The essential micronutrients are present in minute or trace amounts within the body, sometimes in quantities of less than 100 |g. Although trace elements are present in very small amounts, they often have dramatic effects. Deficiencies

TABLE 54-1. Estimated Calorie and Protein Needs

Physiologic State

Calorie Needs

Protein Needs

Mild physiologic stress Moderate physiologic stress Severe physiologic stress

25 to 28 kcal/kg/d 28 to 32 cal/kg/d 32 to 35 cal/kg/d

0.8 to 1.0 g/kg/d 1.0 to 1.2 g/kg/d 1.5 to 2.0 g/kg/d

TABLE 54-2. Mineral and Micronutrient Requirements


Daily Requirement



1000 mg

Bone loss


1000 mg

Muscle dysfunction


400 mg

Cardiac arrhythmias


75 |jg

Glucose intolerance


3 |Jg

Microcytic anemia


150 pg



1 mg

Microcytic anemia


4 pg

Hair deformities


60 pg

Muscle weakness


10 mg

Poor wound healing

are more common than toxicity. Many of these deficiencies develop in patients who are on long term parenteral nutrition (PN) or who are severely malnourished. The assessment of trace element deficiency is extremely difficult. Serum levels may not accurately reflect body stores. Because of this, clinicians may have to depend on physical signs and symptoms to detect micronutrient deficiency (Table 54-3).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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