Nutrition SDL #3: Metabolic Stress & Starvation Flashcards Preview

SMP - MNE Exam 1 > Nutrition SDL #3: Metabolic Stress & Starvation > Flashcards

Flashcards in Nutrition SDL #3: Metabolic Stress & Starvation Deck (67):
1

What are the risks of malnutrition in sick patients?

Slow recovery or worsened states

2

What are the 4 populations at risk for malnutrition upon admission?

1. Elderly
2. Chronically ill
3. Poor
4. Children

3

What are iatrogenic causes of malnutrition?

Malnutrition caused by medical staff (restrictive diets or fasting before procedures)

4

What should be done upon all admissions to the hospital?

ASSESS NUTRITIONAL STATUS

5

Stress causes the increased secretion of what 5 molecules?

1. Cytokines (TNF, ILs)
2. Catecholamines
3. Glucocorticoids
4. Glucagon
5. Insulin

6

What are the 2 types of cytokines?

1. Tumore Necrosis Factor (TNF)
2. Interleukin (IL-1)

7

What are the 7 effects of cytokines?

1. Increased NO
2. Fever
3. Proteolysis
4. Decreased albumin
5. Increased fibroblasts
6. Iron sequestration
7. Zinc liver uptake

8

What 3 micronutrients are required in larger amounts in sick patients?

1. Vitamin A
2. Zinc
3. Copper

9

What are the 2 phases of the stress response to trauma?

1. Ebb
2. Flow

10

How long does the Ebb phase last?

1-2 days post-injury

11

How long does the Flow phase last?

Many days post-injury

12

What happens during the Ebb phase?

Initial response to cytokines and stress hormones

13

What happens during the Flow phase?

Energy production is boosted and fuel is transferred from adipose tissue and muscles to liver and injury site
1. Proteolysis
2. Gluconeogenesis
3. FA beta oxidation
Catecholamine secretion decreases

14

What effect do the stress mediators have on insulin? What effect does this have on target tissues?

Cause insulin resistance to prevent glucose from being converted to glycogen, this impairs glucose transport to tissues so most of the glucose goes to the brain

15

Describe the stressed protein metabolism. 2 steps

1. Cytokines cause proteolysis of muscle and visceral organs
2. AAs go to liver to produce glucose and acute phase proteins

16

How is urine affected by stressed?

Increase nitrogen/urea in urine (but still a (-) NB)

17

Describe the stressed carb metabolism. 2 parts

1. Glycogen stores depleted faster
2. Protein gluconeogenesis

18

Describe the stressed lipid metabolism.

TAGs in adipose cells are broken down for FA beta oxidation in liver

19

How does stress affect ketogenesis?

It inhibits it in the fasted state

20

Why are plasma lipids higher during the stress response? 2 reasons

1. Lipolysis
2. Insulin resistance

21

What are 4 (and optional 2) questions to ask a patient to assess nutritional status?

1. Any food you can't or don't eat?
2. GI problems?
3. Take supplements?
PEDS:
4. Growth rate?
5. Formula or breast milk?

22

What to check during physical examination for malnutrition? 2 things

1. Hair plucking
2. Muscle wasting in temporal area, thighs, deltoids, interosseous muscles (fingers)

23

Describe the starvation carb metabolism. 3 steps

1. Glycogen stores depleted slower (12 hrs or less)
2. Protein gluconeogenesis
3. Ketogenesis

24

What is the effect of excess ketogenesis? What is the minimum daily carb intake to prevent this?

Ketoacidosis
> 100 g carbs/day/adult

25

What is the major fuel source during starvation?

Fats

26

What is the major fuel source during stress?

All of them!!!

27

Describe the starvation protein metabolism. 2 steps

1. Proteolysis of muscle and visceral organs
2. AAs go to liver to produce glucose and acute phase proteins
= SAME AS STRESSED METABOLISM

28

Describe the starvation fat metabolism.

TAGs in adipose cells are broken down for FA beta oxidation and ketogenesis in liver

29

Starvation causes the decreased secretion of what 2 molecules?

1. Insulin
2. THs

30

How is O2 consumption affected by stress and starvation?

Stress: increased
Starvation: decreased

31

Does short-term mobility causes changes in muscle mass?

