Systems and methods for monitoring of fractional gluconeogenesis and targeting of fractional gluconeogenesis via nutritional support

Abstract

Systems, techniques and methods for estimating the metabolic state or flux, e.g., the body energy state (“BES”) of a patient, are disclosed. The BES provides a deep insight into the nutritional needs of the patient, thus allowing for a sort of exquisite glycemic control with regard to the patient. The invention discloses systems and methods for estimating fractional gluconeogenesis. The invention also discloses systems and methods for estimating and targeting patient blood lactate concentration, both as a target itself and as an intermediate step to estimating and targeting patient fractional gluconeogenesis glucose production. Nutritional support methods and formulations are also disclosed. The invention is suitable for any sort of patient, including those who are injured, such as with traumatic brain injury, ill, or have other conditions that stress the metabolic system.

What is claimed is: 
     
         1 . A method of addressing the nutritional status of a patient, the method comprising:
 receiving a fractional gluconeogenesis value or set of values from one or more mass spectrometric readings from a blood sample from the patient, the value or set of values received directly, or indirectly over a network, from one or more mass spectrometric instruments; and   if the fractional gluconeogenesis received is below about 15-30%, ceasing or decreasing a nutritional support to the patient.   
     
     
         2 . The method of  claim 1  wherein the ceasing or decreasing is carried out only if the fractional gluconeogenesis is below about 20-25%. 
     
     
         3 . The method of  claim 1  wherein the nutritional support comprises one or more salts. 
     
     
         4 . The method of  claim 1  wherein the nutritional support comprises lactate or pyruvate or both. 
     
     
         5 . The method of  claim 1  wherein the nutritional support comprises one or more of the following: glycerol, glycerol tri-lactate, glycerol tri-acetate, arginyl lactate, lactate N-acetylcysteine ester, pyruvate, acetoacetate, or beta-hydroxy butyrate. 
     
     
         6 . The method of  claim 1  wherein the method further targets a blood glucose range of values. 
     
     
         7 . The method of  claim 1  wherein the method further targets a blood lactate to pyruvate ratio of at least about 10. 
     
     
         8 . The method of  claim 1  wherein the nutritional support comprises a label which labels hydrogen and is used to determine the fractional gluconeogenesis. 
     
     
         9 . The method of  claim 1  wherein the nutritional support comprises water and at least some of the water is deuterium labeled water. 
     
     
         10 . The method of  claim 1  wherein the nutritional support comprises water and the water is about 0.3-0.5% deuterium labeled water. 
     
     
         11 . A method of addressing the nutritional status of a patient, the method comprising:
 receiving a fractional gluconeogenesis value or set of values from one or more mass spectrometric readings from a blood sample from the patient, the value or set of values received directly, or indirectly over a network, from one or more mass spectrometric instruments;   if the fractional gluconeogenesis received is below about 15-30%, ceasing or decreasing a nutritional support to the patient; and   repeating the receiving and ceasing or decreasing at least once.   
     
     
         12 . The method of  claim 11  wherein the ceasing or decreasing is carried out only if the fractional gluconeogenesis is above about 20-25%. 
     
     
         13 . The method of  claim 11  wherein the nutritional support comprises one or more salts. 
     
     
         14 . The method of  claim 11  wherein the nutritional support comprises lactate or pyruvate or both. 
     
     
         15 . The method of  claim 11  wherein the nutritional support comprises one or more of the following: glycerol, glycerol tri-lactate, glycerol tri-acetate, arginyl lactate, lactate N-acetylcysteine ester, pyruvate, acetoacetate, or beta-hydroxy butyrate. 
     
     
         16 . The method of  claim 11  wherein the method further targets a blood glucose range of values. 
     
     
         17 . The method of  claim 11  wherein the method further targets a blood lactate to pyruvate ratio of at least about 10. 
     
     
         18 . The method of  claim 11  wherein the nutritional support comprises a label which labels hydrogen and is used to determine the fractional gluconeogenesis. 
     
     
         19 . The method of  claim 1  wherein the nutritional support comprises water and at least some of the water is deuterium labeled water. 
     
     
         20 . The method of  claim 11  wherein the nutritional support comprises water and the water is about 0.3-0.5% deuterium labeled water. 
     
     
         21 . A method of addressing the nutritional status of a patient, the method comprising:
 taking a blood sample from the patient;   analyzing the blood sample with one or more mass spectrometric instruments;   determining a fractional gluconeogenesis value or set of values; and   if the fractional gluconeogenesis determined is below about 15-30%, ceasing or decreasing a nutritional support to the patient, wherein the nutritional support comprises a label which is used to help determine the fractional gluconeogenesis.   
     
     
         22 . The method of  claim 21  wherein the administering is carried out only if the fractional gluconeogenesis is above about 20-25%. 
     
     
         23 . The method of  claim 21  wherein the nutritional support comprises one or more salts. 
     
     
         24 . The method of  claim 21  wherein the nutritional support comprises lactate or pyruvate or both. 
     
     
         25 . The method of  claim 21  wherein the nutritional support comprises one or more of the following: glycerol, glycerol tri-lactate, glycerol tri-acetate, arginyl lactate, lactate N-acetylcysteine ester, pyruvate, acetoacetate, or beta-hydroxy butyrate. 
     
     
         26 . The method of  claim 21  wherein the method further targets a blood glucose range of values. 
     
     
         27 . The method of  claim 21  wherein the method further targets a blood lactate to pyruvate ratio of at least about 10. 
     
     
         28 . The method of  claim 21  wherein the nutritional support comprises a label which labels hydrogen and is used to determine the fractional gluconeogenesis. 
     
     
         29 . The method of  claim 1  wherein the nutritional support comprises water and at least some of the water is deuterium labeled water. 
     
     
         30 . The method of  claim 21  wherein the nutritional support comprises water and the water is about 0.3-0.5% deuterium labeled water. 
     
     
         31 . A method of addressing the nutritional status of a patient, the method comprising:
 taking a blood sample from the patient;   analyzing the blood sample with one or more mass spectrometric instruments;   determining a fractional gluconeogenesis value or set of values;   if the fractional gluconeogenesis determined is above about 15-30%, ceasing or decreasing a nutritional support to the patient, wherein the nutritional support comprises a label which is used to help determine the fractional gluconeogenesis; and   repeating the taking, analyzing, receiving and ceasing or decreasing at least once.   
     
     
         32 . The method of  claim 31  wherein the administering is carried out only if the fractional gluconeogenesis is above about 20-25%. 
     
     
         33 . The method of  claim 31  wherein the nutritional support comprises one or more salts. 
     
     
         34 . The method of  claim 31  wherein the nutritional support comprises lactate or pyruvate or both. 
     
     
         35 . The method of  claim 31  wherein the nutritional support comprises one or more of the following: glycerol, glycerol tri-lactate, glycerol tri-acetate, arginyl lactate, lactate N-acetylcysteine ester, pyruvate, acetoacetate, or beta-hydroxy butyrate. 
     
     
         36 . The method of  claim 31  wherein the method further targets a blood glucose range of values. 
     
     
         37 . The method of  claim 31  wherein the method further targets a blood lactate to pyruvate ratio of at least about 10. 
     
     
         38 . The method of  claim 31  wherein the nutritional support comprises a label which labels hydrogen and is used to determine the fractional gluconeogenesis. 
     
     
         39 . The method of  claim 1  wherein the nutritional support comprises water and at least some of the water is deuterium labeled water. 
     
     
         40 . The method of  claim 31  wherein the nutritional support comprises water and the water is about 0.3-0.5% deuterium labeled water.