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SMP - MNE Exam 1 > Nutrition SDL #3: Metabolic Stress & Starvation > Flashcards

Nutrition SDL #3: Metabolic Stress & Starvation Flashcards

1
Q

What are the risks of malnutrition in sick patients?

A

Slow recovery or worsened states

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2
Q

What are the 4 populations at risk for malnutrition upon admission?

A
  1. Elderly
  2. Chronically ill
  3. Poor
  4. Children
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3
Q

What are iatrogenic causes of malnutrition?

A

Malnutrition caused by medical staff (restrictive diets or fasting before procedures)

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4
Q

What should be done upon all admissions to the hospital?

A

ASSESS NUTRITIONAL STATUS

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5
Q

Stress causes the increased secretion of what 5 molecules?

A
  1. Cytokines (TNF, ILs)
  2. Catecholamines
  3. Glucocorticoids
  4. Glucagon
  5. Insulin
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6
Q

What are the 2 types of cytokines?

A
  1. Tumore Necrosis Factor (TNF)

2. Interleukin (IL-1)

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7
Q

What are the 7 effects of cytokines?

A
  1. Increased NO
  2. Fever
  3. Proteolysis
  4. Decreased albumin
  5. Increased fibroblasts
  6. Iron sequestration
  7. Zinc liver uptake
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8
Q

What 3 micronutrients are required in larger amounts in sick patients?

A
  1. Vitamin A
  2. Zinc
  3. Copper
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9
Q

What are the 2 phases of the stress response to trauma?

A
  1. Ebb

2. Flow

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10
Q

How long does the Ebb phase last?

A

1-2 days post-injury

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11
Q

How long does the Flow phase last?

A

Many days post-injury

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12
Q

What happens during the Ebb phase?

A

Initial response to cytokines and stress hormones

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13
Q

What happens during the Flow phase?

A 
Energy production is boosted and fuel is transferred from adipose tissue and muscles to liver and injury site 
1. Proteolysis
2. Gluconeogenesis
3. FA beta oxidation 
Catecholamine secretion decreases
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14
Q

What effect do the stress mediators have on insulin? What effect does this have on target tissues?

A

Cause insulin resistance to prevent glucose from being converted to glycogen, this impairs glucose transport to tissues so most of the glucose goes to the brain

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15
Q

Describe the stressed protein metabolism. 2 steps

A
  1. Cytokines cause proteolysis of muscle and visceral organs

2. AAs go to liver to produce glucose and acute phase proteins

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16
Q

How is urine affected by stressed?

A

Increase nitrogen/urea in urine (but still a (-) NB)

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17
Q

Describe the stressed carb metabolism. 2 parts

A
  1. Glycogen stores depleted faster

2. Protein gluconeogenesis

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18
Q

Describe the stressed lipid metabolism.

A

TAGs in adipose cells are broken down for FA beta oxidation in liver

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19
Q

How does stress affect ketogenesis?

A

It inhibits it in the fasted state

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20
Q

Why are plasma lipids higher during the stress response? 2 reasons

A
  1. Lipolysis

2. Insulin resistance

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21
Q

What are 4 (and optional 2) questions to ask a patient to assess nutritional status?

A
  1. Any food you can’t or don’t eat?
  2. GI problems?
  3. Take supplements?
    PEDS:
  4. Growth rate?
  5. Formula or breast milk?
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22
Q

What to check during physical examination for malnutrition? 2 things

A
  1. Hair plucking

2. Muscle wasting in temporal area, thighs, deltoids, interosseous muscles (fingers)

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23
Q

Describe the starvation carb metabolism. 3 steps

A
  1. Glycogen stores depleted slower (12 hrs or less)
  2. Protein gluconeogenesis
  3. Ketogenesis
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24
Q

What is the effect of excess ketogenesis? What is the minimum daily carb intake to prevent this?

