What metabolic and nutritional support is recommended in the treatment of sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Patients with septic shock develop electrolyte abnormalities. Potassium, magnesium, and phosphate levels should be measured and corrected if deficient.

Patients with septic shock generally have high protein and energy requirements. Although a brief period (several days) without nutrition does not cause deleterious effects, prolonged starvation must be avoided.

Early nutritional support is of critical importance in patients with septic shock. The oral or enteral route is preferred, unless the patient has an ileus or other intestinal abnormality. Gastroparesis is commonly observed and can be treated by administering motility agents or placing a small-bowel feeding tube.

Diminished bowel sounds are not a contraindication to a trial of enteral nutrition, though motility agents or a small-bowel feeding tube may be necessary. The benefits of enteral nutrition are as follows:

  • Protection of gut mucosa

  • Prevention of translocation of organisms from the gastrointestinal (GI) tract

  • Reduction of the complication rate

  • Lower cost

The 2012 Surviving Sepsis Campaign guidelines recommend using nutritional support without specific immunomodulating supplementation. [11]


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