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Background: Postoperatively lowered ascorbic acid (AA) plasma concentration is postulated to be due to an increased perioperative activity (radical scavenging activity, cofactor for enzymes, etc) and consumption in response to surgical trauma. Objective: To test this hypothesis by measuring total clearance (Cl[sub tot]) of AA in plasma. Any alteration in AA consumption would be due to an altered Cl[sub tot] of AA in plasma. Unaltered postoperative Cl[sub tot] would exclude the postulated theory of an increased perioperative AA consumption. Design: The Cl[sub tot] of AA in plasma was calculated for 17 tumour patients undergoing major maxillofacial surgery on the first and third postoperative days compared with the preoperative values after bolus injection of 4 mg kg- 1 body weight AA was given intravenously. Blood samples were taken before and 15, 30, 45, 60 and 120 min after injection. AA in plasma was analysed by high-performance liquid chromatography. Results: The concentration of Cl[sub tot] [median (25%/75% percentile)] was 10.2 (7.9/12.5) l h[sup -1] preoperatively. On the first and third postoperative days [median: 17.6 (10.9/27.9) and 15.3 (12.1/30.5) l h[sup -1], respectively] the Cl[sub tot] was significantly increased (p <0.05). Conclusions: Cl[sub tot] was significantly increased in postoperative patients compared with preoperative values. These results are consistent with the postulated increase in perioperative AA consumption. [ABSTRACT FROM AUTHOR]

A rapid and sensitive high-pressure liquid chromatographic method with simple sample preparation was developed for the quantitative analysis of the β-lactam antibiotic ceftazidime (CAS 78439–06–2, Fortum®). A good linear relationship was established between the peak area and the amount of ceftazidime injected over a concentration range of 1 to 200 μg/ml. The detection limit of the method was calculated to be 0.9 μg/ml. Stability was shown at 4°C and at -196°C for time periods of 2 h and 84 days, respectively. [ABSTRACT FROM AUTHOR]

At the time of admission to an intensive or intermediate care unit, assessment of the patients' nutritional status may have both prognostic and therapeutic relevance with regard to the planning of individualized medical nutrition therapy (MNT). MNT has definitely no priority in the initial treatment of a critically ill patient, but is often also neglected during the course of the disease. Especially with prolonged length of stay, there is an increasing risk of malnutrition with considerable prognostic macro- and/or micronutrient deficit. So far, there are no structured, evidence-based recommendations for assessing nutritional status in intensive or intermediate care patients. This position paper of the Section Metabolism and Nutrition of the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI) presents consensus-based recommendations for the assessment and technical monitoring of nutritional status of patients in intensive and intermediate care units. These recommendations supplement the current S2k guideline "Clinical Nutrition in Intensive Care Medicine" of the German Society for Nutritional Medicine (DGEM) and the DIVI., (© 2022. The Author(s).)

Purpose: Variations of clinical nutrition may affect outcome of critically ill patients. Here we present the short version of the updated consenus-based guideline (S2k classification) "Clinical nutrition in critical care medicine" of the German Society for Nutritional Medicine (DGEM) in cooperation with 7 other national societies. The target population of the guideline was defined as critically ill adult patients who suffer from at least one acute organ dysfunction requiring specific drug therapy and/or a mechanical support device (e.g. mechanical ventilation) to maintain organ function., Methods: The former guidelines of the German Society for Nutritional Medicine (DGEM) were updated according to the current instructions of the Association of the Scientific Medical Societies in Germany (AWMF) valid for a S2k-guideline. We considered and commented the evidence from randomized-controlled trials, meta-analyses and observational studies with adequate sample size and high methodological quality (until May 2018) as well as from currently valid guidelines of international societies. The liability of each recommendation was indicated using linguistic terms. Each recommendation was finally validated and consented by a Delphi process., Results: The short version presents a summary of all 69 consented recommendations for essential, practice-relevant elements of clinical nutrition in the target population. A specific focus is the adjustment of nutrition according to the phases of critical illness, and to the individual tolerance to exogenous substrates. Among others, recommendations include the assessment of nutritional status, the indication for clinical nutrition, the timing, route, magnitude and composition of nutrition (macro- and micronutrients) as well as distinctive aspects of nutrition therapy in obese critically ill patients and those with extracorporeal support devices., Conclusion: The current short version of the guideline provides a concise summary of the updated recommendations for enteral and parenteral nutrition of adult critically ill patients who suffer from at least one acute organ dysfunction requiring pharmacological and/or mechanical support. The validity of the guideline is approximately fixed at five years (2018 - 2023)., Competing Interests: Die Interessenkonflikte der Autoren sind in Tab. 2 aufgelistet., (Georg Thieme Verlag KG Stuttgart · New York.)

The transport mechanisms of ascorbic acid (AA) are described. The metabolism of AA and its function as an antioxidant are covered in some detail. Subsequently, indications for postoperative substitution are discussed. The supplementation of up to 300 mg of AA per day in postoperative intensive care unit patients during par-/enteral nutrition is recommended to prevent hypovitaminosis. It is not clear if this is the optimal dosage of AA in postoperative/-trauma patients. New aspects for an AA substitution are discussed.

In order to study the clinical effects of the antioxidant alpha-tocopherol (tocofersolan, CAS 30999-06-5) a simple, robust, sensitive and reliable high performance liquid chromatography (HPLC) method using fluorescence detection for the daily measurement of alpha-tocopherol concentration in plasma is described. Several methods of HPLC analysis using fluorescence techniques are published, however, investigations of the stability of alpha-tocopherol during sample preparation under different conditions are relevant in the routine measurements and have to date not been reported. Therefore a modified method, both sensitive and robust, qualified for the day-by-day measurement of alpha-tocopherol in plasma was established and the stability of alpha-tocopherol during sample preparation was analysed under different conditions. This method enables the complete separation of alpha-tocopherol from other compounds within 14 min. In addition, investigations on the stability of alpha-tocopherol during sample preparation showed the necessity of rapid sample preparation without delay. Prepared samples can be stored in liquid nitrogen for at least 56 days.

Reduced concentration of ascorbic acid (AA) in plasma is often observed in tumor patients. Besides malnutrition, an increased AA consumption in tumor patients is discussed as a main reason for reduced AA concentration in plasma. A reduced AA concentration caused by malnutrition would not influence the total clearance (Cltot) of AA in plasma; however, a change in AA consumption would alter the Cltot. To investigate this further, a study was carried out on 20 patients hospitalized for major maxillofacial surgery and 20 volunteers. The Cltot of AA in plasma after bolus injection of AA (4 mg/kg body wt) in tumor patients was compared with that in volunteers. AA concentration in plasma (P < 0.05) was significantly lower in tumor patients (median and 25th and 75th percentiles: 23.7, 14.6, and 32.7 mumol/l) than in volunteers (median and 25th and 75th percentiles: 66.5, 59.6, and 78.6 mumol/l). No significant change in Cltot was observed for tumor patients (median and 25th and 75th percentiles: 11.5, 8.0, and 14.0 l/h) compared with volunteers (median and 25th and 75th percentiles: 11.3, 9.9, and 13.2 l/h). No indication of an increased consumption of AA in tumor patients could be detected. The lowered concentration of AA in plasma observed in our patients might be the result of a reduced AA intake.