTH BENKOBO-SHEPETMYECKOMHEAOCTATOYHOCTH (BQH) Tloxaaatent Hopma Tlerxas | Ymerennas | Tsoxenas Hopmanirtil Bec (%) 90=110 85-90 75—85 <75 Vianexc maccur Tena (VIMT) 19-24 18-189 | 16-179 <16 Benox culsoporkn (r/an) 31-34 | 243.0 <24 ‘Tpanocbeppinx ceisoporen (Mr/an) 201-219 | 150-200 < 150 O6ujee wnono numpounTos (smo) | 2000-3500 | 1501-1999 | 800—1500 <800 Viinexe ranepayscrevrenstocrn ga- 2 2 1 0 Mennentoro Tana Y noxnnbx AMT <21 MoxeT YBenMuinTs pK NeTANSHOCTH. Vingexc renepyyectewrensHocTa sameqnenHoro na NOKaSwISaeT BeMNIMHY aaTeepAeHMA, SLIRBNA- Moro KOXHOM NPOGoMi, c MoONsOBAHKeM OBujero axTHTeHa, nomyYeHHOrO us Candida sp. van Trichophyton sp. Crenevs nkaypaunn 0 —< 0,5 0M, 1 —0,5—-0,9 cm, 2—> 1,00,2. HEMOCTATOYHOCTE NMTAHMA 21 Beperos m akanua kynbtypbi Kana Ha sua TMMCTOB Mi NapasvTos, ECM NOHOC TAKeNbIA We nongaetor neveHnio. Horna Mccneay- etca akasina MouM, NipoBoAATCA GakTepHO- ormveckoe uccnenoBaHie Mos, GaxTepHo- ormveckne MccnenoBaHiNa KpoBtt, TySepKy- swHo8as npoGa M peHTreHorpadwa rpyA~HOr KAeTKH ¢ LenbiO AMarHOCTIKH CKPBTEN HH exunii, noromy 470 y monet c BSH MoKer GbiTb saMemeHHan peak Ha VHOEKUVN, TIPO@MNAKTHKA MW SIEYEHKE Bo acem mupe camaa Baxnan cTparerna npodunakrakn BSH cOcTouT 8 TOM, 4TOGbI CHHGMTS ypoBeHb GenHOCTA, ynyMIMT 3Ha- HWA O NPABMNbHOCTA NMTTaHKA M ypOBeHb OkagaHViA MeQMUMHCKOA NOMOLIM. Tlerkasi win yMepeHian BQH, ekniowaa KpatkOBpemeHHoe ronogatine, sesntca ny- Tem ucronssosaHiia cGanaicMposaHHon Awersi, npennoyTiTenbHo opanbHo. Moryt ViCnlOnb3OBaTbCA XMAKVE OPANbHbIe MMUe- able 2o6aeKn (OG 6e3 naKTOsts), ecrn Teepaan nvuja He MoxeT afeKBaTHo nepe- sapneatecA. ToHoc 4acTo ocnoxHaeT opansHoe KopMieHne, noToMy 4To ronona- Hie cnocoGcTayeT nosbiWweHMo 4yscTen- TembHocTa OKT w nonanaHiio GaKTepni 8 nefepoabl Gnauki, cnocoGcrays nibeKun- OHHOM avapee. Ecnm noHoc coxparseToa (npennonoxutenbHo W3-3a OTCyTCTBVA TO- nepaHtHocTu K nakto3e), /laioToA CMeCH Ha ochoge Vorypra, a He Ha OcHOBe MoriOKa, TloTomy 4To mop ¢ oToyTCTENeM TonepalT- HoctH K iakToge MoryT NepeHocT Horypr wapyrve knenomono¥lbie nponykTés. aun @HTbI Take HYKQaIOTCA B HasHa4eHMM NO- MBMTAMMMHHEX 206aB0K. Taxenat BSH Win afmTenbHoe ronona- Hive TpeByloT meeHHA B CTALMOHApHbXK yC~ TOBUAX ¢ KOHTpoNMpyeMol AMeTOM, [naB- HuIMM NPMOpHTeTaM ABNAIOTCA KOPPEKKMA Hapywenni eogHoro uw sneKrponmTHoro Ga- aca (cm. rn. 156 Ha crp. 1585) H neveHne MH>exynii. Cnepyioum MeponpnaTuem signaeToA BOcrionHeHMe MakpoHyTpMeHTaM opansHo niin, 8 cnyae HeoSXOnKMOCTH, 4e- pes 30H: Hagoractpanbibil (O6bINHO) AA xenyouHbilt, MapexTepansHoe ninrane HasHayaeTcA 8 ciyYae Hannan TaAxeNOA Manba6cop6unn (cM. cTp. 28). Ana Koppexuin cneunduveckix nedn- UMTOB NMTaTeNbHbIX BELYECTB, KOTOPbIe Mo- TT nposewTboa npn HaGope Beca, MOxeT nowapo6uTbcA M Apyroe neveHne. Toe va6exaTe MUKPOHYTPMeHTHO! HefocTaTON- HOCTH, nayeHTsl AOMKHEI NPOLOMKATE NpM= HvMaTe MUKpOHYTpHeHTeI B AOsaX, NpMEAM- SuTenbHO B 2 pasa NPeBLILIAIOLINK peKO- MeHAoBaHHbIe CyTONHIe JoabI (RDA), 20 HactynneHva BbisaopoBneHia. Y gereit. Hano newb nexauyve 8 OCHO- Be pasavlleroos naTonlorMyecKoro COcTO- sus paccTpojicrea. Y qeTet ¢ noHocoM KopMnenne MOxer 6biTb oT¢po¥eHO Ha 24— 48 yacos, 4T06bI MaGexKaTb ycyryGneHHA nO- Hoca. KopmneHme nposogvrca acto (6-12 pas/cyr), Ho 80 vaGexanne nopaxe- Hua W 6€3 Toro orpakWeHHOlt cnoco6HocTA KMUIeNHMKa K BCACbIBAHMIO LOMKHO ocy- uectnaTecA 8 Manbix _KONMYeCTBAX {<100 mn). B tevenve nepsoii Heaenn Mo- OMHBIe CMeCH ¢ NOGaBKaMn O6BNHO NaI0T- | B NPOrpecoviBHO YBeNNHMBAIOUIMKCA KO- sivwecTBaX; nocne Hemenn MOXHO AaBaTb Tomiible KonmHecTaa 3 pacuera 175 KKasi/xr 146 Genka/xr. LigoviHbie 036i MAKpOHyTpH- elTo8, npesbiuiarouune pexomeHnann RDA, sensoTcA OOsSaTeNbHEIMM, Dis Hero PeKO- MeHiayeToA vicnonbsoBaHne KoMMepyeCKMX NosMBVTaMMAHEKX 106480K. Nlocne 4 Henest MOnONHaR CMecb MOxeT GbiTb sameHeHa LUembHbIM MONOKOM, PbiGBMM xHPOM HM TBEP- AbIMM nvUeBbIMM nponyKTaMH, BKMIONAA Bi ua, PYKTeI, MACO M1 APOXOKN. Pacnpeneneave akepreTmeckolt yeH- HOT MaKPOHYTpHeHTOB AOMKHO COCTaB- ste npwGrvaurensHo: 16 % Genxos, 50 % xpos 1 34 % yrnesonios. B Ka4ecTBe Np Mepa NpvBoay¥M KOMOnHaUMIO OGesxnpeH- Horo MopowKosoro Koposbero MoNoKa (110 r), caxapossi (100 r), pactutenbHoro macna (70 r) u sogti (900 ma). Moryt Wo- TombsoBaTECA M MHOrMe ApyrMe MONOYHBIE Mech (HanpvMep, UembHOe xKWpHOe cBe- xe MONOKO nml0C KykypysHoe Macno ManbToneKcTpi). Cyxoe MonoKo, ucnonb- 3yeMoe B MOONE cMecAK, pasbaanseTcA Bonoii. O6pisto k MomouHtM cMecaM npvGasnA- ores goGapKn: Mg 0,4 MoKe/kr/cyT BHyTpH- MbIIeHHO B TeHeHVe 7 QHei; BATAMMHEI rpynnbi B 8 AgoviHols RDA, aaiorca napeHte- PambHo B TeveHve nepBEEX 3 AHEM, OBLIMHO.C BuTamMHoM A, dochopom, UMKOM, Map- TaHuem, MepbI0, HiogOM, dTopoM, Monv6-22 PAMEN 1. HAPYLIEHMIS| TMTAHMA neHoM M ceneHoM. Mockonbky BcacbiaaHNe nuuyesoro xenesa y neTeli c BSH satpynHe- HO, TO OHO HasHayaeTcA B AOGaBKax nepo- PANbHO WAM BHYTPHMBIWeYHO. PonuTenelt wiorpyKTupyloT 0 noTpe6HOCTAK B ninTa- TeNbHLX BeLIECTBAX. Y papocnsix. HeoGxonvmo ycrpaHinrs PacotpolicTsa, accoummposanHeie ¢ BSH. Hanpnmep, ecnu CIMA, nnn pax npnsonsr k V3AMUWIHeH NPOAYKUMM UVMTOKMHOB, TO Me- Tecrpona ayevat wnn raapoKcwnporecte- POH MoryT yny4UTs noTpe6neHMe TMU. OniaKo, nockonaky aTH npenaparel peaKo yMeHbwaioT sbipa6oTky TecTocTepoHa y MyXunl (B03MOXHO, BbISBIBAA NOTePH MBI e4Holt acct), Hano OnKOBpeMeHHO Mo- NonbsoBaT» H TecTOcTepoH. MocKonbKy 3TH Npeniaparel MoryT BbIsBaTb CHIDKEHHE YHK- uyim HanNOYesHMKoB, OHM HOMKHBI Moroso 30BATBCA TOMBKO KPATKOBPeMeHHO (<3 Me- caijes). Y GonbHbix c YHKUMOHANBHEIMM orpannueHiaMi KnIOMeBLIMH MOMeHTaMM eveHMA sBnRIOTCA HOCTABKA Ha OM NiMH TOMOUp B KOPMNIeHH. Jlexapcreesiible cpencrea, Boa6yxaalo- ue annem (okcTpakT raumwa — ApoHa- 6uHon), HykHO AaBaTe nauWeHTaM c aHOpeK- neti, Kora He BbinCHeHa HK OnKa V3 npHAMH wx sa6oneBani, Win nayMeHTaM Ha CKIOHE >xWGHH, KOT aHOpeKoMA yxynaeT KAYeCTBO wxoKvi, AHaGommMeckme CTeponb! OKagbi- BalOT HeKOTOpHle ronoxuTenbHble adbeKTo (anpnmep, yeennueHve MbWeSHOM Macc Tena, BOSMOXKHO, >YHKUMOHAIDHbIE yTYYLe- Hina) y GOnbHbXx c KaxeKcwelt, o6ycnoBneH- Holt Mo¥e4HOl HenocTaTOMHOCTbIO M, BO3- MOXHO, Y NOXWINK