Serum trace elements levels in patients transferred from the intensive care unit to wards

Gündoğan, Kürşat; Özer, Nurhayat Tuğra; Şahįn, Gülşah; Mendil, Nilgun Ozlem Alptekinoglu; Şahin, Serap; Temel, Şahin; Guven, Muhammet; Sungur, Murat

doi:10.1016/j.clnesp.2021.06.014

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…The status at discharge from the ICU was investigated in 100 patients (median stay of 5 days), most being still inflammatory with a median CRP of 54 mg/l [10]: serum concentrations of chromium, zinc and selenium were lower than the reference values in 98, 90 and 36% of patients, respectively. The 28-day ICU mortality was correlated with low serum selenium levels ( P = 0.03).…”

Section: Micronutrient Status and Intakementioning

confidence: 99%

An update on essential micronutrients in critical illness

Berger

2023

Current Opinion in Critical Care

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Purpose of review Numerous micronutrients are involved in antioxidant and immune defence, while their blood concentrations are frequently low in critically ill patients: this has fuelled many supplementation trials. Numerous observational, randomized studies have been published, which are presented herein. Recent findings Micronutrient concentrations must be analysed considering the context of the inflammatory response in critical illness. Low levels do not always indicate a deficiency without objective micronutrients losses with biological fluids. Nevertheless, higher needs and deficiencies are frequent for some micronutrients, such as thiamine, vitamins C and D, selenium, zinc and iron, and have been acknowledged with identifying patients at risk, such as those requiring continuous renal replacement therapy (CRRT). The most important trials and progress in understanding have occurred with vitamin D (25(OH)D), iron and carnitine. Vitamin D blood levels less than 12 ng/ml are associated with poor clinical outcomes: supplementation in deficient ICU patients generates favourable metabolic changes and decreases mortality. Single high-dose 25(OH)D should not be delivered anymore, as boluses induce a negative feedback mechanism causing inhibition of this vitamin. Iron-deficient anaemia is frequent and can be treated safely with high-dose intravenous iron under the guidance of hepcidin to confirm deficiency diagnosis. Summary The needs in critical illness are higher than those of healthy individuals and must be covered to support immunity. Monitoring selected micronutrients is justified in patients requiring more prolonged ICU therapy. Actual results point towards combinations of essential micronutrients at doses below upper tolerable levels. Finally, the time of high-dose micronutrient monotherapy is probably over.

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Section: Micronutrient Status and Intakementioning

confidence: 99%

An update on essential micronutrients in critical illness

Berger

2023

Current Opinion in Critical Care

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“…Micronutrients are essential components as cofactors of enzymes critical for numerous metabolic processes and immunological and antioxidant functions. In critical illness, micronutrient deficiencies are common, potentially because of decreased intake, increased losses, and upregulated requirements caused by catabolic processes 3,4 . Previous studies have reported that, in patients receiving CRRT, some micronutrients may be easily lost 2,5,6 .…”

Section: Introductionmentioning

confidence: 99%

“…In critical illness, micronutrient deficiencies are common, potentially because of decreased intake, increased losses, and upregulated requirements caused by catabolic processes. 3,4 Previous studies have reported that, in patients receiving CRRT, some micronutrients may be easily lost. 2,5,6 Deficiency of these essential micronutrients may be associated with impaired biochemical function and, thus, potentially poor clinical outcomes in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Serum micronutrient levels in critically ill patients receiving continuous renal replacement therapy: A prospective, observational study

Gündoğan

Yucesoy

Özer

et al. 2022

J Parenter Enteral Nutr

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Background: Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) may deplete micronutrient levels. Patients are also at risk for micronutrient depletion due to underlying illness(s), poor nutrient intake prior to intensive care unit (ICU) admission and/or increased requirements. We determined vitamin and trace element status before, during and after CRRT in critically ill patients.Methods: This prospective observational study performed in mixed medical and surgical ICU patients. Serial serum vitamin B6 and vitamin C concentrations were measured by HPLC and folic acid by ECLIA. Serum chromium, copper, selenium, and zinc were measured using ICP-MS. Serum ceruloplasmin was measured by the Erel method.Results: Fifty adult ICU patients with AKI were recruited. The median APACHE II score on ICU admission was high at 24.0 (6.0-33.0). The median days on CRRT was 2.0 (2.0-4.0) days. At baseline (within 10-15 minutes of CRRT initiation), serum vitamin C, selenium and zinc were below normal. Serum vitamin B6 levels at 72 hours on CRRT were significantly lower than at 24 hours (p = 0.011). Serum vitamin C values fell significantly at 24 and 72 hours during CRRT (p = 0.030 and p = 0.001), respectively, and remained low 24 and 48 hours after CRRT was stopped (p = 0.021). At baseline and during CRRT, 96% of participants had at least two or more micronutrient levels below the normal range. Conclusion:Serum vitamin C, selenium and zinc concentrations were below the normal range at baseline. CRRT was associated with a significant further decrease in levels of vitamin C, selenium and zinc.

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“…However, calorie and protein intake more frequently remains below predicted targets [4,7]. Additionally, some serum trace elements like chromium and zinc are frequently be below reference values after ICU discharge [8]. A current review suggests that after extubation, ICU survivors consume less than 60% of the required calories [9].…”

Section: Introductionmentioning

confidence: 99%

Nutritional issues concerning general medical ward patients: feeding patients recovering from critical illness

Gressies

Schüetz

2022

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewICU survivors often spend long periods of time in general wards following transfer from ICU in which they are still nutritionally compromised. This brief review will focus on the feeding of patients recovering from critical illness, as no formal recommendations or guidelines on nutrition management are available for this specific situation.Recent findingsWhile feeding should start in the ICU, it is important to continue and adapt nutritional plans on the ward to support individuals recovering from critical illness. This process is highly complex – suboptimal feeding may contribute significantly to higher morbidity and mortality, and seriously hinder recovery from illness. Recently, consensus diagnostic criteria for malnutrition have been defined and large-scale trials have advanced our understanding of the pathophysiological pathways underlying malnutrition. They have also helped further develop treatment algorithms. However, we must continue to identify specific clinical parameters and blood biomarkers to further personalize therapy for malnourished patients. Better understanding of such factors may help us adapt nutritional plans more efficiently.SummaryAdequate nutrition is a vigorous component of treatment in the post-ICU period and can enhance recovery and improve clinical outcome. To better personalize nutritional treatment because not every patient benefits from support in the same manner, it is important to further investigate biomarkers with a possible prognostic value.

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Serum trace elements levels in patients transferred from the intensive care unit to wards

Cited by 3 publications

References 17 publications

An update on essential micronutrients in critical illness

An update on essential micronutrients in critical illness

Serum micronutrient levels in critically ill patients receiving continuous renal replacement therapy: A prospective, observational study

Nutritional issues concerning general medical ward patients: feeding patients recovering from critical illness

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