Answer: a, b The most severe complication of sepsis is multiple system organ dysfunction syndrome, which may result in death. The development of organ failure requires changes in the nutritional requirements and creates special feeding problems. A problem associated with systemic infection is oxygenation and elimination of carbon dioxide. Most of the enteral and parenteral formulas used to provide nutritional support for critically ill patients contain large amounts of carbohydrate, which generate large amounts of carbon dioxide following oxygenation. Such a large CO2 load may worsen pulmonary function or may delay weaning from the respirator. If this factor becomes a problem, the carbohydrate load should be reduced to 50% of metabolic requirements and fat emulsion administered to provide additional calories. When renal failure becomes progressive, the use of hemodialysis minimizes the effect of uremia superimposed on the metabolism of sepsis. Metabolic studies in patients with acute and chronic renal failure have limited the intake of nonessential amino acids, in an attempt to lower urea production. Proteins of high biologic value, but in much smaller quantities than usually given, are administered along with adequate calories, usually in the form of glucose. When enteral feedings are not feasible, a central venous infusion of an essential amino acid solution and hypertonic dextrose provides calories and a small quantity of nitrogen to reduce protein catabolism while simultaneously controlling the rise in BUN. During dialysis, protein intake is liberalized, but the BUN should still be maintained below 100 mg/dl. Hepatic dysfunction is a common manifestation of septicemia. The carbohydrate load is usually reduced to consist of no more than 5% of metabolic requirements, and the additional calories should be provided as fat emulsion. If encephalopathy develops, protein load should also be reduced0