NaLIMeHTOS. Tipwruyénbi koppexumn BSH y sspocnux 8 uenom aHanoriulbl TaKOBbIM y ZeTeM. La GombuwHcTaa eapocnbix KOpMneHWe He AOMKHO GbiT» OTCPOYeHO; PeKoMeHAYIOTCA Manule o6beME NWI C YACTIM ee NpM- emom. BoaMoxHo vcnonsaoBaHie KOMMep- 4eCKOli Mono4HOH cMech AAA opanbHorO kopmnenis, IlutaTenbible seujecTBa 2aloT- os v3 pacuera 60 kxan/kr u 1,2—2r Genka/ xr. Eon xnaxne opanbibie fo6asKn Mo- TombsyoToA ¢ TBepHOl nvueli, TO OHM AOMXHEN NpHHMMATECA No KpaliHel Mepe aa 1 vac no ee npHeMa Tak, 4TO6b! KONHYECTBO cpenaemoi TBepnol4 NUH He CHiDKaNOCD. Tlevenne nauventos ¢ BSH, nomewier- Hex B OM npecTapenby, Tpebyer CoBNIO- AeHMS MHOxeCTBa YCnoBHi, BKniO4aA H3- MeHeHMs OKpyxaioujeli OBcTaHOBKM (Ha- npumep, AenaT> Gonee npuBneKarenbHor OGepeHHy!0 30Hy); NOMOUIb B KOpMneHMn; vaMeHeHMA B QMeTe (HaNpMMep, yCMmeH- Hoe nuTaHve m KanopmitHbie 206aBKM Mex- AY npwemamu nun); seveHve Aenpeccnii W APYrHx neKauMx B OCHOBE PaccTpoliCTB; vicnonbsoBakne cpegcTs, BosbyxKqaInLyMx annetuT, aHa6onv4eckmx CTepongos Man wx coveTaHna. [lis naumeHToB c TAxenoK Anccarveli HesaMeHMMbIM sBSeTOA AH TenbHOe CrONbsOBaHHE Aya KOPMNeHHA TacTPOCTOMb|; XOTA ee MCrOMbsOBAHME y GonbHbx ¢ AeMeHUNe cnopHo. OwyTH My! Nlosibsy NPHOCHT 4 OTKaS OT HEBKyC- HbIx sleveOHbIx MET (HaNPMMep, HM3KOCO- JeBLIX, AMABETHYECKHK, HMSKOXONECTEpH- HOBBIX), Tak Kak OTH AMETE YMeHBUIAIOT notpeGneHve MLM M MOTYT BbISBATb TA- xenyio BSH. Ocnomnenua nevenns. JleveHue BSH MOXET BbISBATS OGNOKHEHMA (CMHAPOM NOB TOpHOro KOpMNIeHMA), BKMOYaA Neperpysky OKMDKOCTEIO, EDMUMTb! SNeKTPONMTOB, r= Neprnnkemnio, cepnesHble apHTMMH HM rOHOC. Tlooc — o6uisHo ymepeHHiilt w npoxopyT ca MOCTOATENbHO; OBHAKO NOHOG y GonbHbH C ‘TmKenolt BSH mHorga BbiabiBaer TaXENyIO Ne- ranpaTaujio wn cMept. Takwe NpHanHbt no- Hoca, Kak, HanpMMep, Cop6MT, HcnoNbayeMbiit Tp nara Yepes 30Hn, Wan Clostridium difficile, ecnv nayjrext nonysan axTuGuoTHKo- Tepannio, Moryr 6biTb yCTpaHeHbI cneyvar~ HbIMM -BMewaTenbcTBamn. OcmoTWYecKa® fvapes, o6ycnosneHHan ynorpeGnexvem AMWHWX Kanopwli, penKo HaGnionaeTcA y BAPOGNbIK M MOXET PaCCMATPHBATECA B Ka- YeCTBe NPMHNHEI TONBKO Tora, Kora HpyrMe pune! BOH 6biin WCKmIO4eHb Tlockonexy 59H moxeT yxyawnTb cep- AeYHYIO W NloYeXHyIO byHKYMH, To rMApaTa~ UWsl MOXeT BbISBaTb YBENMYEHHE BHYTPMCO- cyauctoro oGbema xwpKocTM. SleyeHne chWnkaeT H KOHLIHTpaLIMio BHEKNeTO4HOTO K Mg. YeHbuieHne K nnn Mg Moxer ABT ca npwunHolt apuTmuii. AKTABaUA O6MeHa yrneBonos B Xone eYeHMA cTuMynMpyeT BbiOpoC MHCyNMHa, KOTODEI NPMBOAAT K noctynneHinio docdara B knerku. Funodoc- cbaTemua MoXeT BbISbIBATS MBILIEYHYIO Cna~ GocTs, napectesmu, napanwau, apyTwnn, KomaTosHbie cocTonHna. YposHn docdara &2. HEMOCTATOYHOCTE NMTAHMA 23 kpoav npv napettepansHom nuTaHin AOmK- bl DerynAHO HaMepATECAL B npouecce neyeHua 3HporeHHbiii MHCy- WH MoXeT CTaTb HeadeKTMeHbiM, TO npweogyr K runeprankemin. Cneacrenen TOTO MOryT GorTe permapatauns rinepo- CMonsipHocT®. Moryr pases aranbHiie >xenyO¥KOBLIe ApUTMMI, HTO xapaKTepnay- eTca yBenm4eHviem MHTepBana QT. Nrorto3s Y peteit netanbocts sapsupyer oT 5 0 40 %. Noxasatenn netanbHocT Hixe y Ae- Teli c nerkoli BOH ui y Tex, KOMy NPOBOAM- NlaGb MHTeHCMBHAA Tepanis. CMepTb B nep- BbIe AHI NeNeHWiA OBbINHO HaCTynaeT 13-38 qedvunra snektponuros, cencuca, runo- Tepmnn Wi CeppesHoli HepocTaTo4HoCTH Hapywexe cosHaHus, xKeNTyxa, neTexin, THNOHATPMEMV M NOCTOSHHbII noHOC — SNOBELIMe NPOrHOCTHHECKe CHMNTOMBI, Tpexpaujenve anatuv, orexa v aHopeK- cv — GnaronpwsTHble cumnTomel. Bonee: GbicTpoe BbIsAOpOBNeHNe OTMeYaeTCA ripM kBaumopkope, 4eM nip Mapa3me. lo Hactosusero BpeMeHM nonHOCTBIO He yoTaHoBneHo, K YeMy BepeT AnMTeNbHaA BOH y neTeli. ¥ HexoTopux AeTeli pasenea- eToA CHHAOM xXpoHMYeCKOl Manbabcop6- UM Wt nalKpeaTHyecKan HefoCTaTOuHOCT. Y pereii mnanwero Bospacta 803MOxHO pasevTue yMepeHHOiA onurodpeHnn, KOTO- Pas MOKET COXPaHMTbCA BIIOTb 20 WKONIb- Horo Bospacta. Moryt Ha6nionatboa nocto- sHbIe KOTHITMBHBIE PaccTpOVicTea, aaBN- CIE OT NPOAOMKUTeNbHOCTH, TAKECTM A Bogpacra, B KOTOPOM Havaniacb BOH. Yesgpocnix BSH Moxer nipiBecrM K oCnOx- HeHHOMY Te¥eHNIiO H JeTanbHOCTH (HanpnMep, porpeccnpyiowas noTeps seca yBennuneaeT omepTHocts Ha 10% y noxnnbx moner B 20- Max AIA npectapenbx). Kpome Tex cnyyaes, korfa paseneaeroa HeqocTaTO4HOcTb opraHos wn cvcTeM, neveHve BSH nowt aceraa yo TewHo. ¥ noxwibx nauweHtoe BSH yaennun- BaeT PICK OGNOXHEHWIA M NeTaNbHOCT Np XUPYPTVMECKMX BMEWATENBOTBAK, VC>eKLIAE wai apyrvx pacerpovicTBax. AE@MUMT KAPHATHHA Decmuyr kapHuruua spnsetca cnenc- ‘TaMeM HeapekBaTHOro NocTynneHHA HK Hecnoco6HocTH ycraMBaTs aMMHoKHC- noty KapHHTHH. [ledmuyT KapHHTHHa Npeactasnset reteporenHyio rpynny Hapyweswit. Yxynwaetca Meta6onnaM MbIUIM, TO BeAeT K MMONaTHH, rAnornH- kKemmw WM KapaMomMonaTan. Yawe Bcero neyeHMe SakmioYaeTcA B peKo- Mennaunn aveTel, OGoraujeHHoi L-Kap- HiTHHOM. AwvHoxvcnota KapHuTMH Heo6xoanMa ss Tpaonopra adupos Kodepmenta (ko- ‘9H3MMa) A vi AVIMHHOUBTOYeYHBIX KVPHDIX KicnoT, aleTHn-KOSHaVM A, B MHTOXOHA- ilo MvounTa, rae OHM OKHCNAIOTOA G Ue~ sibio nlonyyeHina sHepriun. KapkMTHH conep- OKVTCA B MMLEBbIX NpoAyKTaX, OCOGeHHO 2XMBOTHOTO NPOUCKOXAeHHA, a TAKKe CHH- TeaupyeTcs 8 opraHname. Tpwuniet aedvunta KapHuTvHa: Hea- AekeaTHoe noctynnexne [HanpyMep, 43-38 MOaHbIX AMET, HeAOCTyNHOCTH NPoAYKTOB, NlonKoro —napeHTepanbHoro§—nMTaHus (TINT)]; Hecnoco6HocTs ycsoeHns 3-34 Aednunta depmexros (Hanpumep, Aedu- UAT KapHMTHMH-nanbmiToMmTpaHcepaabl, MeTMMaOHaTauMaypus, —nponmoxara- UWAeMna, V3OBaNepvaTeMMs); CHKEHHDI SHAOFeHHBIM CMHTeS KAPHMTMHA pH TAKE JOM nlopaxeHMM neveHH; va6bITONHAA nO- Teps KaPHMTHHa NPM NOHOCe, YCHseHHOM Avypese, remMopvanuse; HacnepcTBeHHan TaTonorMs NOeK, MPM KOTOpOM KApHUTHH youneHHo skckpermpyeton; ysennueHne noTpe6HocT B KapHUTHHe npM KeTO3e, Bo3pacTaHMn noTpe6HocTel opraHnama B OK/GAeHM KMPH KUCNOT; MCronb3OBa- He Banbnpoata. Dedvunt KapHUTHHa MO- eT GbiTb reHepanvgoBaHHbIM (cMcTeM- HIM) nM MOxXeT nopaxaTb raBHbiM O6pa- 30M MbILILIBI (MMOnaTHMHeCKHii). ‘Cumntombl 4 Bospact, B KOTOPOM nosB- ASIOTOA CMMNTOMbI, 3aBMOAT OT NPMYMHEL Aedvuya kapHuTinna. DedvuyT kapHuTina ‘MOxeT NPMBECTH K HeKPOSy MBILILL, MMOrnO~ Gvitypiin, Tak HasbIBaeMOli NUNMAHOM