Skildum: GI case Flashcards
Why evaluate nutritional status of a trauma pt?
Malnutrition delays wound healing.
Rapidly replenishing a malnourished pt can cause life threatening complications (i.e. Refeeding syndrome)
What is refeeding syndrome?
hyperglycemia
glucosuria
dehydration
hyperosmolar coma
How do you evaluate the nutritional status of a pt?
Pt hx
PE: Chelosis- vit deficiencies,
BMI, muscle tone in fingers
Labs: 24 hour urine/BUN albumin total protein Fe
What impact does trauma have on nutritional requirements?
Pt needs more N for HEALING!
Protein synthesis
Trauma→ hypercatabolism→ needs more calories
Missing 70% of gut→ let it rest
How does trauma affect metabolism?
trauma>
hormonal changes>
rapid INCREASE in metabolism
How can nutrition be delivered?
Enteral
Parenteral (central line-TPN, peirpheral- PPN)
*higher conc of glucose w/out osmotic effect
What are complications of parenteral nutrition?
TPN requires close monitoring
Damage to veins from needle
Infectious complications (fat emulsifications are common sources of infection)
Metabolic complications (Re-feeding syndrome)
What are the three components of human energy expenditure?
- BEE= this is the energy you expend when you’re BEEing a bump on a log (AKA supine, after sleep, before eating, under stringent conditions)
- Thermic Effect (energy expended in digesting and absorbing food)
- Energy from physical activity
How does BMR differ from BEE?
Usually slightly higher and accounts for upright posture, being non-fasted.
What are our energy needs measured in?
kcal/day
What is REE/BMR based on ?
age, gender, size
What modifies REE/BMR?
pregnancy
activity
sepsis
trauma
How does severe stress affect TEE?
TEE= 1.2- 1.6(this number can change) xREE
FYI
mild stress 1.2
fever 1.1
How much protein, carbs and FA are needed in a person recovering from trauma?
2x protein required in trauma recovery
fatty acids are “calorically dense”
ω3 and ω6 fatty acids–> eicosanoids
How much vitamins, minerals and electrolytes are needed?
Micronutrients may be depleted!
Burns–> copper depletion
What is the goal of TPN?
Swamp out pool of AA to maintain protein pool in skeletal muscle in the organs
How do you evaluate the effectiveness of a nutrition program?
Calculate the pt’s N balance
If it’s positive: net gain of protein
Negative: net LOSS of protein
How do you calculate N balance?
Total the urinary urea N excreted over 24 hrs
NB= N intake (g) - urinary urea N (g) - 3 (g)
N intake: dietary, TPN, PPN
N excreted in urine: Urinary urea N
N excreted other: Urine, feces, sweat, sloughing skin cells
Normal N loss factor (through feces, sweat, sloughing of skin cells) is 2 g. How does it change for parenteral feeding or enteral feeding?
3g for parenteral feeding
4 g for enteral feeding
What if a pt recovering from trauma has a slightly negative N balance?
That’s okay for the short term, though ideally a positive N balance is best.
A 24 year old female is brought to the emergency room 20 minutes after sustaining multiple serious fractures in a car accident.
The patient’s blood glucose concentration is 180 mg/dL (normal 70-100 mg/dL).
What provides the carbon for the patient’s elevated blood glucose concentration?
Hepatic glycogenolysis
A 42 year old male is in the ICU following surgery to set a compound fracture in his leg. The patient is eating while he recovers. One day after surgery, four hours after his last meal, his blood glucose concentration is 165 mg/dL.
What explains the patient’s elevated blood glucose concentration?
Muscle proteolysis
Which of the markers below would decrease in a patient recovering from trauma if the patient were in negative nitrogen balance for a prolonged time?
Transthyretine
AST
ALT
