Klein C J, Stanek G S, Wiles C E
R. Adams Cowley Shock Trauma Center, Baltimore, MD 21201-1595, USA.
J Am Diet Assoc. 1998 Jul;98(7):795-806. doi: 10.1016/S0002-8223(98)00179-5.
Metabolic complications from overfeeding critically ill patients are serious and sometimes fatal. Nutrition care is best provided through repeated 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 macronutrients are discussed, as are factors that could increase the risk of overfeeding. Patients who are very small, very large, or very old are particularly vulnerable to overfeeding. Overfeeding protein has led to azotemia, hypertonic dehydration, and metabolic acidosis. Excessive carbohydrate infusion has resulted in hyperglycemia, hypertriglyceridemia, and hepatic steatosis. High-fat infusions have caused hypertriglyceridemia and fat-overload syndrome. Hypercapnia and refeeding syndrome have also been caused by aggressive overfeeding. Dietitians can prevent or curtail the metabolic complications of overfeeding by identifying patients at risk, providing adequate assessment, coordinating interdisciplinary care plans, and delivering timely and appropriate monitoring and intervention. Dietitians need to document complications, interventions, and the outcomes of their clinical care to evaluate the appropriateness of existing nutrition guidelines.
重症患者过度喂养所致的代谢并发症严重，有时甚至会致命。最好通过反复评估患者对喂养的反应来提供营养护理。随着时间推移，可能需要调整营养支持，以维持代谢稳定性并促进康复。本文描述了过度喂养的10种代谢并发症的病因。讨论了推荐常量营养素的指南以及可能增加过度喂养风险的因素。体型非常小、非常大或年龄非常大的患者尤其容易发生过度喂养。蛋白质摄入过多会导致氮质血症、高渗性脱水和代谢性酸中毒。过量输注碳水化合物会导致高血糖、高甘油三酯血症和肝脂肪变性。高脂肪输注会引起高甘油三酯血症和脂肪超载综合征。积极的过度喂养还会导致高碳酸血症和再喂养综合征。营养师可通过识别有风险的患者、进行充分评估、协调跨学科护理计划以及提供及时且适当的监测和干预措施，来预防或减少过度喂养的代谢并发症。营养师需要记录并发症、干预措施及其临床护理的结果，以评估现有营养指南的适用性。
