The metabolically stressed patient

Question 1

Where does the duration and severity of metabolic responses depend on?

Answer 1

1. Degree of insult
2. Persistence of insult
3. Host response
4. Nutritional status of host
5. Timing in relation to previous insults

Question 2

What are the local stress responses?

Answer 2

Collagen synthesis
Matrix Protein Synthesis
Wound Repair

Question 3

What are the local systemic responses?

Answer 3

• Altered protein synthesis
• Increase oxide synthase
• Increased Leucocyte endothelial cell adhesion molecules

Question 4

What are the phases to Stress response?

Answer 4

Ebb phase
Acute or Flow phrase

Question 5

When does the EBB phase occur?

Answer 5

Immediately after injury

Question 6

How long does the EBB phase lasts ?

Answer 6

24-48 hours

Question 7

True or False? In the EBB phase of Stress response there is Hypervolemia and Hypermetabolism.

Answer 7

FALSE!! There is HYPOvolemia & HYPOmertabolism

Question 8

True or False? During the Acute or Flow phase there is Hypermetabolosum which leads to and Increase in REE, Temperature Catabolism , Oxygen consumption and Cardiac Output.

Answer 8

TRUE !!

Question 9

What is the Acute or Flow Phase of the Stress response mediated by?

Answer 9

It is mediated by cytokines, hormones & afferent nervous signals from injured tissues.

Question 10

How long does the acute pr flow phase of the stress response last?

Answer 10

7-10 days

Question 11

On what days is there a peak in the Acute or Flow phase of the stress response?

Answer 11

Peak Day 3-4

Question 12

What is the fuel source for the CNS along with the wound and immune system?

Answer 12

Glucose

Question 13

What is the energy source for cardiac and skeletal muscle, liver and many other tissues?

Answer 13

Fatty acids

Question 14

What is the source for Gluconeogenesis, majority for the synthesis of APP, Thermogenesis and precursors for tissue repair?

Answer 14

Amino acids

Question 15

What are the counter- regulatory hormones of the Stress response?

Answer 15

The fight or flight hormones

Question 16

Which hormone stimulates lipolysis?

Answer 16

Cortisol & Catecholamines

Question 17

What are hormone regulators of the immune system?

Answer 17

Cytokines

Question 18

Fill in the blanks. “ ___________ is a key mediator of APP.”

Answer 18

IL- 1

Question 19

Which cytokine activates the hypothalamic-pituitary - adrenal axis?

Answer 19

TNF

Question 20

Which substances are released when IL- 6 is activated?

Answer 20

Hepatic APP
CRP
Fibronectin
Antitrypsin
Ceruloplasmin
1- acid Glycoprotein

Question 21

True or False? The Resting Energy Expenditure (REE) is decreased initially but then increased in the Acute or Flow phase.

Answer 21

TRUE!!

Question 22

During Carbohydrate metabolism , after glycogen stores become depleted 12-24 hours , what becomes the Major source of oxidative energy?

Answer 22

Endogenous Lipids ( espc TG)

Question 23

What is a characteristic finding of stress?

Answer 23

Hyperglycemia

Question 24

What is the maximum rate of glucose oxidation in metabolically stressed adults?

Answer 24

4- 6 mg/kg/min

Question 25

What happens if the Glucose oxidation in metabolically stressed adults is over its maximum rate?

Answer 25

This results in - Hyperglycemia - Hepatic steatosis - Lipogenesis

Question 26

True or False? In relation to protein metabolism during stress, Positive APP production is increased and the production of hepatic ally synthesised proteins such as albumin , transthyretin is increased also.

Answer 26

FALSE!! Albumin & Transthyretin is REDUCED!

Question 27

What are the effects of prolonged catabolism of skeletal muscle protein?

Answer 27

- It compromises respiratory function - Impairs wound healing - Exacerbates immunosuppression - Accelerates the loss of strength & endurance necessary for recovery. - Increase risk of death

Question 28

True or False? During stress, there is a increased rate of fatty acid oxidation as a result of increases lipolysis.

Answer 28

TRUE!!

Question 29

What happens to the fluid & electrolyte homeostasis during stress?

Answer 29

Positive water balance Weight gain Positive sodium balance Fluid retention (extravascular space )

Question 30

True or False? In an critical illness , the ketone utilisation is Increased.

Answer 30

FALSE! It is Reduced !!

Question 31

True or False? The Energy expenditure is measured by direct calorimetry.

Answer 31

FALSE!! It is measured by INDIRECT Calorimetry

Question 32

What is the normal Glucose Infusion Rate?

Answer 32

It is less than or equal to 5 mg/kg/min

Question 33

What is the normal protein intake ?

Answer 33

15-20% of total nutrient intake or 1.5 -2.0 g/kg/d

Question 34

What are examples of complications of Intralipids ?

Answer 34

Hyperlipidemia Coagulopathies Impaired immune function

Question 35

What are the most common nutrients in currently enteral immune- modulating formulas?

Answer 35

Mega - 3 fatty acids ( EPA, DHA) Nucleotides Arginine Antixoidants Glutamine

Question 36

Which substance is the primary oxidative fuel for small bowel mucous, lymphocytes ¯ophages?

Answer 36

Glutamine

Question 37

Which substance enhances phagocytosis , protein synthesis and production of Nitric Oxide?

Answer 37

Arginine

Question 38

Fill in the blanks. " ___________ enhances humeral immunity & macrophage activity."

Answer 38

Nucleotides