MNT for Metabolic Stress, Sepsis, Trauma, Burns, and Surgery Flashcards Preview

MNT II > MNT for Metabolic Stress, Sepsis, Trauma, Burns, and Surgery > Flashcards

Flashcards in MNT for Metabolic Stress, Sepsis, Trauma, Burns, and Surgery Deck (25):
1

Metabolic Stress

-Sepsis
-Trauma
-Surgery: systemic response is activated, physiologic and metabolic changes follow and may lead to shock and/or other negative outcomes

2

Metabolic Response to Stress

Involves most metabolic pathways. Rapid loss of LBM results in:
-negative nitrogen balance
-muscle wasting

3

Ebb Phase

-Immediate- hypovolemia, shock, tissue hypoxia
-Decreased cardiac output
-Decreased oxygen consumption
-Lowered body temperature
-Insulin levels drop because glucagon is elevated

4

Flow Phase

-Follows fluid resuscitation and O2 transport
-Increased cardiac output begins
-Increased body temperature
-Increased energy expenditure
-Total body protein catabolism begins
-Marked increase in glucose productions, FFAs, circulating insulin, glucagon, and cortisol

5

Hormonal and Cell-Mediated Response

There is a marked increase in glucose production and uptake secondary to gluconeogenesis, and:
-elevated hormonal levels
-marked increase in hepatic amino acid uptake
-protein synthesis
-accelerated muscle breakdown

6

Starvation vs Stress

Metabolic response to stress differs from the responses to starvation.

7

Starvation

Decreased energy expenditure, use of alternative fuels, decreased protein wasting, stored glycogen used in 24 hours.

8

Late Starvation

Fatty acids, ketones, and glycerol provide energy for all tissues except brain, nervous system, and RBCs.

9

Hormonal Stress Response

-Aldosterone
-Antidiuretic Hormone (ADH)
-ACTH
-Catecholamines

10

Aldosterone

Corticosteroid that causes renal sodium retention.

11

Antidiuretic Hormone (ADH)

Stimulates renal tubular water absorption. These conserve water and salt to support circulating blood volume.

12

ACTH

Acts on adrenal cortex to release cortisol (mobilizes amino acids from skeletal muscles).

13

Catecholamines

Epinephrine and norepinephrine from renal medulla to stimulate hepatic glycogenolysis, fat mobilization, and gluconeogenesis.

14

Cytokines

-Interleukin 1
-Interleukin 6
-Tumor necrosis factor (TNF)
Released by phagocytes in response to tissue damage, infection inflammation, and some drugs and chemicals.

15

Interleukin 1

Metabolic effect that increases body temperature.

16

Interleukin 6

Metabolic effect that activates and release of cellular communication and mediators.

17

Tumor Necrosis Factor (TNF)

Metabolic effect that alters metabolism: catabolism and hypermetabolism.

18

Systemic Inflammatory Response Syndrome (SIRS)

Describes the inflammatory response that occurs in infection, pancreatitis, ischemia, burns, multiple trauma, shock and organ injury. Pts with SIRS are hypermetabolic.

19

Multiple Organ Dysfunction Syndrome

Organ dysfunction that results from direct injury, trauma, or disease or as a response to inflammation; the response usually is in an organ distant from the original site of infection or injury.

20

Diagnosis of Systemic Inflammatory

Site of infection established and at least two of the following are present:
-Temp >38 or 90
-Respiratory rate >20
-PaCO2 12,000/mm3 or <4,000/mm3
-Bandemia
May be caused by bacterial translocation

21

Bandemia

Presence of >10% bands (immature neutrophils) in the absence of chemotherapy-induced neutropenia and leukopenia

22

Bacterial Translocation

Changes from acute insult to the gastrointestinal tract that may allow entry of bacteria from the gut lumen into the body; associated with a systemic inflammatory response that may contribute to multiple organ dysfunction syndrome. Well documented in animals, may not occur to the same extent in humans. Early enteral feeding is thought to prevent.

23

Postoperative Nutrition Support

-Introduction of solid foods depends on condition of GI
-Oral feedings may be delayed for first 24-48 hours post surgery until return of bowel sounds, passage of flatus or soft abdomen
-Traditional practice has been to progress from clear liquids, to full liquids, and then to solid foods. However, there is no physiological reason not to initiate solid foods once small amounts of liquids are tolerated.

24

Hypocaloric Feedings Have Been Recommended In:

-Class III obesity (BMI >40)
-Refeeding syndrome
-Severe malnutrition
-trauma pts following shock resuscitation
-Hemodynamic instability
-Acute respiratory distress syndrome or COPD
-MODS, SIRS, or sepsis

25

Protein and Nitrogen Requirements in Surgery

1.2 to 1.5 g/kg of protein a day of CBW for anabolism mild or moderate stress.
Nitrogen requirements estimated from energy requirements.