The role of nutrition in the management of metabolic stress.

The metabolic response to injury is a different process from starvation. As such, it requires a different set of nutritional support principles in order to provide effective therapy that is cost-conscious and with a minimum of complications. In all cases, it is essential to restore and to maintain oxygen transport prior to instituting nutritional support. In the higher levels of stress, an enhanced response can be achieved with the modified amino acid formulas in a setting of balanced nutritional support. With the principles outlined above, nutritional status can be effectively managed in most settings as a variable that influences morbidity and mortality in surgery, polytrauma, and sepsis.