5 - Metabolism in surgical patients Flashcards
What is the water percentage in an adult men/women?
60%
50
Describe which physical examination features can assist evaluating a patient’s hydration status? 6
mental status skin turgor sunken eyes capillary filling tachycardia/BP urine output
Which lab values can assist evaluating a patient’s hydration status? 3
BUN/Cr > 10
elevated hematocrit
metabolic acidosis
How much liquid is exerted in daily feces?
250 ml
How much liquid is exerted in daily urine?
800-1500 ml
How much liquid is exerted in daily insensible loss
(Breathing/skin, heat, mechanical ventilation)?
1500 ml
Describe the daily requirement for the following: water- Na- K- Cl- glucose- protein-
water- 2500 ml Na- 5-10g K- 40-80 mEq/kg Cl- 1.5 mEq/kg glucose- 100 protein- 0.8 g/kg
What is the TBW (total body water) in an adult?
2.5 L
Which solution will you use for GI secretion loss?
RL
Which solution will you use for stomach secretion loss?
half standard + 20 KCL
Which solution will you use for pancreatic secretion loss?
RL
What is the maintenance fluid for an adult during surgery? 3
first 10 kg- 4cc/kg
second 10 kg- 2cc/kg
extra weight- 1cc/kg
What is the maintenance fluids for a 50 kg adult?
40 + 20 + 30 = 90 cc
When calculating maintenance fluids for an adult- use the following formula:
60 cc + (weight-20)
Which crystalloid solutions do you know? 2
ringer lactate (Hartman)
Normal saline
hypertonic saline
What are the characteristics of ringer lactate? 4
- hypotonic
- pH 6.5
- ECF like electrolytes (Na/K/Ca) and HCO3
- used for volume balance
What are the characteristics of normal saline? 5
- isotonic
- lower pH than Hartman’s (can cause metabolic acidosis in large volumes)
- contains K
- higher electrolytes (Na/Cl/) level than Hartman’s
- used for renal failure, metabolic alkalosis, brain edema
What are the characteristics of hypertonic saline? 2
hyperosmotic
allows fast volume retur
Which keloid solutions do you know? 2
natural (albumin/PPF)
synthetic (HES-starch dextrose)
What are the indications for keloid solutions? 3
quick volume correction
severe catabolic state (burn)
hypoalbuminemia
Describe 5 disadvantages of keloid solution: 5
coagulation disorder anaphylactic reaction GFR decrease pulmonary edema osmotic diuresis
Which patients should receive 5% glucose solution? 3
infants
premature babies
elders
What are the disadvantages of 5% glucose solution? 4
inotropic hyperglycemia and reduced wound healing
it can become hypotonic
osmotic urination
neurological symptoms in cerebral ischemia patients
Surgical patients with nutritional deficiency are more likely to suffer from: 5
delayed wound healing catabolism decreased function slower recovery increased post-op mortality/morbidity
What are the criteria for starting with nutritional support to a surgical patient? 5
- malnutrition/chronic disease
- involuntary weight loss (>10% in 6 months or 5% a month)
- expected blood loss of > 500 ml during surgery
FTT (in infants) - katabolic disease (burn/sepsis/trauma/pancreatitis)
What are the characteristics of a malnutrition patient?
BMI < 18.5
albumin < 3g%
transferrin < 200 mg%
What are the indications for enteral feeding? 1 + 3
inability to eat in the following 7 days
+
> 1 meter of intestine+functioning ileocecal valve+airway
What are the C/I for enteral feeding post op? 7
refractory vomiting/diarrhea bowel obstruction/gastroparesis/paralytic ileus bowel ischemia high output, entero-cutaneouse fistula peritonitis active GIB hemodynamic instability
NGT (nasogastric tube) is used when feeding < __ weeks.
4
When feeding for longer than _ weeks, use __ or __.
gastrostomy
jejunotomy
What are the indications for parenteral feeding?
C/I for enteral feeding dysfunctional intestine bowel rest (e.g. post severe pancreatitis)
Describe the two methods for parenteral feeding:
1-
2-
peripheral vein, <1-2 weeks , <850 mOsmol/L
central vein, >1-2 weeks , >850 mOsmol/L
What are the disadvantages of parenteral feeding? 5
- mechanical (pneumothorax emboli, thrombosis, bleeding)
- infections (sepsis, endocarditis, bacteria migration)
- metabolic (hypertriglyceridemia, hyperglycemia)
- acalculous cholestasis
- re-feeding syndrome (in malnutrition/alcoholic)
What happens in re feeding syndrome?
fast shift of P/K/Mg form plasma to cells when feeding malnourished/ alcohol abusers patients
What are the clinical signs of re-feeding syndrome? 4
neuromuscular
rhabdomyolysis
respiratory failure/arrhythmia/ renal failure
pancytopenia
Name 5 of the neuromuscular signs that can be seen in re-feeding syndrome:
lethargy disorientation dysphagia ocular muscle weakness ataxia/seizures
