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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
Q

What is the major fuel source during starvation?

A

Fats

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26
Q

What is the major fuel source during stress?

A

All of them!!!

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27
Q

Describe the starvation protein metabolism. 2 steps

A
  1. Proteolysis of muscle and visceral organs
  2. AAs go to liver to produce glucose and acute phase proteins
    = SAME AS STRESSED METABOLISM
28
Q

Describe the starvation fat metabolism.

A

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

29
Q

Starvation causes the decreased secretion of what 2 molecules?

A
  1. Insulin

2. THs

30
Q

How is O2 consumption affected by stress and starvation?

A

Stress: increased
Starvation: decreased

31
Q

Does short-term mobility causes changes in muscle mass?

A

Very little

32
Q

What is the equation for nitrogen balance?

A

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
Q

What is the nitrogen balance used for?

A

To determine adequate protein intake (equilibrium)

34
Q

When is the NB (+)?

A

When lean body mass is growing

35
Q

When is the NB (-)? 2 options

A
  1. Inadequate protein intake

2. Excessive protein catabolism (eg: during stress)

36
Q

Where is nitrogen lost? 5 places.

A
  1. Urine
  2. Feces
  3. Skin
  4. Sweat
  5. Body fluids
37
Q

Will stressed patients be able to attain a (+) NB?

A

Probably not, so the goal is to minimize losses

38
Q

Is serum albumin a good indicator of nutrition status? Why/Why not?

A

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
Q

What plasma protein can help determine whether serum proteins are altered due to stress?

A

The C-reactive protein

40
Q

How does kidney/liver failure affect protein metabolism?

A

Causes a decrease in tolerance of excess protein intake

41
Q

What is the daily protein requirement for adults?

A

Male: 56 g
Female: 46 g

42
Q

What are the 7 factors that affect daily protein requirements?

A
  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
Q

What does the quality of a protein source depend on?

A

Ratio of essential over non-essential AAs

44
Q

How does starvation affect nitrogen losses?

A

Decreases because less proteins are used for gluconeogenesis

45
Q

What is the protein requirement per kg per day for healthy people?

A

0.8 g/kg/day

46
Q

What is the protein requirement per kg per day for sick people?

A

1.2-3 g/kg/day

47
Q

Should protein and calorie intake be considered together for sick patients?

48
Q

Can we make essential AAs from non-essential AAs?

49
Q

What are the 10 essential AAs (meaning we cannot make them)?

A

I Want To Kill VHRs. FML

50
Q

What are the 3 conditional essential AAs? What does it mean to be conditionally essential?

A

Cys
Gly
Tyr
Means they might need to be ingested when synthesis cannot meet needs

51
Q

What kinds of fats are directly absorbed by the intestine and which ones need to be transported? By what?

A

Monoglycerides and short/medium FAs can go through

Long chain AAs need to be transported by carnitine

52
Q

How many Cs in short FAs?

53
Q

How many Cs in medium FAs?

54
Q

How many Cs in long FAs?

55
Q

How are the long chain FAs transported to target tissues?

A

Chylomicrons in lymph or blood

56
Q

How are the short chain FAs transported to target tissues?

A

Free or albumin-bound in blood

57
Q

What are the only 2 FAs that MUST come from the diet?

A

Omega 3 and 6 FAs

58
Q

What are the 4 signs of inadequate intake of omega 3 and 6 FAs?

A
  1. Scaly skin lesions
  2. Alopecia
  3. Decreased # of platelets
  4. Poor wound healing
59
Q

What is a subpop of patients that are at higher risk for omega 3 and 6 deficiency?

A

Parenterally fed patients

60
Q

How will the fasting range of lipids be affected by IV lipid administration?

A

Slightly above normal

61
Q

Why would it mean for a patient to have several times higher fasting range of lipids?

A

Pancreatic disease

62
Q

What are eicosanoids derived from?

A

Omega 3 and 6 FAs

63
Q

What are the 3 forms of omega 3 eicosanoids?

A
  1. alpha-linoleic acid
  2. Eicosapentaenoic acid
  3. Docosahexaenoic acid
64
Q

What are the 3 forms of omega 6 eicosanoids?

A
  1. Linoleic acid
  2. Arachidonic acid
  3. gamma-linoleic
65
Q

What are the main 3 differences between omega 3 and omega 6 eicosanoids?

A
  1. Omega 3 more vasconstrictive
  2. Omega 6 more immunosuppressive
  3. Omega 6 induce platelet aggregation
66
Q

In someone who in decreasing fat intake what would be important to monitor?

A

omega-3 and omega-6 FA deficiency

67
Q

A critically ill patient with extensive burns may need more than twice the RDA for protein: T or F?

SMP - MNE Exam 1 (25 decks)

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