MMO narwv, rMnornnkeminn, xWpOBOMY epepox- AeHWO Ne4eHn Mi rvnepaMMoHVeMMM, CO- npogoxnawelicn GoniMM B MbILILIaX, cna60cTbI0, cnyTaHHOCTbIO CO3HaHMA HM Kap- AMommonaTuel. Y HoBopoxneHHEK AeTeM AedMUAT Kap- HuTH-nanbMuToMNTpakcbepaabi AMarHoC~24 PAMEN 1. HAPYLIEHMIS| TMTAHMA TwpyeTca MeTOaOM Macc-cneKTpomeTpHn. MpekatanbHbili AMarHos MOxeT GIT ycTa- HOBNeH nyTeM aHannsa aMHMOTMYeCKOI XMAKOCTH (AMHMOTHHECKMX BOPCHHMATHX KleTOK). Y B3POCHbIX OKOHYATeNIbHbI Ana THOS edMUMT KAPHMTHHa YCTAHABAMBAeTCA Ha OcHOBaHMW ONpeseneHHA ypoBHA ayHn- KaPHMTHHa B CbIBOPOTKe KPOBIM, MOHE Ht TKa- HaK (B MbILIUAX H NeYeHH AVIA CHCTeMHOFO Aedvuyra; TONbKo B MBILIYAX — AANA MMOna~ Teckol cbopmbl AeduunTa). Dedvunr kapHutana, KoTOpBI pasanBa- eTcA w3-3a ero HeaneKBaTHOrO nocTyne- Hus c MnWwel, yBennyeHuA NoTpe6HOCTH B HEM, M36bITONHEX NoTepb, YMeHbUIeHAA ounTesa w (Horna) 13-3a AeduynTa dep- MeHTOB, MOXHO Jle4HTS Nocpe”cTBOM Ha- sHa4eHna L-KapHiMTuHa 13 pacueta 25 Mr/Kr nepopanbHo Kaxable 6 Yacos. AEDT OCHOBHbIX {(S3CCEHLMASIBHbIX) KUPHbIX KMCHOT Deduunt sccenymanbiex -xnpHErx kncnot (3XKK) BcrpeaeToa AOcTaTONHO PeAKo, vauje Bcero y MnageHyes, nnTa- fame KoTOpbIX HeMUMTHO No SKK. CuM- TOMB! BKMIO4YaIOT 4eyZ4aTEIi DepMa- wT, anoneumio, TpoMGouMToneHMIO H samepxxy pocta y qeTeii. Aartos yora- HaBnnBaetca KAMHM4eCKH. MononHeHHe ‘KK ua nM NonHOCTEIO yoTpaHseT Ae- nur. JIMHoneBas M AMHONeHOBAS KMCNOTHI — ‘SOKK — cy6cTparsl ana sHAoreHHOrO cHH- Tega APYTHX KMPHBIX KUCAOT, KOTOPLIe HeoGxoammbl ana OGecneyeHnA MHOrMx qusvonormueckux npoyeccos, aKniovas TOAMepxAHNe YeNOCTHOGTH KOXH M KNETOY- Hb MeMOpaH, CHHTes NpocTarnaHAMHOE M nelikorpnenos. Hanpumep, aiikosanentae- HoBas M AeKOSareKCaeHOBAA KMCAOTbI, CMH Teampyembie 13 DKK, aBnatoTca HeoGxoay- MbIMM KOMNOHEHTAMM rONOBHOrO Mosra M ceTuaren, Js passvTma pedmuyra SKK wx noT- PeGneHne c nMWe AOMKHO ObiT O4eHb Huaxum. YnorpeGnenne paxe HeGonbunx KonmyecTs SKK Moxer npenoTEpaTMTs pas- ByTHe Wx AeduuTa. B KopoBbeM MonoKe comepxutca MpvGrnsnTenbHo 25 % AMHO- J@BON KMCNOTbI OT COMePxaHMA B 4esIOBe- HeCKOM MONOKe, HO KOrZIa KOPOBbE MONOKO ynotpe6sAeTcA B HOPMaNbHbIX KonMHECT- Bax, NOCTynneHve B OpraHM3M AMHONeBOH KMCAOTeI AOCTATONHOe, 4TOGbI NpepoTEpa- Tuts AeduynT SKK. OGujee noTpebneHne XMPOB BO MHOTMx pasBHBAIOUlWwxCR CTpAHax MOXeT ObITb O4eHb HUSKMM, HO OCKOAbKY ‘STOT kp Ba4acTy!O pacTHTenbHOTO NpOMc- XOXDEHHA, C BOMbLIMM CopepxKAHHeM AMHO- esol M NMHONeHOBO! KucnoT, noTpe6ne~ Hie PACTUTENbHBIK KAPOB ABNKETCA HOCTA~ TOYHDIM AYIA NpefoTBpaWeHHA AednuMTa XK. Y mnageHues, KOTOpbix KopMIsM MO- TOYHbIMM CMeCAMM, C opMynoli, o6eA- HeHHO NMHONeBOM KMCHOTO (MonOYHAA ‘CMeCb Ha OCHOBE «CHATOFO» MO/OKa), BO3- MOXHO pagenTne Aeduynta DKK. Aedn- unt OKK MoxeT ABUTEGA M cneACTEMEM AamtenbHoro MNT, ecm OHO He BKNIOYANO mungpl. Ho 8 HacToRUyee BpeMA Gomb- WMHCTBO pacTBopos ana NNT BKniovaeT >XHPOBbIE SMYABCHM C YeNb!O NDeAOTBPA- uleHis aedvunta OXK. ¥ GonbHbix ¢ CMH APOMOM Manba6copounM aMnMgOB Wan yeenm4eHHbimn MeTa6OnM4eckMMM noT- peOHocTAMM (HanpuMep, npm xupypri4ec- KX BMeU/aTeNbCTBAX, MHOXECTBEHHEIX Tpasmax, OxkOrax) AMarHOs MOXKeT ObITb yoTaHosneH Ha OCHOBaHMM peaysbTaToB na6opatopHbxX AakHbXx AeduuNTa SKK pH OTCyTCTBMM KAKHMeCKHX NposBAe- nuit. Dlepmatur, o6ycnosneHHbli Jebuyn- Tom SXXK, — revepannaosaHibiii H Yeluyli- arbiii; y MnageHues OH MOXeT HANOMHiITS BPOXAeHHEI WxTHOS, yBenHunBaeT O6e3- BOXUBAHME KOXM. Ayartos o6bI4HO ABNAeTCA KIMHMYeECKHM; ‘opHako naGopaTopHbie TecTbI, no~TBepX- Aaroume Aednynt DKK, Tenepb AOCTyNHE! B KpynHbix MocnepoBaTeNbcKux YeHTpAX. Fle- 4eHne 3aKnio¥aeTca B OGA3aTeNbHOM noc- Tynnennn SKK c niueli, 410 nomHOCTBIO BOCTIONHAT Hx ACALMT.3, VCKYCCTBEHHOE NMATAHVE 25 3 MCKYCCTBEHHOE MUTAHME Maorne naujiente! ¢ HegocTaToNHOCTBIO TUTAHMA HYKDAIOTCA B MCKYCCTBEHHOM ni ‘TaHin, KoTOpOe HanpaBneHo Ha yaennueHne MblulesHOii Maccbi Tena. NepopanbHoe nu- Tanve SaTpyaHMTensHO ANA nayVeHTOS & alopeKcneli wim MMeIoWyHX npoGneme! TpweMoM nM, e@ NepeeapneanneM BcacisaHvem. Pasniunbie noBeneHueckHe NOAXOAD!, BKMONAA NOOU{PEHAA ga ey, NO- Horpesaxne vin poGasneHne npvnpas 8 uujeBble NOAYKTEI, puroTOBNeHIKe MO6H- MbiK MIM O4eHb apOMaTHBIX Glog, no~bap- pwBaHHe 3a KaKAYIO CbeseHHYIO MaIeHbKyIO NOpuMio, COBMeCTHOe COcTaBNeHHe nnaHa MTaHME, NOMOUb NPM KOPMAeHHM, HHOrAa ObiBaloT ONeHE oddexTHBHbI. Eon nosepeHieckne nopxonbi Heap- PeKTMBHb, TO NoKasaHO UcKyCCTBeHHOE nit- Tanne: opanbHbiii, QHTepanbHwll 30H, Na- PelTepanbHoe nutarne. McxyccteeHHoe uTaHne He HasHa¥aeTcA yMMpaIoWMM MAA NauweHTaM C BbIpAKeHHOH eMeHUMEH MrortosnPoBaHHE NOTPEBHOCTEA B MMLE Notpe6Hoctm 8 nue MoxHO nporHo3n- Posatb no opmynam win M3MepuTb Me- TOAOM HenpaMoli KanopumeTpun. O6uHe sarpatbl aHeprun (033) 4 noTpe6HoCTA B Genke oGbi¥HO paccumTbiBaioTca. O39 O6bI4HO OnpeAeNAOTCA Ha OCHOBAHMN Be- ca nayeHTa, YPOBHA aKTMBHOCTH M cTene- Hw MeTaGonmyeckoi akTMBHOCTH (MeTaGo- smyeckne Tpe6oBaHna); O39 Bapbupyer ot 25 xkan/kr/oyt ana monel, BeayuyNx cunsuuii o6pa3 XM3HN M He B YCROBHSX cTpecca, Ao 40 Kkan/kr/oyt ans moneli, KOTOpHIe HaXOAATCA B KPUTHHECKOM CO- ctosHin. O39 cKnapbipaetca v3 Gasanb- Hbix (OCHOBHEIX) 3aTpatT sHeprun (B39, o6biI4HO mpu6susnTenbHO 70 % O39), ‘SHepriin, NoTpeGnaeMoli npv meTabonvs- Me nuTaTenbHbx Bewects (10 % 033), SHEPrMM, M3pacKOAOBAHHOK npn dush- 4eckoi akTuBHocTn (20 % O39). Henocta- TOuHOe NMTAHe MOxeT CHWKaTb B39 Ao 20 %. Coctoslina, KoTopbie ysenuuneaioT metaGonw4eckve noTpeGHocTM (kpMTH- yecKHe COCTosHKA, MHdeKWNH, Bocnane- Hua, TbaBMel, xnpypruveckHe BMeWaTenb- cea) moryt yaennuneats B33, Ho penko Gonee vem Ha 50%. Ypasnenne Xappvca—BexennKta qaet BOSMOXHOCTS OWeHMTb B39: Mypxswbi: xkan/cyt=66 + [13,7 ec (Kr)] + +[5 poct(cm)]-(6,8 sospacr) >KeHuebs: kkan/cyT = 665+ [9,6 Bec (Kr)] + +[1,8 poct(cm)]- (4,7 Bospacr) 039 Take MoryT GbiTb OWeHeHbI noc- penctaom qoGasnenna x B39 np6nuan- TesbHO 10 % Ana BenyUINK CHAM O6pa3 oKMSHM H 10 40 % — Ana Mopeds, HaXOAALYMX- CAB KDHTH4ECKOM COCTORHAN, Ans snopossx mopek cyrounbie norpe6- HocTH B Genke coctasnaior 0,8 r/kr. OnHaKO ANA TayneHToB C MeTaGonM4eckim cTpec- COM Mn C NlOYe4HO! HeAOCTaTOYHOCTBIO, a TakxKe AYIA NOXKMNLIX OHM MOryT ObITb Gonee BbICOKMMM (cM. Ta6N. 3-1). 