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Flashcards in Nutritional support in trauma Deck (30):
1

When does phase 1 occur? What is it? For how long?

2-6 hours after trauma, shock, for 24-48hrs

2

What does phase 1 involve release of?

Cortisol, catecholamines, cytokines

3

4 things that happen in phase 1

HR and respiratory rate increased, peripheral vasoconstriction, hypovolaemia

4

When does phase 2 happen, what is it called?

2 days after
Catabolic

5

3 things released in phase 2?

Cortisol (stimulated by ACTH)
Catecholamines
Glucagon

6

5 things that happen in phase 2

Increased O2 consumption
Increased metabolic rate
Increased glycolysis
Increased lipolysis
Negative nitrogen balance (muscle broken down to AAs)

7

Phase 3 name and when?

Anabolic, weeks after (or 3-8 days after minor surgery) lasts for a few weeks/months

8

4 things that happen in phase 3

Protein synthesis
Normal nitrogen balance
Fat stores
Muscle strength

9

10 affects of cytokines

chemotaxis
Vasodilation
cell adhesion proteins
catabolic (metabolic effect)
Acute phase proteins
T and B cell activation
Anorexia
Endocrine - stimualtes catabolism (catecholamines, cortisol, glucagon) and inhibits anabolism (GH and insulin decreased)
Fever
Fibroblast production

10

Brain obligate substrate?

Glucose

11

How many mins of circulatory failure can the brain survive?

2 mins

12

What does the CNS switch to metabolising in the absence of glucose?

Ketones

13

What do the kidneys and liver metabolise?

Fatty acids and AAs

14

What does skeletal muscle metabolise?

Fatty acids and glycogen stores

15

If glucose and O2 supply interrupted, what 3 stages of metabolism occur?

1. glycogenolysis (glycogen to glucose) max 24hrs
2. gluconeogenesis (muscle to AAs to glucose and lactate)
3. lipolysis and ketogenesis (free fatty acids to acetyl coA to ketones (acetoacetate and hydroxybutarate)

16

Ketosis causes

Diuresis

17

Aerobic resp 1 mol glucose --> ? mol ATP?

36

18

Anaerobic resp 1 mol glucose --> ? mol ATP?

2

19

In an anaerobic response what happens to pyruvate?

Reduced to lactate

20

What is lactate a marker of?

Low pH

21

Why proteolysis increased in trauma?

AAs needed to create inflammatory modulators and gluconeogenesis

22

What are markers of increased proteolysis?

Increased plasma ammonia, increased N2 loss in urine

23

Will adequate calories prevent muscle breakdown in trauma patients?

No, cytokine secretion stimulates muscle breakdown regardless

24

How might a trauma patient get pneumonia?

Muscle breakdown = respiratory muscle weakness

25

Increased lactate is a marker of?

Tissue hypoxia.
Also prognosis

26

What affect does immobilisation have on loss of substances?

Increases loss e.g. Ca, P, Mg

27

Is parenteral or gut-involved feeding better?

Gut

28

What is primary malnutrition?

Starvation or dietary deficiency of specific nutrients

29

What is secondary nutrition?

Nutrition present in adequate amounts but appetite suppressed/absorption failure/increased demand

30

What is refeeding syndrome?

Sudden change from catabolic to anabolic state, insulin produced which = cellular uptake of K+, P, Mg for glycogen, fat and protein synthesis. Results in serum electrolyte defecits e.g. hypokalaemia --> cardiac arrhythmia