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Z06-Maxwold Norma Nutri
Z06-Maxwold Norma Nutri
NJ Maxvold MD
Pediatric Critical Care Medicine
DeVos Children’s Hospital
Grand Rapids, MI, USA
Nutrition in Pediatric ARF
• Critical Illness Metabolism:
Stress: h Inflammatory Cytokines; Gene Expression Modulation
NeuroEndocrine Axis Phases
Altered Substrate Utilization
Metabolic Alterations in ARF
h catabolism from uremia, acidosis, impaired fluid/solute K
AA Profile / Interconversion in ARF
Vitamin Derangements
Impaired Lipolysis: i Lipase Activity; h LDL & VLDL, i Cholesterol
“ Hyperglycemia” of Critical Illness
• Glycolysis:
Glucose>>> 2 Lactate
DG°´= - 47.0 kcal/mol
TCA Complete Oxidation:
Glucose + 6 O2 a 6 CO2 + 6 H2O
DG°´= - 686.0 kcal/mol
Metabolic Alterations in Critical
Illness
• Lipid Utilization in Acute Illness:
Stress Hormones (Catecholamines/Cortisol) h Lipolysis:
“FFA (major fuel in acute illness)”
a. Oxidation via TCA cycle
b. Lipogenesis
c. Ketogenesis (Glucagon inhibited during critical illness)
d.PDH Inhibition (prevents Glucose TCA Oxidation and
increases FFA TCA Oxidation)
• Protein Metabolism in Acute Illness
Catabolism (Skeletal Muscle)
a. Gluconeogenesis (Alanine)
b. Acute Phase Proteins (Liver Synthesis)
Biotin
• Regulatory Effect on genes of Intermediary
Metabolism
a. Stimulates genes for Insulin, Insulin Receptor,
Glucokinase (pancreatic and Hepatic)
b. Decreases gene expression of hepatic
Phosphoenolpyruvate Carbosykinase
(*Gluconeogenic Enzyme in the liver)
Conditional” Essential Nutrients?
Fat Soluble