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This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations.
A 67-year-old woman with type 2 diabetes mellitus undergoes extensive resection of the small bowel and right colon with a jejunostomy and colostomy because of mesenteric ischemia. In the surgical intensive care unit, severe systemic inflammatory response syndrome with
The Clinical Problem
Pathophysiology and Effect of Therapy
Clinical Evidence
Clinical Use
Adverse Effects
Areas of Uncertainty
Guidelines
Recommendations
Source Information
From the Department of Medicine, Division of Endocrinology, Metabolism and Lipids, and the Emory University Hospital Nutrition and Metabolic Support Service, Emory University School of Medicine, Atlanta.
Address reprint requests to Dr. Ziegler at the Atlanta Clinical and Translational Science Institute, Room GG-23, Emory University Hospital, 1364 Clifton Rd., Atlanta, GA 30322, or at tzieg01@emory.edu.
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