Very little

32

What is the equation for nitrogen balance?

NB = nitrogen intake - nitrogen losses = N intake* - UUN - 3g OR 4g

* 1g protein = 0.16 g N
UUN = 24h urinary urea N
3g for parenteral / 4g for enteral

33

What is the nitrogen balance used for?

To determine adequate protein intake (equilibrium)

34

When is the NB (+)?

When lean body mass is growing

35

When is the NB (-)? 2 options

1. Inadequate protein intake
2. Excessive protein catabolism (eg: during stress)

36

Where is nitrogen lost? 5 places.

1. Urine
2. Feces
3. Skin
4. Sweat
5. Body fluids

37

Will stressed patients be able to attain a (+) NB?

Probably not, so the goal is to minimize losses

38

Is serum albumin a good indicator of nutrition status? Why/Why not?

NOPE because it changes in response to non-nutritional factors (eg: increase when dehydrated and decrease when over hydrated, liver/renal disease, protein-calorie malnutrition, malabsorption)

39

What plasma protein can help determine whether serum proteins are altered due to stress?

The C-reactive protein

40

How does kidney/liver failure affect protein metabolism?

Causes a decrease in tolerance of excess protein intake

41

What is the daily protein requirement for adults?

Male: 56 g
Female: 46 g

42

What are the 7 factors that affect daily protein requirements?

1. Lean body mass
2. Growth/weight gain
3. Rate of protein loss
4. Quality of protein source
5. Metabolic stress
6. Lifecycle stage
7. Activity level

43

What does the quality of a protein source depend on?

Ratio of essential over non-essential AAs

44

How does starvation affect nitrogen losses?

Decreases because less proteins are used for gluconeogenesis

45

What is the protein requirement per kg per day for healthy people?

0.8 g/kg/day

46

What is the protein requirement per kg per day for sick people?

1.2-3 g/kg/day

47

Should protein and calorie intake be considered together for sick patients?

NOPE

48

Can we make essential AAs from non-essential AAs?

NOPE

49

What are the 10 essential AAs (meaning we cannot make them)?

I Want To Kill VHRs. FML

50

What are the 3 conditional essential AAs? What does it mean to be conditionally essential?

Cys
Gly
Tyr
Means they might need to be ingested when synthesis cannot meet needs

51

What kinds of fats are directly absorbed by the intestine and which ones need to be transported? By what?

Monoglycerides and short/medium FAs can go through
Long chain AAs need to be transported by carnitine

52

How many Cs in short FAs?

2-6 Cs

53

How many Cs in medium FAs?

8-12 Cs

54

How many Cs in long FAs?

>= 14 Cs

55

How are the long chain FAs transported to target tissues?

Chylomicrons in lymph or blood

56

How are the short chain FAs transported to target tissues?

Free or albumin-bound in blood

57

What are the only 2 FAs that MUST come from the diet?

Omega 3 and 6 FAs

58

What are the 4 signs of inadequate intake of omega 3 and 6 FAs?

1. Scaly skin lesions
2. Alopecia
3. Decreased # of platelets
4. Poor wound healing

59

What is a subpop of patients that are at higher risk for omega 3 and 6 deficiency?

Parenterally fed patients

60

How will the fasting range of lipids be affected by IV lipid administration?

Slightly above normal

61

Why would it mean for a patient to have several times higher fasting range of lipids?

Pancreatic disease

62

What are eicosanoids derived from?

Omega 3 and 6 FAs

63

What are the 3 forms of omega 3 eicosanoids?

1. alpha-linoleic acid
2. Eicosapentaenoic acid
3. Docosahexaenoic acid

64

What are the 3 forms of omega 6 eicosanoids?

1. Linoleic acid
2. Arachidonic acid
3. gamma-linoleic

65

What are the main 3 differences between omega 3 and omega 6 eicosanoids?

1. Omega 3 more vasconstrictive
2. Omega 6 more immunosuppressive
3. Omega 6 induce platelet aggregation

66

In someone who in decreasing fat intake what would be important to monitor?

omega-3 and omega-6 FA deficiency

67

A critically ill patient with extensive burns may need more than twice the RDA for protein: T or F?

True!!