Sepsis and Critical

Question 1

What is refeeding syndrome

Answer 1

Refeeding syndrome is a constellation of biochemical findings that occur after introducing caloric intake to at risk malnourished patients or

“a collection of electrolyte derangements associated with a massive intracellular shift of electrolytes. Hypophosphatemia is commonly observed as extracellular phosphate is rapidly taken into the cells to generate adenosine triphosphate (ATP).” – uptodate

Drop in
* Phosphate
* Magnesium
* Potassium
* Due to intracellular shift due to insulin

Question 2

Define AKI

Answer 2

Different systems but all pretty similar (RIFLE, AKIN, KDIGO)

Either creatinine or urine output

1: 1.5-2x creatinine baseline
2: 2-2.9x creatinine baseline
3: 3x creatinine baseline or 400 or RRT commenced

1: <0.5ml/kg/hr for 6 hours
2; <0.5ml/kg/hr for 12 hours
3; <0.3ml/kg/hr for 24 hours or anuria for 12 hours

Question 3

Inotropes

Answer 3

A = arterial smooth muscle contraction
B1 = cardiac tissue
B2 = smooth muscle relaxation (generalised)

Question 4

Tell me about TXA

Answer 4

Antifibrinolytic agent that inhibitrs plasminogen conversion to plasmin, thereby preventing fibrin degradation, keeping clots stable
CRASH2 1g IV TXA within 3 hours of injury reduced risk of death
in trauma patients
CRASH3 head trauma

Question 5

Define sepsis

Answer 5

Sepsis 3 definition (1 sentence, 4 points)
* life threatening
* organ dysfunction
* due to dysregulated host response
* to infection

Clinical criteria
Organ dysfunction is assessed using the SOFA score (6 variables) or the qSOFA (3 bedside parameters “HAT” SBP<100, GCS minus 1 point, RR22+)

Question 6

Define septic shock

Answer 6

Sepsis 3 definition
* Subset of sepsis (as defined by sepsis 3 criteria)
* Underlying circulatory, cellular and metabolic abnormalities
* Are profound enough to substantially increase mortality

Clinical criteria
Adequate fluid resuscitation (?how much)
1. Vasopressors to maintain MAP 65mmHg
2. Lactate 2+

Question 7

Nutritional requirements

Answer 7

Water= 30ml/kg/day
Na=1mmol/kg/day
K = 1mmol/kg/day
Energy=30kcal/kg/day
Protein =1/3 energy, 1g/kg/day
Ratio= 30:70 lipids:carbs
Vitamins

Immunonutrition: pharmaconutrients arginine, glutamine, omega-3-fatty acids, nucleotides
anti-oxidants: copper, selenium, zinc, vitamins B, C and E

Calories: start at 10kcal/kg/day,
up to 45 kcal/kg/day for critically ill patients