The metabolically stressed patient Flashcards
Where does the duration and severity of metabolic responses depend on?
- Degree of insult
- Persistence of insult
- Host response
- Nutritional status of host
- Timing in relation to previous insults
What are the local stress responses?
Collagen synthesis
Matrix Protein Synthesis
Wound Repair
What are the local systemic responses?
- Altered protein synthesis
- Increase oxide synthase
- Increased Leucocyte endothelial cell adhesion molecules
What are the phases to Stress response?
Ebb phase
Acute or Flow phrase
When does the EBB phase occur?
Immediately after injury
How long does the EBB phase lasts ?
24-48 hours
True or False? In the EBB phase of Stress response there is Hypervolemia and Hypermetabolism.
FALSE!! There is HYPOvolemia & HYPOmertabolism
True or False? During the Acute or Flow phase there is Hypermetabolosum which leads to and Increase in REE, Temperature Catabolism , Oxygen consumption and Cardiac Output.
TRUE !!
What is the Acute or Flow Phase of the Stress response mediated by?
It is mediated by cytokines, hormones & afferent nervous signals from injured tissues.
How long does the acute pr flow phase of the stress response last?
7-10 days
On what days is there a peak in the Acute or Flow phase of the stress response?
Peak Day 3-4
What is the fuel source for the CNS along with the wound and immune system?
Glucose
What is the energy source for cardiac and skeletal muscle, liver and many other tissues?
Fatty acids
What is the source for Gluconeogenesis, majority for the synthesis of APP, Thermogenesis and precursors for tissue repair?
Amino acids
What are the counter- regulatory hormones of the Stress response?
The fight or flight hormones
Which hormone stimulates lipolysis?
Cortisol & Catecholamines
What are hormone regulators of the immune system?
Cytokines
Fill in the blanks. “ ___________ is a key mediator of APP.”
IL- 1
Which cytokine activates the hypothalamic-pituitary - adrenal axis?
TNF
Which substances are released when IL- 6 is activated?
Hepatic APP
CRP
Fibronectin
Antitrypsin
Ceruloplasmin
1- acid Glycoprotein
True or False? The Resting Energy Expenditure (REE) is decreased initially but then increased in the Acute or Flow phase.
TRUE!!
During Carbohydrate metabolism , after glycogen stores become depleted 12-24 hours , what becomes the Major source of oxidative energy?
Endogenous Lipids ( espc TG)
What is a characteristic finding of stress?
Hyperglycemia
What is the maximum rate of glucose oxidation in metabolically stressed adults?
4- 6 mg/kg/min
What happens if the Glucose oxidation in metabolically stressed adults is over its maximum rate?
This results in
- Hyperglycemia
- Hepatic steatosis
- Lipogenesis
True or False? In relation to protein metabolism during stress, Positive APP production is increased and the production of hepatic ally synthesised proteins such as albumin , transthyretin is increased also.
FALSE!! Albumin & Transthyretin is REDUCED!
What are the effects of prolonged catabolism of skeletal muscle protein?
- It compromises respiratory function
- Impairs wound healing
- Exacerbates immunosuppression
- Accelerates the loss of strength & endurance necessary for recovery.
- Increase risk of death
True or False? During stress, there is a increased rate of fatty acid oxidation as a result of increases lipolysis.
TRUE!!
What happens to the fluid & electrolyte homeostasis during stress?
Positive water balance
Weight gain
Positive sodium balance
Fluid retention (extravascular space )
True or False? In an critical illness , the ketone utilisation is Increased.
FALSE! It is Reduced !!
True or False? The Energy expenditure is measured by direct calorimetry.
FALSE!! It is measured by INDIRECT Calorimetry
What is the normal Glucose Infusion Rate?
It is less than or equal to 5 mg/kg/min
What is the normal protein intake ?
15-20% of total nutrient intake or 1.5 -2.0 g/kg/d
What are examples of complications of Intralipids ?
Hyperlipidemia
Coagulopathies
Impaired immune function
What are the most common nutrients in currently enteral immune- modulating formulas?
Mega - 3 fatty acids ( EPA, DHA)
Nucleotides
Arginine
Antixoidants
Glutamine
Which substance is the primary oxidative fuel for small bowel mucous, lymphocytes ¯ophages?
Glutamine
Which substance enhances phagocytosis , protein synthesis and production of Nitric Oxide?
Arginine
Fill in the blanks. “ ___________ enhances humeral immunity & macrophage activity.”
Nucleotides
