Answer to Question 1
Notable metabolic changes in patients undergoing metabolic stress include hypermetabolism, negative nitrogen balance, insulin resistance, and hyperglycemia. Hypermetabolism and negative nitrogen balance can lead to wasting, which may impair organ function and delay recovery. Hyperglycemia increases the risk of infection, which can lead to complications and higher mortality risk. Therefore, the principal goals of nutrition therapy are to preserve lean (muscle) tissue, maintain immune defenses, and promote healing. The amounts of protein and energy to provide during acute illness are controversial and still under investigation. Research results have been mixed, in part because various conditions are associated with metabolic stress and each patient's situation is somewhat different. Moreover, protein and energy needs can vary substantially over the course of illness, requiring frequent reevaluation. The guidelines presented here are subject to change as new findings help to resolve the complex issues related to nutrient intakes and delivery methods. To help guide their decisions about treatment, clinicians need to closely observe patients' responses to feedings and readjust nutrient intakes as necessary.
Answer to Question 2
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