Lecture 37+38

Question 1

role of cytokines

Answer 1

Ex: interleukins, TNF, PGE2

released by macrophages in response to damage, infection, inflammation

promote wound healing 
stimulate angiogenesis 
increase WBC count 
mobilize amino acids 
fever
pain

Question 2

I- Ebb phase (Unresuscitated phase)

Answer 2

hypovolemia
shock
tissue hypoxia

decreased:
CO (lactic acidosis)
O2 consumption
body temp

seen a few hours after injury
low insulin levels (hyperglycemia)
Glucagon, epinephrine and cortisol elevated

Question 3

II- flow phase (Adrenergic - corticoid)

Answer 3

last up to 2 weeks after injury (hypermetabolic)

increased CO + HR
fever
increased energy usage
increase in protein catabolism

Increase in catecholamines, glucagon, cortisol and cytokines (hyperglycemia) (increased FFA’s)

Question 4

critical illness and carb metabolism

Answer 4

blood glucose is high
gluconeogenesis is high
insulin is high.. but resistant

Question 5

prolonged starvation and carb metabolism

Answer 5

blood glucose is low
insulin is low
gluconeogenesis is active
ketones and glucose

Question 6

critical illness and lipid metabolism

Answer 6

hormone sensitive lipase is active (due to cortisol and epi)
lipolysis is very active (deplete fat stores quick)
insulin high but resistant
ketones are low

Question 7

prolonged starvation and lipid metabolism

Answer 7

hormone sensitive lipase is active (low insulin)

lipolysis is active
insulin is low
ketones are high

Question 8

flow phase and proteins

Answer 8

negative nitrogen balance

reduced protein synthesis and AA uptake
higher urea excretion

Question 9

acute phase of the liver

Answer 9

Cytokines stimulate

Positive acute phase proteins are C-reactive protein, α1
-antitrypsin, ceruloplasmin, haptoglobin

Question 10

critical illness and protein metabolism

Answer 10

muscle proteolysis
muscle wasting
negative nitrogen balance
higher urea

Question 11

prolonged starvation and protein metabolism

Answer 11

muscle proteolysis
muscle wasting not as pronounced
negative nitrogen balance
urinary urea excretion will decrease

Question 12

anabolic phase or recovery

Answer 12

positive nitrogen balance 
increase protein intake 
rebuilding of fat stores 
normalization of glucose levels and insulin 
tissues sensitive to insulin again

Question 13

features of diabetic ketoacidosis

Answer 13

hyperglycemia
metabolic acidosis
ketosis
high anion gap metabolic acidosis

Question 14

Features of hyperosmolar hyperglycemic state

Answer 14

hyperglycemia (really high)
hyperosmolarity
dehydration

no metabolic acidosis
no ketones

found more often in DMII