ANTICATABOLIC AND ANABOLIC STRATEGIES IN CRITICAL ILLNESS - A REVIEW OF CURRENT TREATMENT MODALITIES

Critically ill patients characteristically exhibit a pronounced catabo lism in addition to a down-regulation of normal anabolic activity, lea ding to major complications from loss of body protein stores. The mark ed decrease in lean body mass and protein stores leads to the loss of essential structural and functional proteins required for restoring an d maintaining homeostasis. The standard management of the catabolic re sponse to injury and illness has centered on optimizing nutrient intak e that modulates but does not reverse the process. Complications of on going catabolism therefore remain a major cause of morbidity. Addition of anticatabolic and anabolic agents that may counteract ''the stress response to injury or illness'' may be of significant clinical benefi t. Agents currently available for clinical use, which will be describe d, can be divided into two groups. The first group are nutrients and n utrient metabolites, namely protein and the specific amino acids, glut amine, arginine, and branched chain amino acids, especially leucine, T he second group are anabolic hormones, namely growth hormone, testoste rone, and the testosterone analog oxandrolone. The pros and cons of th ese agents, as to their anabolic and anticatabolic value, are describe d.