039 MOxHO VaMepHiTh HenpAMOl Kano- pumerpneli, wononbayn meTabonmueckyio kamepy (3akpbiTan cMcTema BO3BpaTHOrO: ApixaHMA, KOTOPAA ONpeAeNAeT PacXoAbl ‘SHEPrHM, OCHOBAHHBIe Ha OOWeH NponyK- uw CO,), Meta6onmeckaa kamepa Tpeby- eT CheunanbHol okcnepTnabi M He BCerna foctynva. Kanopnmerpis Moxer TaKKe MC TloMb3oBaTECA ANA MOHMTOpHHTa pacxoAa sHeprni, Tasnnua 3-1. MpHenKsvTENbHOE CYTOYHOE NOTPEBSIEHME BENKA BSPOCKLIMK Tloreeshocre (r/xr Coctosine WAEATBHOA MACCHL Tena / cyt) Hopma 08 Bospact > 70 net NoveuHan HemocTaTo4- HocTb Ges avannsa MlovesHan HegoctaTo4- ocr camannaoN MeraGonmyecknii crpecc 1,0-1,8 (kpurtmeckoe coctoaune, TpapMa, oxor, xApypru- Yeckve BMewaTenbcTBa)26 PAMEN 1. HAPYLIEHMIS| TMTAHMA QUEHKA PEAKUMM HA VICKYCCTBEHHOE MMTAHHE He cyujectayer «sonororo craHpapTa>, To6bi OUeHHTS AaHHyIO peaKunio. Moryr no- ‘Moub Take OKagaTesIM, KaK MbILICSHAR MaC~ ca Tena, ManeKc Maccb! Tena (IMT), aHanns cocrasa Tena, pacnpenlenenve xvpa Tena (om. orp. 15 73). Taroxe MoxHO Mcnionb30- BaTb DaHHbIe agsoTucToro GanaHca, peaKuvn Ha KOXHbIe AHTMTeHbI, VSMepeHMA MBILIEY- HOM cel v HenpAMol KanopnMerpyn. Asorucrbi Ganac, KOTOpbi oTpaxaeT GanaHc Mexay norpeGHocTamn B Genke 1 eo AOCTABKOI, — TO PasHOCTb MExAY KO- suecTBOM nocTynaloulero M BbILeNHeMOrO agora. Nonoxntenbubii Ganaxc (T. e. korga Gonbwe noctynaer, 4em TepaeToA) osHaya~ eT anexsarHoe noctynnesve. TouHoe 13Me- PeHve HeOcylecTBVMO, HO loMoraeT OUe- HiT PeaKUWO Ha VCKYCCTBEHHOe NMMTAHHe. Mpegnonaraemble notepM agora COcToAT 43 norepn agora ¢ Mooi (paccumTbiBaeTCA NO ComepxKaHnio a30Ta MOYeBMHbI B NpaBMsBHO coOpaHHoii cyTOMHO! Move) nnioc NoTepH kanom (1 r/cyt, ecn Gbin ctyn; m He rmocy- em, ecsin CTyna He 6biN0), Koc pyre, He Tonaaiowmecs onpeneneHnio noTepi (3). Peakua Ha KOXKHbIe aHTMreHbl (MHDeKC rinepyyscranrembHooTn samesyieHHoro TH Ta) ¥acTo HopManvayeTcs, Korpa NayweHT HesOCTATONHOCTBIO NMITaHMA NONOXMTENHO «oTBeuaeT» Ha napeHTepanbHoe ninTaHne (ovo emy ajexearHo). OnHaKo " apyrne akTopb! MOryT BIMsTp Ha PeaKLAKO Ha KOK Hble aHTureHBl. MolweuHas citna KocBeHHO OTpaxaer yBe- JW4EHMS MbILUEYHOM MaCCbI Tena. STO MOET GbiTb MSMePeHO KONIMYECTBEHHO (cia CxKa- Ws nagoHH nyteM AVHaMoMerpii) nn snexrpodusvonormeckn (o6bIHO nyTeM cTuMynsUyin noKTeBOrO HepBa aneKTpOLOM). Onpenenexne yposHa cbisopoTouHEKX GenkoB, OCOGeHHO KOpOTKOXNByLINX: npe- anbOyMunva, peTuHonceasbisaiowlero Genka w Tpakodeppinva, niomoraer oueHMear> pe- AKUMMIO Ha MCKyCCTBeHHOE ninTaHve (CM. Crp. 15). NMTAHME C NOMOLIbIO SHTEPASIbHOrO 3OHAA Takoe nvTaHve Ha3Ha4aeTcA TeM Naly- exTaM, y KOTOPEIX @yHKUMOHMpyeT KKT, HO KoTopbie He Moryt notpe6nsTb nepopanbHo B MOCTATONHX KONMHECTBAX NMTATENbHBIE BeuleCTBa, NOTOMy 4TO OHM HYKAAWTCA B vuTeHCHBHOM nocTynneHMn sHeprin uM Gen- Kos nuGo He XOTAT Wn HE xXeNaIOT NPMAM- MaTb Nvully Yepes POT. SHTepanbHoe NuTa- Hye, B OTAMMe OT NapeHTepanbHoro, NOMO- FaeT COXpAHATS CTpyKTypy M yHKLAIO KKT; OHO Takxe Goslee DEWEBO M1, BEPOSITHO, BbI- ‘SbIBAET MEHbLLE OCNOXHEHM. Cneundyweckvmm noKagaHnamn sana \oTOR asMTenbHas aHopexcna, TAxKeNaA BSH, Koma, yrHeTeHHOe COsHaHHe, neveHoHHaR HepocTaToHHocT, HECrOCO6HOCTb NpMHM- MaTb NMUly NepopanbHO M3-3a TpaBMbl ro OBLI, eM, HeBPONOTMECKMX paccTpolicTs, kpuTneckne CocTosHis (HanpHMep, OX0- 'W), BbISbIBajoU\e MeTaBonMMecKHii crpecc. Apyrne nokasaHins — 310 nogroToBKa Kn- we4Huka K Onepaumn y TAxeNbIX GonbHbix Wn NauWeHTOB C HeAOCTATO4HOCTBIO NMTa- HWS, 3aKPEITHE NOCTORHHON SHTepOCTOMb:, CHHAPOM KOPOTKOM KMWKM riocne MaccHB- Holi KMWe4HOM peseKyMM WnM paccTpolic- ‘Ba, KOTOpble MOFYT BbIaBaTb Manba6cop6- unio (Hanpnmep, Gomes Kpoxa). Merona Texnua. Eon nurarve c NOMOUbIO 3OHAA NPOBOAMTCA B NepHon Me- Hee 4eM 6 Henens, To OBbINHO HconbayeTcA 30H Manoro KanvOpa, MArKKi HagoracT- PanbHbili wn HagosHTepanbHbil (HanpuMep, HagOnyoneHanbHbili), cpenaHHblli “3 cMNM- Kona Wn nionuyperaia. Eon nospexneHne Hoca unv ero Jedopmauys saTpyAHAIOT NoC- ‘TaHOBKY 30HfIa B HOC, TO CTaBATCA OporacT- PanbHbili wilt OposHTepanbHbili SOHAL Kopmnexe 4epes 30Hg Gonee 6 Hefenb O6bI4HO TheGyeT racTpOCTOMMM WIM eHOC- TOMMM Ayia yCTaHOBKM 3oHpa. TaKOM 30H OGbINHO CTaBMTCA sHocKONMeCKH, xMpyp- Tweckn WK peHTreHonornveckn. Bi6op ‘3aBMCHT OT Cnoco6HoCTeli Bpaya V NpeANoy- TeHMs NayeHTa. EOHOCTOMHbIe 30HAbI NOA- XOAAT As NaleHTOB C NPOTMBONOKAsAHHNA- mw K racrpoctommn (HanpvMep, racTpoKTO- MvM, KVIENHO HenpoxonVMOcTH BBIWe Towel Knuiky). OnHaKo OHM niopBepra‘oToA HeMeHbeMy PuicKy TpaxeoGpoHxvanbHoni acnmpaln (XOTA MHOrMe AYMatOT, 4TO MEHb- emy), 4eM py racrpocTommn. ElHOCTOM- HbIe SOHAbI Nerko CMewUAaIOTCA M OBbINHO HC MonbsyioTcA TonbKO {YI CTALIMOHAPHbIX GonbHEKx.3. VCKYCCTBEHHOE NMATAHVE 27 Xupyprueckan noctakoska nuTatenbHo- ro aoa OcOGeHHO nogKonMT, ecm aHAOC- KONMHeCKaA M peHTreHONOTMHeCKAR NocTa- HOBKH HEAOCTYNHI, TEXHMHECKH HEBOSMOX- Hbl WM OnacHbl (HanpHMep, nipH 3aBopoTe knweyHika). Moryt Mcnonb30BaTbca OT- kpbtran sanapoTomis win JanapocKonwa. Nuratenbubie cmecn. O6bi4HO ucnonb- SYeMbIe XVAKHE NMTATENbHbIE CMEGH BKMIO- 4aioT nMTaTenbHble MopyA (cTaHnapTHbIe Ha6opbl HyTpneHTOB) M nO/MMepHbIe win Apyrve cheynannsnposakible nuTatenb- ble cmecn: Muratenbrble Moaynn — KoMMep4ecKn AOCTyNHble W3peNKA, KOTOpLIe COAepxAT ‘TOMbKO ODHO NuTaTeNbHOe BELYeCTBO: Genkn Wn >kMpbI, WIM yrneBoAL. MuTaTenbHbIe MOAysM MOrYT McronbsoBaTbCA MHAMBMAY- aNbHO ANA NeveHHA onpeneneHHoro AebH- ysTa WIM KOMOMHMpOBAHHO C ApyrMMn ni- TaTesbHBIMM CMeCAMM, YTO6bI NOAHOCTIO yAOB/eTBOpUMTS NoTPeOHOCTH B NMWYe. Tloammepxbie nrarenbHbie cMecH (BKMIO- Yas TOMOreHASMPOBAHHBIe M KOMMepHeCKne MosiouHble CMeci 6e3 aKTO3bI MIM Ha OCHO- ‘Be MonoKa) KOMMepYeckM JOcTynHbIM O6eC- NeunsaioT nonHblli, C6anaHcMpoBaHHBiii pa- WOH. OHM Moryr Mcnonb3oBaTbCA ANA O6bI4HOro KOPMAeHHA Hepes por MN 3OHA, Vicnonbayemwie ana cTaumoHapHbx Gonb- HbIx MONIO4HIE CMeCH 6e3 akTOSbI — 9TO OBI4HO NONMMEPHBIE MONOYHbIe cMeCh Oanako Monio4Hbie CMeCn Ha OCHOBe MoNo- ka Oonee BKyCHble, YeM MONOYHBIE CMeCK 6e3 nakro3bi. MayneHTbl ¢ OTCyTCTBMeM TO- SepaHTHOCTA K siaKTO3e MOTYT NepeHOcHT’ MONONHBIE CMECM Ha OCHOBE MOsIOKa NpH MesIeHHOM noCTOsHHOM BBeseHMN. TaponnsoBaHHbi Genok wan vHorna CMeCH