Prophylaxis, diagnostics and correction of nutritional status disturbances is considered as one of the main treatment methods of patients with COVID-19 infection-directed to resolve systemic inflammatory response and correction of metabolic response to a viral infection. Systemic Inflammatory Reaction (SIR) manisfestation as a result of viral infection leads to pronounced metabolic processes disturbances. The main metabolic manifestations of SIR is reflected as hypermetabolic-hypercatabolic syndrome with complex disturbances of protein, lipids and carbohydrates metabolism, increased consumption of carbohydrate-lipid reserves and breakdown of tissue proteins. Thus, adequate correction of metabolic disorders and a wholesome nutritional support, taking into account the clinical picture, severity of the disease, ongoing respiratory and intensive care therapy is an integral component in treating patients with COVID-19 infection which determines the efficiency of its treatment and reduction in mortality. Given the relevance of the problem, the authors decided that it was important to increase the COVID-19 treatment efficacy by producing guidelines based on the most fundamental provisions of the modern approach to nutritional support in critical patients with community acquired pneumonia, acute respiratory failure, ARDS, sepsis, multiple organ failure.

No abstract

INTRODUCTION: Sepsis remains an actual problem of modern medicine. Among other treatment options, timely prescribed optimal nutritional-metabolic support is one of the priority methods of intensive treatment for this category of patients. OBJECTIVE: To study the severity of metabolic dysfunction in sepsis and determine the parameters of optimal substrate supply for this category of patients. MATERIALS AND METHODS: The study included 166 patients with sepsis. We studied the severity of systemic metabolic dysfunction and the impact of various options for energy and protein supply on the course of the disease and its outcome. Energy expenditure and the severity of the catabolic reaction of the body were studied by dynamic evaluation of indicators of indirect calorimetry, actual losses of nitrogen and nitrogen balance. RESULTS: Actual energy expenditure in sepsis reaches its maximum values by the 5-6^th day of the disease (33.5 ± 1.8 kcal/kg/day or 2366 ± 126 kcal/day). The average energy consumption in sepsis is 2226 ± 96 kcal/day or 30.9 ± 1.4 kcal/kg/day. Energy supply in sepsis less than 25 kcal/kg/day leads to a significant increase in mortality. Protein losses in sepsis reach their maximum values by the 5-6^th day of the disease (1.93 ± 0.12 g/kg/day). The average loss of protein in sepsis is 1.68 ± 0.06 g/kg/day. Protein provision of this category of patients with more than 1.5 g/kg/day contributes to a significant decrease in mortality, relative to patients receiving less protein per day. CONCLUSIONS: Energy supply in the range of 25-35 kcal/kg/day, as well as protein supply of more than 1.5 g/kg/day, significantly contribute to better survival of patients with sepsis.

Aim. To study the condition of the problem, the prevalence and severity of dyselectrolytemia, as a possible manifestation of the syndrome of renewal of nutrition (refeeding syndrome) in patients with anorexia nervosa (AN). Materials and methods. We studied somatometric indicators and the prevalence of electrolyte disturbances of 81 women aged from 18 to 55 years, who were treated in the somato-psychiatric department of the Dzhanelidze Saint Petersburg Research Institute of Emergency Medicine. Results. Hypotrophy predominates as marasmus (95.2%) in the early stages of AN. At the later stages of development of AN, the frequency of mixed hypotrophy by the type of marasmatic kwashiorkor increases significantly (up to 63.2%), which is manifested by a decrease not only in somatometric indices, but also in depletion of the visceral protein pool. When studying the frequency of electrolyte disturbances, hypokalemia was most often observed in patients with NA in the initial period of realimentation (14.8%). At the same time, its moderately expressed degree prevailed. Moderate hypophosphatemia (not less than 0.6 mmol/L), which may indicate a latent manifestation of refeeding syndrome, was relatively often (21.1%) observed in patients with severe malnutrition (body mass index less 12.5 kg/m²). Hypomagnesemia for the entire period of observation of patients with various stages of the disease were not detected. Conclusion. Diselectrolytemia is often observed in patients with AN during their refeeding, which requires regular dynamic monitoring of serum potassium, magnesium and phosphate levels and timely correction of their deficiency.