Nutritional support in Trauma Flashcards Preview

Clinical Pathology > Nutritional support in Trauma > Flashcards

Flashcards in Nutritional support in Trauma Deck (36)
Loading flashcards...

What is Trauma?

Injury/would caused by an extrinsic agent


What are the immediate possible outcomes of trauma?

Intravascular/extravascualr fluid loss

Obstructed or impaired breathing

Tissue destruction


What are the later possible outcome son trauma?



If you survive initial blood loss/head injury, what other conditions can potentially kill you?

Acute respiratory distress syndrome - weakness of resp muscles

Multi organ failure

Nutrition can prevent this!


What is haematological shock?

Disruption to supply of substrates to cell e.g. O2, glucose, lipids, AA, H2O

Disruption ot removal of metabolites e.g. CO2, H2O, free radicals, toxic metabolites


What are the 3 phases following trauma?

1. Clinical shock (haematological)

2. (if spontaneous recovery/intervention) Hypercatabolic state

3. Recovery phase (anabolic state)


When and for how long does phase I last for?

Starts 2-6 hrs following injury

Lasts 24-48 hrs


What are the clinical characteristics of phase I? What cause these?

Increased HR, RR, peripheral vasoconstriction

Increased catecholamine, cortisol and cytokine secretion


What are the main aims in phase I

Stop bleeding and prevent infection


When does Phase II occur ?

Approx 2 days after injury


What are the characteristics of phase II? What cause these?

Increased metabolic rate and oxygen consumption

- Increased negative nitrogen balance (increased skeletal muscle breakdown and increased AA)
- increased lipolysis and glycolysis

- due to catecholamine, glucagon and ACTH to cortisol secretion


What are the primary clinical aims of phase II?

-Prevent sepsis
-Provide adequate nutrition


When does phase 3 occur? How long for?

Between 3-8 days following trauma

May last weeks!


What are the clinical characteristics of phase 3?

Anabolic state
- coincides with diuresis and request for food/drink

- Restoration of body protein synthesis, normal nitrogen balance, fat stores, muscle strength


What are the clinical aims of phase 3?

Adequate nutrition = key

- avoid referring syndrome


What is the obesity paradox?

Those who are more obese are likely to recover from trauma quicker


What can the inflammatory response at the trauma site cause? what is its effect?

Systemic capillary leak

Loss of H2N NaCl, Albumin, and energy substrates


What are the 3 main cytokines involved in the inflammatory response?

IL-1, IL-6, TNF alpha


What are the effects of the cytokines in the inflammatory response?

Local effects - chemotaxis, vasodilation, cell adhesion

- metabolic effects ( catabolic)

- endocrine effects (catabolic/anabolic states)


T cell activation and B cell proliferation


What are the endocrine effects of cytokines?

Up-regulation of catabolic hormones (ACTH and cortisol), catecholamines, glucagon

Down regulation of anabolic hormones (insulin and GH)


What is glucogenolysis?

Glycogen breakdown to glucose


What is gluneogdnesis?

Glucose generation from skeletal and secreted protein breakdown

Not very efficient!

Produce lactate, loss of skeletal muscle and nitrogen loss


What is lipolysis and ketoacidosis?

FFA > acetyl CoA . acetoacetate + hydroxybutyrate


When/why is lipolysis and ketogenesis used?

Gradual change from gluconeogenesis to ketone metabolism to spare protein/skeletal muscle loss


How does hypoxia result in increased cell death?

Increased use of anaerobic metabolism (only 2ATP generated and lactic acid produced)

- Cell death results from metabolic acidosis (LA) and metabolic failure (insufficient energy provided)


There is a protein synthesis/proteolysis imbalance with trauma. Why is this?

Reduced synthesis of new protein - use to generate proteins important for inflammation e.g. CRP, haptoglobin, clotting factors

Increased proteolysis
- increased free AA; gluconeogenesis and inflammatory protein synthesis
- increased plasma albumin
- increased nitrogen loss


Protein turnover - what i the difference between starvation and sepsis?

Starvation - administration of CHO/fats will stop muscle wasting

Sepsis - cytokines (from macrophages) stimulate protein breakdown (not energy deficit), resulting in increased proteolysis of essential structural/secreted proteins (life threatening e.g. resp muscles)


What blood marker, resulting from anaerobic metabolism, can be used as a prognostic marker of trauma?

Blood lactate


What is the difference between primary and secondary malnutrition?

PRIMARY - Protein-calorie malnutrition, dietary deficiency of specific nutrients e.g. vitamins, trace elements

SECONDARY - adequate nutrition but inadequate absorption, appetite, utilisation
- increased demands not met by intake


What are the consequences of malnutrition?

Negative nitrogen balance
Muscle wasting
Cellular dysfunction

Decks in Clinical Pathology Class (50):