aMMHOKHCNOT UconBSyIOTCA AAs Na UMeHTOB, KOTOPbIe TPYAHO YCBAMBAIOT CHOX- ble Genk. OpHaKo 3TH MonOYHbIe CMech AOPOrH MW OGLIYHO He HBNAOTCA HeOGXonH- MbiMM. BOnbUMHCTBO nayMeHTOB C HEDO- CTaTOHHOCTBIO NOAXKeNYADYHO! >xKenesbi, eCnn WM HasHaHaTe depMeHTbl, M Gonb- UMHCTBO nayeHTOB ¢ Manba6cop6unelt MOryT yCBanBaTb CNOxKHBIe Genk Moryr 6bire noesHbimn HM Apyrne cneuj- asM3MpOBaHHbIe NMTaTeNbHbIe CMECH (Ha~ pMMep, BBICOKOKaNOpiiitbie w BbICOKOBeN- KOBLIe JIS NALIMeHTOB, Y KOTOPbIX MMeeTCA HeAOcTaTONHOCTs >xMpKOCTeH; OGoraleH- Hble BONOKHAMM nuTaTeNbHbIe CMeCH Asi nayjeHtos c sanopamn). Npvmexenve. Mayventel 80 BpeMs aH- TepaNbHOrO KOPMMIEHHA AOMKHE! CHET C TOQHATEIM NOAFONOBHMKOM KpoBaTH NOA yr- TOM 8 30—45", a sarem ewe 2 4aca nocne kopmmenns, Mluraxne Hepes 30Hg ocywecT- BNRETCA GOMOCHO HECKONbKO pas B eH wn nyteM HenpepsiBHoli MHdy3¢n, Bomoc~ Hoe niTaHne HasHaNaeTcA nayJeHTaM, KO- ‘Topbie He Moryr HenpepbiBHO CHET BepTH- kanbHo. Henpepbistas unysia Heo6xoan- ma, ecnm OonocHoe nuTaHve BbisbIBaeT TOWHOTY; STOT METOA MOXeT YMEHbLLWT BePOATHOCTS roHoca M acnmpauyan. Tp 6oniocHom nitaHnn nonHbli exe- AHeBHbIA OObem paspensioT Ha 4—6 4ac- Teli, KoTOpbIe BBOAATCA Hepes 3OHA WNpH- eM Wil HHOysMOHHO Noa AejicTBMeM CMe ‘TAKECTH M3 NOABeWeHHOTO nakeTa. Mocne KOpMeHHs 30HA npombiBaeTcs BOAOH, 4TO- 6ti npegoTapaTiT® 3axynopuBaHne. Tlockonsky nuranme vepes Hagoract- PaNbHbIl Win HasOAYOReHANbHBIM SHA YaC~ To WaHaYANbHO BbISbIBAeT NOHOC, KOPMse~ Hite OGbINHO HAYMHAeTCA C MasIbIX KONIMYECTB pas6asneHHoro npenapata, KoTOpsie yBe- ‘MHMBAIOTCA AO TEX NOP, MOKA STO BbIAEpH- BaeT nauneHT. BonbumHctso cMecei co- aepxar 0,5, 1 wan 2 Kkan/ma. Kopmnenne 4yacTo Ha4MHaloT C pacTsopa B 0,5 Kkan/Mn (nonysaior 50 % pas6aaneHnem Kommep- ¥eckh roToBoro pacTsopa B 1 Kkas/Ma) ro 50 mn/4. Kak anbTepHaTHBa McnonbsyeTcA pactgop c 1 Kkas/Mn no 25 mn/4. O6bI4HO STM pacTBOpbI He /1aI0T OCTATOHHOTO KOsIM~ YeCTBa BOAbI, OCOHeHHO ECM pBOTA, NOHOC, noTeHve WM NlxXopanka yBENMYMNH BOAHYIO notepio. ZononnirenbHoe KonMueCTBO BO- Abl BBOANTCA GomOcHO Hepes 30H WnM BHYTPHBEHHO. Moone HECKOMEKHX AHEM CKO- OCT BBE/eHWA MAK KOHUeHTPALMA MOryT GuiTb ysennveHbl, 470Gb! BEOAMT PacTBOp B 1 kkan/ma no 50 mn/4 wn Gone, HTO6bI YAOBNETBOPATE NOTPEOHOCTM B BHEprMM M Boge. MutaHne 4epes 30H Np eKoHOCTO- Me Tpe6yeT ewe Gonbuwero passeqeHun npenapata m MeHbUIMx O6bemoB. KopMne- Hive OObIHHO Ha4MHaioT C KOHWeHTpALWAA < 0,5 kkan/mn M ckopoctu 25 mn/4. Mocne HecKOMbKMx AHEM KOHLIeHTPAUM HM OEM MOryT 6biTb yBeNMHeHbI, HTOObI, B KOHEYHOM cueTe, yoBneTBOpHTbNoTPeOHOCTH BoHED-28 PAMEN 1. HAPYLIEHMIS| TMTAHMA Twn W sone. OBLNHO TOT MaKcHMyM, KOTO- pli MOXeT MepeHOCuTb nayweHT, — 0,8 kxan/wun 8 125 wu/4 Ayia 2400 Kkan/cyr. OcnoxHeHa. OcnoxKHeHiA LOBONHO pacnpoctpaventi n Moryr Guitb cepbesiei- mn, 30HnbI, OCOBeHHO BonbuiMe, MoryT cro- coBcTeoBarb apoann TkaHelt Hoca, rnoTKH waw nuwesona. VHorga passsaetca cHHy- cut. Tycteie (Baskve) pacTsopbl win Ta6- eTKH MOrYT GnloKnpoBaTb NpOceeT 3OHLOB, ocofeHHo Manbix. VHorna sty saKynopKy MoxHO sVKBNANPOBATS NyTeM BBENeHVA PacTsopa maxkpeatmyeckux «epMeHTOB aw apyrux KoMMepyeckix npoAyKTOB. Sots! MoryT cMewlaTbcR, OcOGeHHO e10- HocToMHbie. 3aMeHiTTe 30H ropaazio TAKE lee MW BOSHVKHOBeHNE OCHOXHEHI Gonee BePORTHO, ecni 304A CTABMNIGA HHEAINBHO, Hexenn HenHBaanaHO. HasoractpanbHble 3OHpbI MOryT cMe- aTboA MHTpAKpaHVaNbHO, ecnin peuleTsa- Tam miaCTHHa paspyuleHa np TAxeNOH AM- esol Tpasme. HasoractpanbHble wn opo- TacTpanbible SOB MoryT CMeUIATECA B Tpaxeo6porxvanbHoe Nepeso, BbISbIBaR Ka- wen 4 PBOTHBIA pedaeKc y 4YyBcTEMTeNb- HbxX NayMeHTos. Tpaxeo6poHxnayibHoe cMe- UWeHVe MOXET NOTH HE BbI3BaTb CHMNTOMOB y 3aTOpMoxeHHbix nauneHToB. Ecn Tpaxe- o6porKvanbHoe CMeleHne He pacnosHaHo, TO nua noctynaet 8 jerkne, BbisbiBAR nieaMoHWio, CMeuleHHbIA racrpocToMH- eckitii Win eIOHOCTOMMYECKH BOHM! MO- TyT Monacts 8 GprowlHyio nonocte, Torna nocTynnekve ruTarenbHoit cMecn 8 MHTpa- NepuToHeanbHoe npocTpaHcTo Bbi30BeT nepuronnr. ¥ 20% naunenos uy 50 % nauneHToB 8 Kpymuveckom cocroaHnn pageneaioToA n0- HOC M XXeny104HO-KHWEYHbIM NUCKOMAOPT, o6ycnosneHibi HenepeHoCMMOcTEIO OLHO~ To M3 rNaBHbX KOMNOHEHTOB nuTaTenbHENX cmeceit, ocoGeHHo npr GomocHom Kopmie- ii. Cop6ir, Yacto conepxauiicn 8 xna- Kix neKapcTBeHHbix npenaparax, BBOnMMBIK epes 30HA, MoxeT yoyryOuTb NoHo. Moryt TakKe passiTecA TOWHOTa, psoTa, Comb B .xnB0Te i Mora GpeokeeHan MWeMIA, Moxer ectpevarsca m acnmpauna, axe pv TOM, 4TO 3OHAbI NocTaBneHbI NpaBMb- Ho, #a-3a ped>moxca nnn HecoaMecTuMocTH POTOrNOTOUHEIX CexpeToB M nM. AcrMpa- Um MoxXHO HaGexaTb, ECiIN BepxHAA YaCTb TyROBMUla NalweHTa HaxogyTCA B Npunop- HaTOM CoCTORHHM. BoamoxHo paasuTne HapyweHni anexr- ponmTHoro Ganalca, rvnepravkeMnn, rH nepsonemnn n runepocmonapHoctu. PeKo- MeHpYeTCA NOCTORHHBIM MOHMTOPHHT MacCbI Tena, anekTponMTOB KPOBM, rsI0KOaH, Mg v1 éocdara (exenHesHa 8 Te¥eHne nepaoii een). NIOMHOE MAPEHTEPASIbHOE NMTAHME TaperTepanblaa niraHme no onpene- neHnio npoBogMTon BHyTpHBEHHO. YacTH4- Hoe napesTepanbHoe niTaHne AaeT Tonb- Ko YacTb exeAHeBHBX NoTpeGHoCTe! B nine, NoaKpennan ee npveM Hepes por. Muorve v3 rocnwtanvanposaHHex nay eHTOB Nlony¥aioT STM MeTONOM pacTBOpEI AexcTpoabl nv ammvoKwcnor. MonHoena- PeHTepanbHoe nutakne (IMM) ynosnet- BOpAeT sce exegHEsHEIe NOTPeGHOCTH B nie. TIMI moxet ocywectsnsTscA 8 Gonbunye min Aoma. MocKonbky pactBo- poi ans NNN KoHeHTpHpOBAHHble M MoryT BLISBaTe TPOMGOS nepMdepM¥ecKNx BH, To OBbINHO UCnonbayeTCA YeHTpANbHbilt BeHOSHBIM KaTeTep. Tloxaganna. NNN HasHavaetca nayneH- Tam, y KOTOpLK He yHKuWoHMpyeT XKKT. UWpoko pacnpoctpaHeHHbiM, HO elle He- AocTaTONHO ViccneAOBAHHBIM noKasaHVeM sBNAeTCA npenynpexmeHve HenocTaTos- HocTH nuraHis (MeHee 50 % ynosnerope- His MeTaGonMHeckHX NoTpe6HOCTe!), ANS: uleroca Gone, 4eM 7 AHH, NNN HasHa4a- eTcA HO M noone neveHMA nayVeHToB ¢ TAKEN HELOCTATONHOCTEIO MUTAHHA, KO- Topbie He Moryr notpeGnaTb Gonbuine OOb- ‘eM niiuyM OpaNbHo M roTOBSTOR K xMpyprH= Neckomy BMewlaTenboTBy, my¥esoit Tepanvin wan xamvotepannn, TMM Moxer cHiaHTS PMCK OGROXHEHHIA M AeTaNbHOCTS noche KPYMHbIx xvpYPrivecknx BMewaTeNLCTB, TA- xeNbIK OXOFOB, TPABM FONOBEI, OCOGeHHO