RESUMO
PURPOSE OF REVIEW: To summarize current knowledge about nutritional aspects in the final stage of life, with emphasis on mechanisms and clinical diagnosis, ethical aspects and management. RECENT FINDINGS: The most recent advances on the subject include new mechanisms involved in the pathophysiology, use of therapeutic approach combined with n-3 fatty acids and the active intervention of the patient in decision making. SUMMARY: The nutritional deterioration in a patient who passes the last stages of his life constitutes a subject area to varied analysis and considerations. For this reason, there exist an increasing number of investigations, particularly in the areas of pathophysiology and of therapeutics. The aspects related to quality of life, cultural context and bioethics, add more complexity to the subject.
Assuntos
Estimulantes do Apetite/uso terapêutico , Estado Nutricional/fisiologia , Apoio Nutricional/métodos , Assistência Terminal/métodos , Doente Terminal , Anorexia/tratamento farmacológico , Anorexia/etiologia , Estimulantes do Apetite/efeitos adversos , Caquexia/tratamento farmacológico , Caquexia/etiologia , Humanos , Apoio Nutricional/ética , Apoio Nutricional/psicologia , Participação do Paciente , Qualidade de Vida , Assistência Terminal/ética , Assistência Terminal/psicologiaRESUMO
Symptoms and laboratory evidence of adrenal suppression developed in 2 children with the human immunodeficiency virus after megestrol acetate (MA) therapy was discontinued; both required transient glucocorticoid replacement therapy. High-dose corticotropin stimulation testing performed on children with the human immunodeficiency virus treated or not treated with MA showed that baseline and post-corticotropin cortisol levels were extremely low in 7 of 10 treated patients and normal in 10 of 10 members of a control group (P <.01). MA may suppress adrenal function, and replacement glucocorticoids may prevent or relieve associated symptoms at times of severe stress or on discontinuation of MA therapy.