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AAA-MEDICAL NUTRITION > NUTRITION IN SEPSIS (AB) > Flashcards

NUTRITION IN SEPSIS (AB) Flashcards

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1
Q

What defines sepsis?

A

Life-threatening organ dysfunction caused by a dysregulated host response to infection.

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2
Q

What are early metabolic features of sepsis?

A

Massive catabolism. Lean body mass loss. Escalating hypermetabolism.

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3
Q

How long can recovery from sepsis take?

A

Up to two years.

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4
Q

What is the early nutrition goal in sepsis?

A

Correct micronutrient deficiencies. Deliver adequate protein and moderated non-protein calories.

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5
Q

What is the protein requirement post-resuscitation in sepsis?

A

1.5 to 2.0 g/kg/day.

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6
Q

When is parenteral nutrition added in sepsis?

A

When enteral nutrition is failing based on pre-illness malnutrition.

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7
Q

What is ICU-acquired weakness (ICU-AW)?

A

Clinically detected weakness in critically ill patients due to critical illness itself.

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8
Q

What are energy stores mobilized during sepsis?

A

Muscle for protein. Glycogen for glucose. Lipid for fat.

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9
Q

What syndrome results from rapid LBM loss in ICU patients?

A

ICU-acquired weakness (ICU-AW) or Post-ICU syndrome (PICS).

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10
Q

What are key features of critical illness myopathy (CIM)?

A

Severe muscle atrophy. Preferential myosin loss. Sarcomere disorganization. Electrical hypoexcitability.

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11
Q

How much LBM can critically ill burn patients lose daily?

A

Up to 1 kilogram per day.

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12
Q

How long can hypermetabolism persist after critical illness?

A

Up to two years.

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13
Q

What are the three phases of catabolism in sepsis?

A

Acute. Chronic. Recovery.

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14
Q

During the acute phase of sepsis, what is the non-protein calorie requirement?

A

15 kcal/kg/day.

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15
Q

What is the initial protein requirement during the acute phase of sepsis?

A

Approximately 0.5 g/kg/day increasing to 1.0 g/kg/day.

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16
Q

What is the protein requirement during the recovery phase?

A

At least 2 g/kg/day.

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17
Q

Which energy processes are active in early sepsis?

A

Gluconeogenesis. Glycogenolysis. Lipolysis.

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18
Q

What causes hyperglycemia in sepsis?

A

Insulin resistance and high hepatic glucose production.

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19
Q

What is the early protein target in septic ICU patients?

A

Approximately 1.0 g/kg/day.

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20
Q

Why avoid very high protein (>1.2-1.5 g/kg/day) early in sepsis?

A

Risk of impaired autophagy.

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21
Q

When should parenteral nutrition be started in malnourished ICU patients?

A

At ICU admission.

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22
Q

What is the thiamine dose recommendation for septic shock patients?

A

200 mg IV thiamine daily for 7 days.

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23
Q

What percentage of septic shock patients are thiamine deficient?

A

Approximately 35%.

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24
Q

Does TPN increase infection risk compared to EN?

A

No.