y Gombkbx c cencncom. MayneHT o pac cTpojictsamn, Tpe6yiouyMn sHa4ITTeNBHO- TO CHIDKeHN CpyHKYMOHANLHOM akTHBHOCTHM KvweyHnka (HeKoTopbe cTanvm GonesHn Kpowa, saseHHelii KonMT, TAKenbIM naHKpea- Tm), vs BETH c paccTpoiicTaamn (BpOx- AeHHbIe NopoKn; ANMTeNbHBI NoHoC Hesa-3, VCKYCCTBEHHOE NMATAHVE 29 BMICHMO OT ero NPM) 4aCTO TaKxe XOpO- wo pearmpyioT Ha MMMM. Conepxanne nutatenbHbix BewecTB. Ans NNN Heo6xonmati Bona (30—A0 mn/Kr/ cyt), sHeprisi (30—60 xxan/kr/oyr B aaBn- ‘CMMOCTH OT pacxogoe aHepriin), aMMHOKHC- note (1—2,0 r/kr/oyt 8 3aBMcrMocTn oT Tene karaGonvama), HeaaMeHiMbie XMPHBIC KUCHOTEI, BUTAMMHBI W MMHepamb~ le Bewjecrea (cM. TaGn. 3-2). ¥ yeTel, KO- Topbie Hyxnaiorca 8 NNN, norpeGHoctn B XWIKOCTH MoryT oTnintaTACA, a NoTPebHOC- Tm B aHeprmnm (120 Kkan/kr/cyt) 1 aMMHO- knonoTax (2,5—3,5 r/Kr/cyt) — Hayter Ho 6onbwe. Ocosdble pacteopsi aia INN rotosatca 8 CTEPMNbHbIX YCROBMAX, B NUTPOBLIK yna- KOBKAX No CTaHqapTHEIM cbopMyiam. O6bI4- HO B flekb HeoGxogMMo 2 11 craHnapTHoro pacteopa. Pacrsopel Moryt Obit HaMeHeHt Ha OCHOBaHVIM faHHbIX Na6opaTopHbix WC- cnenoBakvii, HaNWMiA OCHOBHBIX pac- CTpoiicre, rvnepmeta6onvama wnn npyrax paxropos. Yacto qoSasnnioTca KoMMep- Yeckn ocTynHble SMynbcvM nunngoB ANA OBecneveHvs SCceHuVanbHbIMI xMDHEIMAM kvonoTamn Tpuranuepwnamn; 20-30 % o6uweli sHeprin BocnonsReToA snigiamn Onnako orkas or nino8 w Wx aHeprina MO- XT MOMoMb CTpanaioulmM oxMpeHHeM Na- WveHTaM MO6WnNg0BaTb SHAOreHHbIe KUPO- able Janachl, yBeNMNMEAA TeM CAMbIM 1x ayBCTEMTeNBHOGTE K MHCynVHY, Pacteoppl. OGbivHo McronbayioTca pa3- swstisie pacTeopés. Moryr GtiTb loGaBneHbl anekrponutil, 4T06b! YAOBNeTEOpHTe noT- peGHocTa nalyweHTa 8 HM. Mauvextam, y KOTOpbix uMeeTCA no4e4- HaA HEZOCTATOYHOCTh M He HAXOAALUIMMCA Ha piannge, WIM y KOTO HMEeTCA TIeHeHOH- HAA HELOCTATOYHOCTh, HEOOXOMMbI pac- Taopbl C YMEHBUNEHHEIM ConepxaHineM Ben- Ka V1 BBICOKMIM NIPOLIeHTOM SCCeHUWATBHbIX ammiokucnoT. Y nayeXTos c cepaeyHon Wn NOYe4HOM HeEOCTATOYHOCTbIO BBODV- Mili OB beM (KMIKOCTH) NloMKeH GbsTb orpa- H4eH. MauveHTam ¢ bixaTenbHO HepO- CTaTosHOCTbIO AMMMiAHAR SMyMbCHA NOMKHA O6ecre4nTb GonbuivHCTBO HeGeNKOBbX Ka- lopwii, AIA MMHMMM3auMA nponyKyWn CO, npn meTaGoname yrnesonos. Hopo- POKNeHHLIM HeOGxORMME Gonee ~HMaKne KOHUeHTpaUNMh HeKcTpO3bI (17—18 %). TasnMua 3-2. OcHOBHBIE EKEAHEBHBIE MOTPEBHOCTM Y BSPOC/IBIX NPM NONHOM TAPEHTEPAMIbHOM TMTAHHM Konwsect- Hyrpnent ns Bona (/xr macou Tena/cyr) 30—40 mn ‘Suepra Tepanestmvecknitnaunent | 30 xxan Mlocneonepaunowneiina- | 30—45 xran 4560 xan SwawwrensHo HoTOUIEHHSIA ‘Ammvoxwcnores (/kr macs Tena/cvT) Tepaneaniieckni naument 10r Mocneonepaunownei na 2.06 3,06 SuawwTensHo HoTOUIeHHI MMHEPANGHBIE BEWIECTEA ‘Auetat/rmoxowat 90 axe Kansuis 15 woxs Xnopna, 130 MaKB Xpom 15 mer Mens on 120.mxr Marni 20 waka Mapraveu ur ocop 300 wr Kanai 100 maxe Cenex 100 uxr Hatpiit 100 MaKe ren Sur Butamanist ‘AckopGmHowaa KncnoTa 100ur Bvorn 60 wer KoGanamnn Sar onvesas knenora 400 wer Haut 40M MaxroreHoBaa xncnoTa MiapanoKome 4ur PrGodnasnn 3,6 mr Tuan 3ur Brawn A 4000 ME Byram D 400 ME Brawn E Brawn K 200 wr ‘Motpe6HocTn 8 sHepran ysenmuneaioTca Ha 12% Ha 1°C npn nuxopane. Havano npoueaypet NINN. Mockoneky UeHTpanbHbil BeHOSHEIT KaTeTep AONKeH ocTagaTbcn Ha MeCTe B TeNeHne jMTenb- Horo BpemeHM, HeOOxXoRMMO cOBmIOneHMe CTporvx mep cTepvmbHocTH Bo Bpems ycra- HOBKH m oGcayxvealia. Cuctema ans NINN30 PAMEN 1. HAPYLIEHMIS| TMTAHMA He MOMKHA VCNONbsOBATbCA HM C KaKOi Apyro# yenbio. BHewHss Tpy6xa nomKHa SaMeHATBCA Kaxable 24 yaca C MOMeHTa ycTaHoBky nepgoro Meuika. MpyMeHeHve BCTPOeHHEIX bUNETPOB CNOPHO M1, BOMOK- Ho, He nomoraeT. Benbe HOMKHO xpaHHiTs- CA CTEPMNbHLIM VM OGIYHO 3aMeHATECA kaxapie 48 ¥acos npn nonkol crepunb- Hoty. Eon NNN nposogutca BHe Gonb- HMUpl, TO NayVeHTOB HYXHO Hay4HT pac- NOSHaBaTb CHMNTOMbI MHEKUM, a TAKE uM fomKeH GwiTs OpraHU30BaH XOpOUIMi OMawiHni yxon. Beegenve pacrsopa HaNMHaloT MepneH- Ho, CO cKopocTbI0 50 % pacueTHEIX Tpe6o- BaHni, ncronb3ys 5 % pacTBop AeKCTpOSbI Ana KoMneHcaunn GanaHca xnpKocTH. Vic- TOMHMIKH SHEPTHM M a3OT HEOOXOAMMO fa~ Barb onHoBpemeHHo. KonuecTBo cTaHaap- THbIX EAMHNY MHCYNMHa, ROGaBnAeMoro He- nocpencrseHHo « pactsopy ana NNN, SABVCHT OT YPOBHA rm1OKO3bI B KPOBIK; eCnin YPOBeHb HOPManeH M KOHeYHbI pacTBop ConepKMT oBbI4KyIO 25 % KOHWeHTpALWO AeKCTPOSbI, OBbINHAA CTapToBaA noza — 5—10 crannapTHbx eonHMy vACynAHa/n >xwpKocTH Ans NN. Moxwtopuur. AvHamuKa npouenypb! OMKHa ConpoBOxpatscA GnoK-cxemoi. Bpiraga cneuanncTo-cMexHiKkos no nit TaHMio, eCnK TaKOBam MMeeTCA, AOMKHa MOCTORHHO KOHTPONMpoRaTb nauweHTa. Macca Tena, o6uit aHanna KpoBm, aneKT- PONTE! NOMKHEI NPOBEPATECA HEONHOKpAT- Ho (As19 CTAUMOHApHbIX BONbHbIX @XeAHEB- Ho). Fnioko3a KPOBM AOmKHa NpoBepATECA kaxkgpie 6 4acos, noka He CTaGunnaupyerca. Tloctynnenne BbiBeneHMe KHAKOCTH Tak- Xe OMKHbI NOCTOAHHO NpoBepsTboA. Mocne cra6wnvgaynm naumeHTa aHanvabl Kposn MOXKHO enaTb He Tak YaCTO. Domxrbi 6biTe cnenatbl TecTbI ANIA OWCH- kw yHKWWA neveHH. MnasMeHHIe Genkn (Hanpmmep, cbiBOpOTOUHEIH anb6yMinH, BO3- MOXKHO TpaHCTMpeTHH WK peTHHONCBAgBI- Baiouynii Genok); NpoTPOMGNHOBOe BpEMs; OcMonApHOGTE nage! v Moun; Ca, Mg M ochat (He B xOBe MHdysHM rMIOKO3Es) AOMXHbI M3MepATECA ABAXObI B HeDeNIO. Tlontias oyeHka CoToRHMA niMTaHMA (BKNIO- yas sbluncnenne VIMT w aTponomerpvuec- kve uamepeHiia — om. crp. 15173), omkHa ToBTOpATECA C MHTepBavIOM B 2 HELEN, Ocnoxtenna. pv TwarenbHoM MOHII ‘Topmire 6prrranoii no nuraHMo ypoBeHb oc AOXKHEHMI MOXxeT ObiTe MeHee 5 %, Ocnoxk- HeHMS MOFYT 6bITS CBASAHbI C LeHTPANbHbIM BeHOSHBIM KaTeTepOM (cM. TaGn. 63-5 Ha cTp. 687) ww c oGecneyeHnem nutatenb- HbIMM BeeCTEAM. Orknonenus oT HopManbHoro ypoBHs TmioKoaBI ABNAOTCA NOCTAaTO4HO xapaKTep- Hbimv. TunepraivKeMvn MOXxHO Vi36exKaTb, NOCTORHHO KOHTPONMpYs YPOBEHb FH0KO3I posi, eryniipysi Nosy MHCynMHa 8 PacTBO- pe ana NNN w BBO MHCyAMH NOKOxHO NPM Heo6xonmmocty. TwnornuKemva MOXxeT GuiTb yorpaHeHa HeMesVIeHHbIM BBeLeHKEM KOHLeHTPYpOBAHHOM AeKCTpOSb. JleNeHHe, 8 aBMGMMOCTH OT CTeneHA rMnormvKeMMin, SaKMO¥aeTCA BO BHYTPMBEHHOM BBeDeHKM pacrsopa 50 % nexcrpoab win mHdbyaKn 5 % mn 10 % pacrsopa neKcTposbi 8 Teve- tne 24 