title: Nutritional management of the metabolically stressed patient.
abstract: The nutritional management of the critically ill metabolically stressed patient has changed drastically within the last two decades. Alterations in carbohydrate, fat, and protein metabolism following severe injury affect effective substrate utilization and the provision of nutritional or metabolic support. This article describes the acute alterations in carbohydrate, fat, and protein metabolism during severe metabolic stress; reviews nutritional assessment and requirements during metabolic stress; and presents recent findings that influence nutritional support during metabolic stress. The role of gut in the provision of nutritional support and the pharmacologic properties of select enteral nutrients are reviewed.
authors.forename: L
authors.initials: L
authors.lastname: Fitzsimmons
authors.forename: S A
authors.initials: SA
authors.lastname: Hadley
mesh_terms: D016638:Critical Illness; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D009104:Multiple Trauma / Q000378:metabolism* / Q000628:therapy*; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D013312:Stress, Physiological / Q000378:metabolism / Q000628:therapy