Chapter 2-Energy

Question 1

TEE=

Answer 1

BMR or RMR(60-70%)+thermogenic effect of food(5-10%)+physical activity(5-30%)

Question 2

RQ

Answer 2

Primary lipid catabolism

Pt is being underfed 👆calories

Question 3

RQ>1 with excessive CO2 production suggests…

Answer 3

Over feeding, potential lipogenesis and 👆respiratory demand

👇total caloric and CHO delivery

Question 4

RQ=0.85

Answer 4

Mixed substrate utilization 🙌

Keep it up! 👍

Question 5

Clinical indications for consideration of hypocaloric feeding

Answer 5

Class III obesity(BMI <40)
Refeeding syndrome risk
Severe malnutrition 
COPD
ARDS
SIRS
Sepsis with hemodynamic instability
Multiple organ dysfunction syndrome
Hypercapnia, Hyperglycemia or Hypertriglyceridemia
Persistent elevations in respiratory rate

Question 6

What are the metabolic response to critical illness phases and how are they characterized?

Answer 6

1 Stress phase-hemodynamic instability, hypometabolism, surging counterregulatory horomones, and insulin resistance

2 Catabolic phase-fever, hypercatabolism, gluconeogenesis, increased O2 demands

3 Anabolic phase- repletion of LBM and adipose tissue. Caloric delivery increased to 100% to 130% of RMRto support tissue repair, repletion and recovery

Question 7

Risks of underfeeding

Answer 7

Deterioration of LBM
Immunosuppression
Poor wound healing
👆risk of nosocomial infections
Impaired organ function
👇 respiratory muscle strength
👇 ventilator drive 
Failure to wean from vent

Cumulative deficits in caloric intake have been linked with increased morbidity and mortality

Question 8

Risks of overfeeding

Answer 8

Exacerbates respiratory failure by increasing CO2 load
Hyperglycemia
Azotemia
Hypertriglyceridemia
Electrolyte imbalances
Immunosuppression
Alterations in hydration status
Hepatic steatosis
Failure to wean from mechanical vent