A

Ketoacidosis

> 100 g carbs/day/adult

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25
What is the major fuel source during starvation?
Fats
26
What is the major fuel source during stress?
All of them!!!
27
Describe the starvation protein metabolism. 2 steps
1. Proteolysis of muscle and visceral organs 2. AAs go to liver to produce glucose and acute phase proteins = SAME AS STRESSED METABOLISM
28
Describe the starvation fat metabolism.
TAGs in adipose cells are broken down for FA beta oxidation and ketogenesis in liver
29
Starvation causes the decreased secretion of what 2 molecules?
1. Insulin | 2. THs
30
How is O2 consumption affected by stress and starvation?
Stress: increased Starvation: decreased
31
Does short-term mobility causes changes in muscle mass?
Very little
32
What is the equation for nitrogen balance?
NB = nitrogen intake - nitrogen losses = N intake* - UUN - 3g OR 4g * 1g protein = 0.16 g N UUN = 24h urinary urea N 3g for parenteral / 4g for enteral
33
What is the nitrogen balance used for?
To determine adequate protein intake (equilibrium)
34
When is the NB (+)?
When lean body mass is growing
35
When is the NB (-)? 2 options
1. Inadequate protein intake | 2. Excessive protein catabolism (eg: during stress)
36
Where is nitrogen lost? 5 places.
1. Urine 2. Feces 3. Skin 4. Sweat 5. Body fluids
37
Will stressed patients be able to attain a (+) NB?
Probably not, so the goal is to minimize losses
38
Is serum albumin a good indicator of nutrition status? Why/Why not?
NOPE because it changes in response to non-nutritional factors (eg: increase when dehydrated and decrease when over hydrated, liver/renal disease, protein-calorie malnutrition, malabsorption)
39
What plasma protein can help determine whether serum proteins are altered due to stress?
The C-reactive protein
40
How does kidney/liver failure affect protein metabolism?
Causes a decrease in tolerance of excess protein intake
41
What is the daily protein requirement for adults?
Male: 56 g Female: 46 g
42
What are the 7 factors that affect daily protein requirements?
1. Lean body mass 2. Growth/weight gain 3. Rate of protein loss 4. Quality of protein source 5. Metabolic stress 6. Lifecycle stage 7. Activity level
43
What does the quality of a protein source depend on?
Ratio of essential over non-essential AAs
44
How does starvation affect nitrogen losses?
Decreases because less proteins are used for gluconeogenesis
45
What is the protein requirement per kg per day for healthy people?
0.8 g/kg/day
46
What is the protein requirement per kg per day for sick people?
1.2-3 g/kg/day
47
Should protein and calorie intake be considered together for sick patients?
NOPE
48
Can we make essential AAs from non-essential AAs?
NOPE
49
What are the 10 essential AAs (meaning we cannot make them)?
I Want To Kill VHRs. FML
50
What are the 3 conditional essential AAs? What does it mean to be conditionally essential?
Cys Gly Tyr Means they might need to be ingested when synthesis cannot meet needs
51
What kinds of fats are directly absorbed by the intestine and which ones need to be transported? By what?
Monoglycerides and short/medium FAs can go through | Long chain AAs need to be transported by carnitine
52
How many Cs in short FAs?
2-6 Cs
53
How many Cs in medium FAs?
8-12 Cs
54
How many Cs in long FAs?
>= 14 Cs
55
How are the long chain FAs transported to target tissues?
Chylomicrons in lymph or blood
56
How are the short chain FAs transported to target tissues?
Free or albumin-bound in blood
57
What are the only 2 FAs that MUST come from the diet?
Omega 3 and 6 FAs
58
What are the 4 signs of inadequate intake of omega 3 and 6 FAs?
1. Scaly skin lesions 2. Alopecia 3. Decreased # of platelets 4. Poor wound healing
59
What is a subpop of patients that are at higher risk for omega 3 and 6 deficiency?
Parenterally fed patients
60
How will the fasting range of lipids be affected by IV lipid administration?
Slightly above normal
61
Why would it mean for a patient to have several times higher fasting range of lipids?
Pancreatic disease
62
What are eicosanoids derived from?
Omega 3 and 6 FAs
63
What are the 3 forms of omega 3 eicosanoids?
1. alpha-linoleic acid 2. Eicosapentaenoic acid 3. Docosahexaenoic acid
64
What are the 3 forms of omega 6 eicosanoids?
1. Linoleic acid 2. Arachidonic acid 3. gamma-linoleic
65
What are the main 3 differences between omega 3 and omega 6 eicosanoids?
1. Omega 3 more vasconstrictive 2. Omega 6 more immunosuppressive 3. Omega 6 induce platelet aggregation
66
In someone who in decreasing fat intake what would be important to monitor?
omega-3 and omega-6 FA deficiency
67
A critically ill patient with extensive burns may need more than twice the RDA for protein: T or F?
True!!

SMP - MNE Exam 1 (25 decks)

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