MONITORING OF

NUTRITION IN ICU
Hippocrates 400 B.C.

‘A slender and restricted diet is always dangerous in

chronic and in acute diseases’
 >40% of hospital patients malnourished on
admission

McWhirter and Pennington 1994

“…do not let your patients starve and when you
offer them nutrition support, do so by the safest,
simplest, most effective route.“

Dr Mike Stroud Feb 2006

Chair of NICE committee
Monitoring
Short term Long term

Blood
Weight
biochemistry

Feed volume received

Vs Trace elements
Feed volume prescribed

Bowel motion & gastric

Urinary urea
aspirate

Any changes in stress/ patient

Urinary electrolyte
activity

Anthropometric measurements

Indirect calorimetry
Physical examination
 Examine regularly
 Nutritional status
 Weight should be measured daily
 Hydration status
 Reasonable predictor of body fat and caloric
balance
Functional assessment
 Repletion of protein and energy reserves is
associated with:

IMPROVEMENT IN FUNCTIONAL
ABILITIES

• Grip strength
• Activity level
• Physical endurance
Laboratory test
 Useful for monitoring individual patient responses
to parenteral and enteral nutrition support

• Metabolic state
• Protein – energy balance
• Micronutrition status
• Fluid and electrolyte
• Acid – base balance
• Organ function
PN and Tube feeding Test
Na+,K+,Cl-,CO2,Glu,BUN,Cre Daily until stable
at
Albumin Weekly
Transthyretin Weekly
C- Reactive Protein As needed
PO4 Every other day
Mg Every other day
Vitamin C As needed
Zinc As needed
24-hour Urinary Nitrogen As needed
Parenteral only
Chemsticks 6 hourly
iCa Every alternate day ( until
stable)
Alkaline Phosphatase Weekly
AST Weekly
Total Bilirubin Weekly
Triglyceride As needed
PT As needed
Nitrogen balance
 Useful in determining individual protein
requirement

Nitrogen Balance = Nitrogen Intake – Nitrogen

Output
Nitrogen intake = feed received in 24 hours (enteral/parenteral/oral)
Nitrogen output = urinary urea/mmol/24 hours x 0.033 + obligatory losses + any extra
renal losses
Protein Energy Balance

 During periods of inadequate dietary protein or energy, a reduction in

hepatic synthesis and secretion of these proteins causes plasma levels to

fall.

 Transthyretin
 previously known as prealbumin

 Half life of 2 days ( rapidly respond to nutrition balance)

 Transferrin

 Retinol binding protein

Vitamins & Minerals
 Micronutrients in wound healing and immune
function may need to be monitored to assure the
adequacy of supplementation
 Zinc
 Vitamin C
 Copper
 Magnesium
THANK YOU