Metabolism and Nutritional Needs of Surgical Patients

Question 1

Which statement is true
a.The “ebb/flow” concept states there is an initial hypometabolic response occurs
with hemodynamic instability and shock, and then a hypermetabolic state occurs
after successful resuscitation.
b. Supporting nutritional needs is appropriate during the flow period, but not during the ebb period.
c.By the second postoperative day energy expenditure is no different than normal
animals.
d.All of the above

Answer 1

D all of the above

Question 2

Which of the following statements is true
a.IL-6 is responsible for increased energy expenditure, hepatic gluconeogenesis, protein breaksdown, activation of hypothalamic-pituitary-adrenal axis, lipolysis, peripheral insulin resistance
b. Early nutritional support is feeding as soon as possible even if hemodynamically
unstable. ​
c.Feedings tubes should be considered if sufficient amounts to meet 75% of
RER is not voluntarily consumed.
d.Reach target nutrition over 12-24 hours

Answer 2

C

​TNF-alpha​ is responsible..
(AFTER hemodynamic stability is achieved
(​reach target nutrition over 48-72 hours​)

Question 3

What statement is true regarding the feeding of veterinary patients?
a.Ingredient breakdown: Dogs 6-8 grams
of protein/100 kcal and cats usually 4-6 grams of protein/100 kcal
b.Glutamine is the primary energy source for enterocytes and cells of the immune
system, and may attentuate GI permeability and improve overall outcome, and is
recommended in veterinary patients.
c.Most animals tolerate 20-30 ml/kg per feed; but if there is dysfunction only
5-10 ml/kg/feed
d.Refeeding syndrome occurs when increase in insulin concentrations due to food result in hyperphosphatemia, hyperkalemia, ​hyperglycemia​.

Answer 3

C

Proteins:
DOGS​= 4-6 aka 15-25% total energy requirements
CATS ​​=6-8 25-35% of TER​)
glutamine ​in humans but not dogs and cats)
Refeeding DECREASE in potassium, phosphorus, magnesium)

Question 4

True or false: Amino acid solutions, dextrose >10%, and lipid emulsions should only be administered in a central line

Answer 4

FALSE: lipid emulsions are iso-osmotic and may go in a peripheral line

Question 5

Which of the following is true?
A Protein-energy malnutrition has been reported in <25% of human patients
B Malnutrition can lead to impaired healing, incisional dehiscence, muscle weakness, organ failure, and death
C There are two major categories for nutrition - those in non-critical and those in critical issues

Answer 5

A 25-65%
B true
C non-critical and critical are both part of nutrition in the surgical period, the other category is post-op and rehabilitation

Question 6

Which of the following is true with regard to starvation?
A There is an increase in insulin and decrease in glucagon
B The brain converts to fatty acid derived energy
C Villous atrophy occurs within 1.5 days, with potential for decrease in ⅓ of GIT weight within 7 days
D Feeding within 36 hours has been shown to decrease mortality in humans

Answer 6

Aa increase glucagon, decrease insulin
B glucose dependent
C true
D 48 hrs

Question 7

What is true?
A Resting requirement for protein intake in dogs at maintenance is 2.62 to 3.28 g/BWkg and for adult cats is 3.97 to 5.90 g/BWkg .
B Water intake should be 40-50ml/kg/day in patients in rehab
C The factor in which to multiple the RER to reach the daily energy requirement for “critical care” patients is 1.5
D Lipid emulsions range from 10-20% and at higher concentrations should be administered centrally

Answer 7

A true
B 50-60 and increased potentially with rehab
C 1.5 critical care p
D can be administered peripherally