Newsletter

[ Vol. 10 No. 1 ] (January - April 2009 )
Impact of mironutrient deficiency in critical illness

Krishnan Sriram
StrogerHospital of Cook County, and Rush University, Chicago, IL, USA 

Pre-existing micronutrient (vitamins and trace elements) deficiencies, especially zinc (Zn), iron (Fe), selenium (Se), vitamins B and C, are often present in critically ill patients. Additional deficiencies occur due to inadequate or inappropriate administration, increased or altered requirements and increased losses, which can affect various biochemical processes, resulting in organ dysfunction, poor wound healing and altered immune status with deleterious sequelae.

The American Medical Association has established guidelines for the 13 essential vitamins (4 fat soluble and 9 water soluble.) and for trace elements (Cu, Cr, Co, Fe, Fl, I, Mo, Mn, Se, Zn). These recommendations are applicable to healthy adults and not for critically ill patients. Decreased serum levels may indicate actual deficiencies but also redistribution.  Benefits of supplementation, which may not result in increased serum levels, are also unclear. Vitamin requirements (specifically vitamins B1, B6, C and K) are increased in disease states, but a similar recommendation for trace elements has not been initiated except for Se and Zn.

In practice, a multivitamin preparation (including vitamin K) and a multiple trace element admixture {containing Zn, Se, Cu, Cr, and Mn is added to parenteral nutrition formulations. Most enteral nutrition preparations also contain adequate amounts of vitamins and trace elements, though bioavailability may be an issue.

Detailed information about individual micronutrient use specifically in critical care practice will be discussed, emphasizing the practical and clinical aspects. Clinical case scenarios will be presented. Recommendations for specific disease states, especially renal and hepatic dysfunction will also be discussed. Appropriate references will be provided and more recent information reviewed.

From  
The 12^th PENSA Congress
October 18-20 2007, Century Park Hotel. Manila, Philippines 
Page: 24