RT Book, Section
A1 Wong, Theodoric
A1 Hardy, Gil
A2 Goday, Praveen S.
A2 Mehta, Nilesh M.
SR Print(0)
ID 1105178683
T1 Micronutrient Requirements in the Critically ill Child
T2 Pediatric Critical Care Nutrition
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179852-5
LK accesspediatrics.mhmedical.com/content.aspx?aid=1105178683
RD 2024/04/19
AB Inflammation  and  the  generation  of  free  radicals  is  the  hallmark  pathology  of  critical  illness.  Micronutrients  with  antioxidant  properties  have  received  much  attention  due  to  their  role  in  these  reactions.  Reactive  oxygen  species,  produced  by  leukocyte  aerobic  metabolism  and  free  radical  generation  from  nitric  oxide  metabolism,  facilitate  the  release  of  nuclear  transcription  factor  kappa  B  (NFκB).  Cytoplasmic  NFκB  translocates  to  the  nucleus,  where  it  binds  to  DNA  and  increases  acute-phase  mediators  like  tumor  necrosis  factor  α  (TNFα),  interleukin  2  (IL-2),  and  IL-2  receptors.  Micronutrients  such  as  selenium  act  to  down-regulate  NFκB.1,2  Micronutrient  deficiency  may  be  due  to  suboptimal  premorbid  intake;  redistribution  from  the  circulation  to  tissues;  and  excessive  losses  from  the  kidneys,  gastrointestinal  (GI)  tract,  skin,  and  drains.  Iron,  selenium,  zinc,  vitamin  D,  and  water-soluble  vitamins  are  decreased  in  critical  illness,  whereas  copper  and  manganese  levels  may  be  increased.  Administration  of  micronutrients  during  illness  is  an  area  of  great  interest.  Trace  elements  and  vitamins  that  support  antioxidant  function—particularly  high-dose  parenteral  selenium,  alone  or  in  combination  with  other  antioxidants—are  reportedly  safe  and  may  be  associated  with  a  reduction  in  mortality  in  critically  ill  patients.2  Studies  investigating  the  role  of  supplementation  with  selenium,  vitamin  E,  and  vitamin  C  in  the  critically  ill  have  shown  promising  results,  although  there  are  still  a  number  of  unanswered  questions.3  Systematic  reviews  and  meta-analyses  in  adults  have  shown  that  micronutrient  supplementation  may  be  associated  with  a  decrease  in  overall  mortality  and  specifically  28-day  mortality.  Decreased  mortality  seems  to  be  mainly  associated  with  combination  products  rather  than  any  single  micronutrient.  However,  supplementation  does  not  affect  infectious  complications  or  length  of  stay  in  the  intensive  care  unit  (ICU)  or  hospital.  The  majority  of  trials  have  reported  no  adverse  effects  from  micronutrients,  with  the  exception  of  one  study,  which  reported  a  worse  outcome  in  patients  with  severe  acute  pancreatitis.4