yacos nepep, Bo306HoBNeHKeM NNN Yepes UeHTpaNbHBIl BEHOSHBIM KaTeTED. Orknovenns oT HOpManbHbix ypoBHelt ‘9NeKTPONMTOB M MMHEpanbHbIX BELECTE B KPOBH O/KHbI BoiTe OTKOPPeKTMpOBaHbI nyTeM MonMduKALIAN NOcNeAYOUINK MHdby- ‘ani wm, ecnm Cpo4Ho Tpe6yeTcA KoppeK- Uva, HAMNHaA COOTBETCTBYIOLIME VHY3iit B nepndepvseckue BeHbl. HenoctatoyHocTb BMTaMMHOB M MMHepalibHbix BeLECTB BCTPe- yaeTOA PepKO B chyYamX, ecnM PacTBOpEI BBOASTCA NpaBMNbHO. JlervnpaTauAMOKeT GviTb oTKoppexruposala BEEpeHWeM BONE! 15 % pexctpoael B nepndepneckyio BeHy. Tunepsonemun (ee Hasmne MOXHO npegnonoxuts, eon npv6aska B Bece Gonbuwe 1 kr/cyr) MoxeT BcTpeYaTEGA, KOr- Aa Gonbume exenHeBHbIe NoTpeGHOCTH B ‘Heprnn Tpe6yior GonbwHx O6beMOB xMA- KooTH. MetaGonmyeckoe nopaxenne KocTeii, wan ReMmbepannsauyia KocTedi (ocTeonopos win ocTeomannuyia), pasBvBaeTcA y HeKOTO- Pbix nauneHToB, nonywatoumx MITIN Gonee 3 Mecaues. MexaHv3m HevaBecTeH. Ipo- Tpecoposanve sa6onesaHna MOXeT BbI- 8aTb CWNIbHbIE OKonocycTaBHBIe Gonk, Gon BHMKHIAK KOHESHOCTAX MH NOACHVUe. BpeMeH- Hoe win nocToAHHoe npexpaweHne IN — AVHCTBEHHbI V3BECTHbIM MeTOA NeYeHHs. TloGounbie peakymn Ha sMnMpHBIe ‘MYNBCHM (B TOM HMGNe ODbILIKA, KOXHEIE annepraveckne peakuvi, ToWHOTA, TonO-3, VCKYCCTBEHHOE NMATAHVE 31 Has Gonb, 6onu B noscHMue, NoTeHMe, ro- MOBOKDYKeHMe) PenKM, HO MoryT 6bICTPO NOABUTECA, OCOGeHHO eGnn NMNApbI AaWoT- caa pacueta Gonee 1,0 kkan /kr/4. Moxet BoTpevaTscA BpeMeHHaa rineprwnupe- Mis, OCOGeHHO y GonbHbIx C NOYeYHOM MK MeYeHONHOM HEROCTATOYHOCTBIO; eee O6bINHO He Tpe6yeToa. FosnHne NOGOMHEIE peaKuyn Ha nuiMgHbIe OMysbCHH: renaTo- Meranus, YMepeHHOe noBbILIeHMe B KPOBH NeveHONHEK (epMeHTos, crneHOMerasis, TpomGounToneHua, nelikoneHKA M, OCO- GeHHO y HeAOHOWeHHbX AeTeM c pecnupa- TOpHbIM AMCTPeCc-CMHAPOMOM, — Hapy- WeHwA OyHKUWM NerKX. BpeMeHHoe mnt NOCTORHHOe SaMeAfeHHe MN OCTaHOBKA vHcyann AMNMaHOR oMyNbCHM MoxkeT Npe- AOTEPATHTb MAK MMHAMMSHPOBATb 9TH NO- 6ouHbie peaxuinn. TevenouHbie ocnoxHeHMs BKnIO4aI0T AvcoyHKuMo neveHv, GonesHeHHyio rena- Tomeranwio M runepamMoHnemnio. OHM MoryT pasemTbcA 8 m060M BOspacTe, HO HavGonee YacTbl y MiageHyes, OcoGeHHO HEMOHOWEHHBIX, 4bA NeveHb >YHKUMOHANIb- Ho Kespenaa. B Havane MINN 6biBaer Mnpe- XOAPUIAA AMCOYHKUMA Ne4eHH, NH KOTO Poh HaGmionaeTca ysenH4eHHe ypoBHelt ‘qpakcamnas, OvnupyOvHa, wenoyHo ocdarasbi. MosaHne wn cTolikne Wx no- BRIWEHMA MoryT ObiTb O6ycnoBneHb! W3- SWMUIHHMA KONMAYeCTBaMA AMMHOKuGHOT. Matorexes HenspecteH. Ceol eknag BHO- CAT, BePOATHO, xOnecTas M BOcraneHe. Vvorna paseneaetca nporpeccupyiounit @uG6pos. YmeHbueHve BBeAeHWA Genka B TaKWX CHTYAUINAK MOXeT OKASATEGA nones- Heim. BonesHenHas renaromeranua caMge- TenboTsyeT 0 HaKOnNeHMA xMpa; OMKHO GbiTe CHMxeHO BBeDeHNe yrneBogos. Y MnaleHues MOxeT pasBitTeca rMnepaMMo- Hwemva. CMMnTOMbI BKMIONaIOT COHNM- OCT, CYOPOXKHEIe NoAeprnBakna, O6WMe napanwan. KoppeKuiia saknioaeTca B 0 GaeneHun apruHwva B KosMuecTse 0,5— 1,0 mMonb/kr/cyr. Y MnageHyes c neve- HOMHbIMH OCROXHEHHAMM HaZO OrpaHMYMT aMMHOKMCNOTbI BO 1,0 r/Kr/cyT. OcnoxneHua co CTOpoHb! xKen4HOrO HysbIpa BKMOYAIOT XONeNHTMas, 3acTOH KEN M XONEUVCTHT. STH OCNOKHEHVA MO- TYT 6biTb BbISBAHEI MAK ycyry6neHbI AYIA TeNbHbIM 3ACTOEM KENYN B XEMHHOM MYSbI- pe. Momoraer cramynauya ero coKpauleHin nyTem oGecneveHia nocTynneHna 20—30 % SHEP 3a CHET KMPOB Mi NPeKpaleHHA MH ‘y3MM FmWOKOSbI HA HECKOMIbKO 4ACOB B CyT- xv, Tlomoraer Takxe npvem niu Hepes por wakTepanbHoe nitanne. HeKoTOpbIM nalqi- eHTaM C XONlesIMTMa30M NOMOraeT NPHMeHe- He MeTpoHMasona, ypconesoKcMxonesoli xcnoTel, eHoGapGwrana, xoneuMCTOKH- Hua. TIMTAHME YMMPAIOWMX W MAWMEHTOB C TADKENIbIM CNABOYMVMEM AviopeKcna unk notepa annetiTa YacTo BCTPevaloTCA cpeAN YMMpAIOLIMK NayWeH- Tos. MopegeHyeckne nogxopbl (Hanpwmep, rHGKMii rpaduk nipvema nu, MenneHHOe KOpMneHve, ManeHbkve nopynn, moGumbie wiv o4eHb apomarHble Giofja) 4acTo yeenn- uBaioT noTpeGneHie nun Yepes por. Mo- >keT TaKXKe FOMO4b ripMeM MasIbix KONMAYECTB sNuMoro ankoromibHoro HarwTKa 3a 30 MM HyT fo ent. Moryt cTaMynpogate anneTHT M onpeneneHHble akTupenpeccaHTbI: Me- FecTpona ayetat M ApoHaGuHON. MeToKnon- Pamig ycunueaeT onopoxHeHe xenyaKa, NTO TakKKe MOXeT yee/MHItT anneTHtT, HO Moxer norpeGosatbon 1—2 Henenn, 470Gb AOcTArHyTe ninka adcbexTMBHOCTH. Nporpeccupyowan femeHuya, 8 KOHeN- HOM cHeTe, NpMBO_KT K HeCnocO6HOCTA NpMHVMaT® NMUy CaMMMM nauveHTaMn; MHOra TaKMx BonbHBIX KOPMST Hepes OHA. OgHako HeT HHKaKHx Y6enuTeNbHEX 1OKa- ‘3ATEsIBCTB, 4TO KOPM/IEHME C NOMOLIEIO 30H Aa npognesaet xn3Hb, OGecne4ywBaeT KOM- opr, ynyawaer dyHKuvH MnK npenorEpa- uaeT ocnoxHeHins (acnupayms, nponexHi).. Kopmnenne 4epes 3onig M napeHTepanb- Hoe niTaHve NpWHMHsIT Heyno6cTBa HW ‘OBbINHO He HasHa\aloToR YMMpaIOWIMM naUWt- eHTaM Mn NaueHTaM C TAXxeNbIM cnaGo- YMMeM, KoTOpble He CnocoBHbI NpMHMMAT Tuuly. YneHam CeMbh TpyAHO CornacTbca c OTKa3OM OT NapeHTepanbHoro nMTaHMA, HO ‘OHM DOMKHbI NOHMMATS, 4TO AYIA TakMx Gonb- Hb0x Oosiee NpMATHbI Te ea M NMTbe, KOTOPBIE ‘OHM CaMM BbI6MpaIOT. Moryr GeITb nonesHEl ManeHbkie NOTKM BOMB M slerKHe ANA rota Hua NMUeBbIe NPOAYKTEI. NonepKNBAIOUYAT yxon, BKMOHaS XOPOWIyIO rMrMeHy NonocTH32 PAMEN 1. HAPYLIEHMIS| TMTAHMA pra (wnerxa 3y608, yanaxheHwe nonocTu pra TamnonaM 1 kycOHKaMM mza npy HeO6xo- AMMOCTH, Maab Lia ryG), MOKeT CUsHYECKH WB ncvxKonorv4eckOM OTHOUIeHA YCrIOKOVTe ayyeHra m4neHos CeMbit, KoTOpHIe OGecne- uneaior sTor yxon. Ynevam cembh, KoTOpBIe Gecrokosres rio nosony HeoGxonvMOcTH vc- NlonbaoBaHins MHEAsMBHOTO NapeHTepasHo- TO nMTaHA, TloMoraloT KOHCYABTALIAN W pe- Komengaunn cneuranncroe. 