Laboratory support of the clinical nutrition service

This article critically reviews the role of the laboratory services in asse ssment, monitoring and management of complications in patients requiring nu tritional support. It has broadly been divided into three sections. (i) Assessment of protein and energy status: whilst it is stressed that cli nical judgement and anthropometric measurements are the most effective meth ods of evaluation of nutritional requirements, laboratory tests which can b e of use in assessment of protein energy status are discussed in detail, in cluding an appraisal of the value of each test in various clinical situatio ns. (ii) Assessment of micronutrient and electrolyte status: the clinical justi fication for assessment of the various micronutrients and electrolytes is c onsidered. A few selected examples are discussed in detail including an eva luation of the tests of status available and examples of situations where m easurement may be clinically helpful. (iii) Effective use of the laboratory: this section attempts to guide the c linician in the most appropriate use of laboratory tests, firstly in the as sessment of requirement for aspects of nutritional support, secondly in the continued monitoring and evaluation of the support provided, and thirdly i n prevention and treatment of metabolic complications. It is emphasised that clinical nutrition is a multidisciplinary topic requi ring input from the laboratory in conjunction with other specialities to pr ovide the best available patient care.