OVERFEEDING MACRONUTRIENTS TO CRITICALLY ILL ADULTS - METABOLIC COMPLICATIONS

Metabolic complications from overfeeding critically ill patients are s erious and sometimes fatal. Nutrition care is best provided through re peated evaluation of patients' responses to feeding. Nutrition support may need to be modified over time to maintain metabolic stability and promote recovery. This article describes the etiology of 10 metabolic complications of overfeeding. Guidelines for recommending macronutrie nts are discussed, as are factors that could increase the risk of over feeding. Patients who are very small, very large, or very old are part icularly vulnerable to overfeeding. Overfeeding protein has led to azo temia, hypertonic dehydration, and metabolic acidosis. Excessive carbo hydrate infusion has resulted in hyperglycemia, hypertriglyceridemia, and hepatic steatosis. High-fat infusions have caused hypertriglycerid emia and fat-overload syndrome. Hypercapnia and refeeding syndrome hav e also been caused by aggressive overfeeding. Dietitians can prevent o r curtail the metabolic complications of overfeeding by identifying pa tients at risk, providing adequate assessment, coordinating interdisci plinary care plans, and delivering timely and appropriate monitoring a nd intervention. Dietitians need to document complications, interventi ons, and the outcomes of their clinical care to evaluate the appropria teness of existing nutrition guidelines.