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25
What improves infection control in TPN use?
Better glucose control. Improved line care. Balanced lipid formulations.
26
What kind of lipid formulations are preferred in TPN?
Balanced or non-pure soy-based lipid formulations.
27
In the first 2-5 days of sepsis, what are typical REE and TEE?
REE ~1850 kcal/day. TEE ~1920 kcal/day.
28
What is the ideal non-protein calorie intake in early sepsis?
~15 kcal/kg/day.
29
What is trophic feeding in early sepsis?
10-20 kcal/hour up to 500 kcal/day.
30
When is aggressive feeding started after trophic feeds?
After 24-48 hours if tolerated.
31
What protein intake is needed during chronic phase post-resuscitation?
1.2 to 2.0 g/kg/day.
32
What calorie intake is targeted during chronic phase?
25 to 30 kcal/kg/day.
33
What mortality risk is associated with poor nutrition in ICU?
Increased mortality if <50% predicted needs are met.
34
What happens to TEE during recovery from critical illness?
TEE increases up to 1.7-fold above REE.
35
By the second week post-sepsis, what is the typical TEE?
~3250 kcal/day or 47 kcal/kg/day.
36
What study emphasized the need for nutrition during ICU recovery?
Minnesota Starvation Study.
37
What is the recommended protein intake for enteral nutrition in the chronic and recovery phase of sepsis?
1.2–2.0 g/kg/d
38
How many nonprotein kcal/kg/day are recommended for enteral nutrition in sepsis recovery?
25–30 kcal/kg/d
39
Why is increased kcal and protein delivery needed during the recovery phase of sepsis?
To prevent ongoing lean body mass wasting. weakness. and infections to improve recovery
40
What historical study showed >4000 kcal/day required for recovery?
Minnesota Starvation Study
41
When should parenteral nutrition be delayed in well-nourished sepsis patients?
Until day 3–7 if <60% EN protein/kcal goal is reached
42
When should parenteral nutrition be initiated in malnourished ICU patients?
At ICU admission
43
What is the protein goal for parenteral nutrition in sepsis?
Approximately 1.2 g/kg/d
44
Does TPN increase the risk of infection compared to EN?
No
45
What is the recommended frequency of high-protein oral nutrition supplements when oral intake is initiated?
2–3 times daily
46
What is the rationale for providing oral nutrition supplements to ICU patients?
Oral intake is exceedingly poor and supplements reduce mortality. complications. length of stay. and hospital costs
47
What level of Vitamin D warrants supplementation in ICU patients?
Vitamin D level <20 ng/ml
48
How should Vitamin D be supplemented in deficient ICU patients?
100.000 units of Vitamin D2 or D3 for 5 days. then 1–2x weekly with monitoring
49
What type of lipid solution is recommended for TPN in sepsis?
Balanced lipid solutions containing fish oil and/or olive oil
50
Why should pure soy lipid not be used for TPN in sepsis?
Soy lipids are immune suppressive. associated with increased infections and length of stay. and increase cholestasis risk
51
When should glutamine supplementation be avoided?
During early shock. while on vasopressors. or in renal failure
52
What is the safe dose of parenteral glutamine?
<0.35 g/kg/day
53
What is the average caloric intake over the first 12 days in ICU worldwide?
1034 kcal/day
54
What is the average protein intake over the first 12 days in ICU worldwide?
47 g/day or approximately 0.6 g/kg/day
55
What is the protein goal post-hospital discharge in sepsis patients?
1.2–2.0 g/kg/day
56
What is the kcal goal post-hospital discharge based on the Minnesota Starvation Study?
4000–5000 kcal/day
57
How long should high-protein oral nutrition supplements be continued post discharge?
3 months to 1 year
58
How much spontaneous calorie intake was observed in the week after extubation?
Approximately 700 kcal/day
59
What electrolyte abnormalities must be monitored for refeeding syndrome?
Phosphate. potassium. and magnesium
60
What essential vitamin plays a key role in the Krebs cycle and pentose phosphate pathway?
Thiamine
61
What vitamin deficiency occurs in up to 35% of septic shock patients?
Thiamine deficiency
62
What effect does thiamine supplementation have in septic shock?
Reduces mortality when combined with vitamin C and low-dose steroids
63
What is the role of vitamin C in burn patients?
Reduces fluid leak from interstitial and extracellular spaces
64
What is the recommended high-dose Vitamin D supplementation for ICU patients with levels <12 ng/ml?
Single 540.000 IU followed by 90.000 IU monthly for 5 months
65
What is glutamine’s status in critically ill patients receiving TPN?
Supplementation is considered beneficial if not in shock or renal failure
66
What is the benefit of fish oil in critically ill patients?
Significantly reduces infections
67
When should enteral nutrition be initiated in septic shock patients according to the Surviving Sepsis Guidelines 2021?
Within 72 hours
68
What are the physiologic advantages of early enteral nutrition in sepsis?
Maintenance of gut integrity. dampening of inflammatory response. modulation of metabolic responses to reduce insulin resistance

AAA-MEDICAL NUTRITION (10 decks)

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