KEY POINTS

1. Nutritional support is important for patients who cannot regulate their own nutritional intake.
2. Patients with a functional gastrointestinal tract should receive enteral (tube feedings) nutritional support.
3. Parenteral nutritional support should be used for patients without a functional gastrointestinal tract.
4. Advances in central venous catheter placement and care techniques have made TPN equally safe as total enteral nutrition.
5. Avoid overfeeding (i.e., hyperalimentation); a good starting point is 25 kcal/kg/day and 1.5 g of protein/kg/day.
6. Indirect calorimetry is an invaluable tool to determine a patient's metabolic rate and caloric requirements.
7. Evaluation of the 24-hour urinary urea nitrogen level provides invaluable information concerning a patient's nitrogen balance. Extreme negative nitrogen balance can be completely or partially reversed by increased protein intake.
8. Sepsis causes profound metabolic changes that include insulin resistance, high levels of stress hormones, and protein wasting from skeletal muscles.
9. Aggressive insulin management to maintain blood glucose less than or equal to 110 mg/dL has significant survival advantages for critically ill and septic patients.
10. Patients with acute renal failure need adequate protein intake, even if that requires dialysis to control their urea levels.