4 rpynne Bw euramnn C). Burammnnbs rpynnibs TMNOBUTAMMHOSbI, B Bkmioyaior 6uoTHH, @onat, HnALNH, naH- TMINEPBMTAMMHOSb! rorenosyo wacnory, pioqnasn, THaMi, Vi BATAMMIHHAR DHAOKCH H By 3ABMCMIMOCTb B passvrex cTpavax rvnosiTaMvHosbl FIBNAIOTCA CHEACTEMeM TaBHbIM OGpasom GepHocTv, HOBOMODHBIX AVeT, NPYMeHeEHHA Pala NeKapcTBeHHbK npenaparos (cM. CTP. Tw TaGn. 4-1), xpoxMueckoro ankoroniama, AywTenbHoro v. HeafeKeaTHOro BcnoMora- TesibHOrO NapeHTepabHoro nitTaHna, BUTa~ MMMHHas| 3aBcVMOCTS (HEBOCnPHMMYMBOCT BUTAMMHa B OPraHM3Me, HEBOSMOXHOCTb BKTIO4eHVA B MeTaGoNMaM) — TO pesynbTaT reveTw4eckoro Aehekta, 3aTparveaiouero meta6onvam siramvia. B HeKOTOpKX Cry- asx npveM 103 BUTaMMHa, NPeBbILIAIOLUINX 8 1000 pas pexomexnosaHHoe exepHesHoe notpeGnexve (PEM), ynyawaer yHKuWO vameHeHHoro MeTaGonmuecKoro nytH. Bu TaMVHHaa §TOKCHYHOCTe —(runepsvTaMu- Ho3) — CnepcTene NpveMa BbICOKMX 103 (meranos) evramvios A, D, C, B,, HAKOTH HoBOH KMCROTEL Tuwestie npogyxtbi camu no cee MoryT oGecnednTs mw cyGomVManbHble KonM- YecTBa HeKOTOpbX BUTAMMHOB. B OTH Cry- asx YBEMVHMBATOA PUCK PasBMTHA onpe- DeneHHbIx OHKONOrMYeCKHX sa6oneBaHViA wan KaKMx-T0 Apyrix paccrpoiicrs. Stor PMGCK onpenensieT Heo6xopMMoCTS Hcnonb- 30BaHMA OObINHBIX EXeHEBHEIX nonMBHTa~ MMMHHbIx 06aB0K. Timuweasie norpe6Hocru, cro¥HnKu, yHKyN, NposBNeHHs rAno- HW rAnepsHTa- ‘MAHO30B, YDOBHM B KOBM H OObI4HBIE Tepa- MeBTAYECKHe AOSMPOBKM BUTAMMHOB repe- ncneHbs 8 Ta6n. 4-2 4-3. BuTaMnit! MOryT 6tirs xupopacraopumbimu (BuTaMnHb! A, D, Ew) wiv sogopacrsopumbimn (euTaMnHbl BMOTHH BuOTHH B KaNecTBe KotbepmeHTa yvacT- ByeT B PeaKLWWAX KapOOKCHIMpOBAHMA, He o6xoavMux aA HopManbHoro ocywjecrEne- va MeTaGonama XxMpoB mM yreBoqo8. Anexeatioe notpe6nenie Ana espocmbx — 30 mxr/oyr. Tunosurammnos sasncuMmocts. lpo- TwBocyZopoxHble cpencrea MoryT yaen- Tasninua 4-1. MoTEHuMAnbHbIE HETATMBHBIE BSAMMOMEACTEMA JIEKAPCTBEHHOTO CPECTBA M BATAMHHA Hytenent Mleenapat onar ‘Anxorons, 5-ropypauinn, MeT= opmins, MeroTpexcar, dbeHo- Gap6uran, cbenmTonH, npwnan- ROH, cynbspacanaaii, TpHaMTe- ex, TpuMeTon AM Haun ‘Acnnpnt PuGodnasin | Denormasnnsi Tuam ‘AWTarOHMCTs!THAMIAHa — 8 KO- de, vae, cbipol pbi6e Mm KpacHo- ovanHof kanycTe} ankorons BrrawnwA | Xonecrapamnn, Hedrenpoaykrat BrrawmuB, | Umknocepnn, ranpanasinn, n30- wasn, nesogona, neMuanna- or BurawaB,, | AHTauMAsl, MeTé>opMnl, oxcHD agora BrrawmyD | Xonectapamnn, rmoxoxopTaKon= ‘ui, Hed>Tenponyxres, eHMTOnH, piano BrrawnwE | Bapdapnn Braman | AvTuGnoTaxn4, TMOBMTAMMHOSBI, FAMEPBMTAMMHOSbI M BMTAMMHHAS SABMCHMOCTD 33 Tasnnya 4-2. PEKOMEHAYEMbIM EXEQHEBHbIM MPMEM BATAMMHOB! Pa- o- Tu-] -K oapact 50@- -B, -C} .D| .E 1 Kareropnn] FST) ar | ea] MAH | A | oe (Mey? Mnapex- [0—6mec.| 65 0,2 0,1 40 4 | 2,0 bt '7—12mec.| 80 500| 0,3 | 0,5 | 50 5 | 25 Dem 1-3r. 150 | 0,5 0,5 | 300} 0,5 15 6 30 48 200 | 06 0,6 | 400/ 06 12 25 7 55 My :k4itHb 9-13 | 300 | 09 600 1.8 14—18 19—50 251 AZ Xenuyn | 913 | 300 600 18 14-18 65 19-50 >51 4,5 BepeveH+ 600 | 1,4 14 | 770) 1,9 26 85 Hue (19— 50 net) Kopms- 500 | 1,6 1,4 | 1200) 2,0 28 | 120 19 une (19— 50 ner) Bepxninit 1000] HO | HO [3000] 100 | HO | 2000 | 2000 | 1000 | HO npenen (Bn) *Pexomexayemble gonycTHMble 20st (PLY) yasatb! OObMHbIM LupHdToM, a agexeaTHbie (AL) — xnp- Huim, Yorakoaneniie PEA yaoanetsopaot notpeGHocra 97—98 % anoposbx nogel. B cnyyae Heno- cTaTouHocT# anit ana pacsera PEL nposoaMTos KaK MoxHO Gone ToHHeil pacer AD, BM — maKcn- ‘MaribHoe KONMNECTBO BMTAMIAHa, KOTOpOE BSpOCTH MOXET NoTPEGIT Ges PHoKa HeraTMBHEK NooneAC- Toni, Hem Gonbwwe npesbiwieH BIT, TeM Gonbive prick HeraTMBHBKX NocnenCTBMi. °200 ME evrammlia D—5 mr. 3600 ME svTamuna D pexomexayeToa mionam crapwe 70 ner. HO — ne onpegenen 3-28 HexBaTKM JaAHHBIX; HCTONHMKH noTpeGneHMA AOMKHb! GbITb OrpaHMNeHEI NH ‘weatimn npogykraMn. ‘Agantuposaxo us: Dietary Reference Intakes, Star Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Washington, DC: National Academy Press. ant meTaGonmueckne noTpe6HoCTH B GuO- THe, HO, BEPORTHO, He ababIBAIOT rMnOBHTa- MuiHo3. Penko acrpeNaeca naomiMpoBaHHbit nedvuT OvoTMHa, Kora pacropl ana NNN He conepxar noGaskn GnoTaHa. B OveHb penkmx ciysasx AAMTeNbHOe ynoTpeGneHNe GonbUNX KOAMYECTB CbIPEIX AMMHEIX BenkOB (conepxar asian — alTaroHMcT 6MOTHHa) BLISbIBAeT ero AEDHUNT, NPHBOAA K ceCO- pelitomy jepMariTy 4 rnoccHty; 3TH caMn- Tomb! GbICTpO MCHESAIOT NPM HasHaYeHMH 150—300 mr GvoTuHa exerHeBHo opantHo, Jivuam, npnHnmatownm npotBocynopox- Hble CpencTsa, MOCTATOYHO MeHBLINK exe- AHEBHIX N06aB0k (30 M«Kr). HapyuleHHbili metaGonnam 6voTaia (3a- BMCHMOCTs) — pesynbTaT MyTauMit xon0- KapBoxcunar cnsTetasts (depmerTa, He06- XOAMMOTO ANA CBASbIBAHKA GHOTHHA C 4e- ‘TeIpbMa KapGOKcMasaMn, yYaCTBYIOLIMMM B Mera6onnaMe) un 6noTHHMpastl (epMeH- Ta, HeOGxonMMorO ANA ynaneHna GnoTHHa wa Tex ke CaMbix ¥eTbIpex KapGOKcMNas Np wx KataGonvame). ¥ feTeli c TaKoli saBHcH- MOCTbIO (HapyweHKem MeTaGonusma Gvo- ‘THHa) HaGmogaioTcA samepneHne dusn4ec-34 PAMEN 1. HAPYLIEHMIS| TMTAHMA Tasnnya 4-3. VcToHHWKH YHKUAM CHMNTOMBI THMO- M THMEPBHTAMMHOSA OcHosHBIE © (Cumnromii rano- Horpnest WCTOUHMKK “une MATEPBHTAMMHOSA Borne Tevet, nowxn, sv | Peaxunn xap6oxcan- | Tanosmramnno: Hull xKemTox, apox- | posaHua Depmarnr, rmocent, Meta6o- >xit, uBeTHAS KANO muveckii aus Ta, opexn, GoGoauie onar (ponve- | Caexwe senertie Cospesanne apirpoun- | TMnoBHTaMMHo: san kvcnora) | Bou; pykrbr;ne- | ToB; cnHTes nypinlios, | Merano6nacrrseckan aHe- Nek; O6orAWeHHBIE snakosuie w x1e6 TupyMagMHos, MeTHO- Hiv; paseuTue He PBHOM cvcTeMs nnona Maa, RedexTel pagBMTMA He- paHol Tpy6Kn inane (HinKo- ‘TwioBaR KACO- Tlevers, xpacubie copra maca, pbi6a, OxvcnmrensHo-soccra- HOBHTenbHBle peaKuIAN, Tunosntamnno: Mlennarpa (aepmarir, rmoc- Ta, Knauia- — | ntiua, monoKo, 60- | yrnesonHbilim kneroy- | cm, aycoyrKuns KKT m UHC) mann) Gosbie, uenbHiie Hoi meTabonnsM Tunepsnramnnos: snakosbie win 060- Tlokpactehie nua raUyeHHbie anaKOBKIE wxne6 PuGocnasn — | MonoKo, cuip,ne- | Mxormeacnextaiyrne- | TMnosHTaMMHo: (evrawan B, eH, Maco, sua, BopHoro w Genkosoro Xelinwr, anrynspHsti croma- oGorawentiie ana- | o6MeHo8, uenocTHocTs | THT, BackynapHaayys poroan- oabie cnusncrix oGonovex | ub TwaMmui (BMTa- UentHoe aepHo, ma- | MetaGonmae yrneBo- TunosuTamnHo: na B, co(ocoBexHo.can- | 08, xnpos, ammvoxne- | Bepn-Gepr (neprdepmvecxan nia wneveHs),060- | nor, rmi0Ko3ss, ankoro- | Heliponamms, cepneswas He~ TauyenHite anaKo- ‘a; QYHKUMM KNIETOK OCTATONHOCTE), CMHAPOM ‘BbIE, OPEXH, WeHTPanbHbix m nepw- Bepxvke—Kopcaxosa GoGoabie, kapto- cepieckix Hepa08; ens bynkuna mvoKapna BurammuA(pe- | Kak stamai:neveHs | O6pasosanve ponon- | TwnosmTamnno: won) Wxup pbi6, Mu ~—| Cua (nrMeHT doTope- |

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