Pomen podpornega zdravljenja s prehrano pri kritično bolnem hematološkem bolniku = Role of nutrition in supportive therapy of the hematologic patient
Zver, Samo, 1966-
In haematological patients, malnourishment is a consequence of reduced food intake, malabsorbtion and metabolic changes. The main etiological factors are therapy with cytostatics, irradiation ...treatment and the release of some cytokines, which are responsible for the increase of basal metabolism and catabolic predominance in patients. One of the catabolic cytokines is tumor necrosis factor alpha, also known as cachexin. Malnourishment should be promptly recognised and treated. Because many haematological patients suffer from acute gut failure and the introduction of a nasogastric tube may be associated with some serious side effects, we prefer total parenteral nutrition (TPN). TPN as well may be associated with some side effects, especially catheter related sepsis or thrombosis, deep vein thrombosis and volume overload. Another problem associated with TPN is the addition of some drugs, usually heparin or insulin, to the TPN mixtures. In TPN mixture stability of either TPN or drugs may change. In the last decade the value of immunonutrition has increased. With the use of immunonutrition we increase immune system response, especially cellular response. In haematological patients most experiences are gathered with glutamine supplementation. The addition of glutamine in critically ill patients may decrease the infection rate in allogeneic bone marrow transplant recipients.
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