MMSL 2017, 86(4):145-157 | DOI: 10.31482/mmsl.2017.026

THE CENTRAL ROLE OF GLUCOSE IN METABOLISM AND NUTRITION OF CRITICALLY ILL PATIENTSReview article

Pavel Skořepa ORCID...1,2*, Ondřej Sobotka2, Joao Fortunato2, Vladimír Bláha2, Jan M. Horáček ORCID...1,3
1 Katedra vojenského vnitřního lékařství a vojenské hygieny, Fakulta vojenského zdravotnictví, Univerzita obrany, Hradec Králové, Česká republika
2 III. interní gerontometabolická klinika, Fakultní nemocnice Hradec Králové, Česká republika
3 IV. interní hematologická klinika, Fakultní nemocnice Hradec Králové, Česká republika

K vykonávání fyziologických funkcí a udržování buněk při životě vyžaduje lidský organismus pravidelný přísun základních živin v podobě sacharidů, lipidů a proteinů. Tyto makronutrienty poskytují nejen energii pro metabolické děje, ale zároveň plní roli jako důležité strukturní nebo signální molekuly. Glukóza je nejvýznamnějším sacharidem v živočišné říši, téměř všechny sacharidy v potravě se postprandiálně přeměňují na glukózu, která hraje nezastupitelnou roli pro další (nejen intermediární) metabolismus. Metabolismus člověka se specificky liší ve zdraví a nemoci, zásadní změny nastávají u kriticky nemocných pacientů (1). Autonomní nervový systém spolu se zvýšenou produkcí hormonů mají na udržování adekvátního glukózového metabolismu v průběhu kritického stavu zásadní vliv (2). Nutriční podpora představuje součást komplexní péče o kriticky nemocné. Přestože je glukóza historicky nejdéle a v současné době v parenterální výživě i jediným používaným sacharidem v nutriční podpoře, do současné doby není odborná veřejnost sjednocena v otázce stresové hyperglykémie, významu inzulinové rezistence, adekvátní dávky glukózy či jejich nežádoucích a pozitivních účincích. Tento přehledový článek pojednává s klinickým přesahem o vzájemně kontroverzních výzkumech na poli metabolismu glukózy u kriticky nemocných pacientů v posledních desetiletích, ale současně není systematickým přehledem literatury.

Keywords: glukóza; insulinová rezistence; kriticky nemocný pacient; nutriční podpora

To carry out the physiological functions and maintaining human life requires the regular supply of essential nutrients in the form of carbohydrates, lipids and proteins. These macronutrients not only provide energy for metabolic role, but also act as an important structural or signal molecules. Glucose is the main carbohydrate in mammals, almost all dietary carbohydrates are converted to glucose, which is essential, not only for the intermediate metabolism. Specific changes in metabolism occur in critical ill patient. Autonomic nervous system together with hormone production play essential role in maintaining adequate glucose metabolism in the critical illnes. Nutritional support is an important part of a comprehensive care for critically ill. Although glucose is historically and currently the only carbohydrated used in parenteral nutrition and nutritional aid, the answers to the questions of the experts about stress hyperglycaemia, importance of insulin resistance, adequate of glucose dose or their adverse effects still remain unclear. The present paper raises clinically relevant questions focused on the metabolism of glucose of the critically ill patient, but is not intended to be a systematic review of the literature.

Keywords: metabolism; glucose; insulin resitance; critical ill patient; nutrition support

Received: November 6, 2017; Revised: November 27, 2017; Published: December 8, 2017  Show citation

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Skořepa, P., Sobotka, O., Fortunato, J., Bláha, V., & Horáček, J.M. (2017). THE CENTRAL ROLE OF GLUCOSE IN METABOLISM AND NUTRITION OF CRITICALLY ILL PATIENTS. MMSL, 86(4), 145-157. doi: 10.31482/mmsl.2017.026
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