The document discusses metabolic stress that occurs in critically ill patients. It describes the ebb and flow phases of the metabolic response to stress or injury. In the ebb phase, metabolic rate decreases as the body shuts down in response to trauma or infection. In the flow phase, metabolism increases as the body enters an acute response with catabolism predominating. This is followed by an adaptive response where anabolism predominates as the body recovers. The document outlines the hormonal and metabolic changes that occur during stress, including increases in energy expenditure, protein breakdown, and impaired fuel utilization. It provides recommendations for nutritional support and assessment of critically ill patients experiencing metabolic stress.
MEDICAL NUTRITION THERAPY FOR METABOLIC STRESSDewi Sophia
This document discusses various topics related to nutrition support for critically ill patients. It covers causes of injury and metabolic stress, phases of the stress response, differences between starvation and stress-induced metabolic changes, major causes of death, and considerations for providing nutrition support to critically ill patients with conditions like infection, trauma, burns, and obesity or undergoing surgery. Key points emphasized include the importance of early initiation of nutrition support to minimize complications, meeting calorie and protein needs while avoiding overfeeding, and managing fluid, electrolytes and glycemic control.
This document discusses glycemic index (GI), a measure of how foods affect blood glucose levels. It provides details on GI determination, factors that influence GI values, benefits of a low GI diet, and recommendations. Specifically, it finds that a low GI diet is associated with lower blood glucose and HbA1c levels, improved lipid profiles, weight control, and decreased risk of heart disease and diabetes. The take home message encourages choosing high-fiber whole grains and fruits/veggies while limiting refined sugars and large portions of high GI foods.
The document discusses nutrition and HIV/AIDS. It notes that adequate nutrition is important for health for all individuals, including those with HIV/AIDS, but that HIV and malnutrition are interconnected - HIV can cause malnutrition and malnutrition can worsen HIV. Good nutrition can help manage HIV symptoms and reduce susceptibility to opportunistic infections. The document outlines recommendations for nutritional assessments and counseling for people living with HIV/AIDS.
This document discusses the relationship between HIV/AIDS and nutrition. It notes that HIV contributes to and is affected by nutritional status, and that malnutrition increases the severity of HIV/AIDS. Poor nutrition can accelerate the progression of the disease and reduce the effectiveness of medications. The document recommends that people with HIV/AIDS consume a diet that is higher in calories, protein, and micronutrients in order to support the immune system and increase quality of life. Regular nutritional assessments and customized diets are important for managing the disease.
The document discusses liver disease and nutrition. It begins by reviewing the functions of the liver and various liver diseases. It then discusses nutritional features of end-stage liver disease and nutritional assessment and management guidelines. Specific topics covered include neurological symptoms associated with liver disease, nutritional assessment tools for patients with end-stage liver disease, daily energy expenditure calculation methods, progression of liver disease, and ESPEN guidelines on enteral and parenteral nutrition for various liver diseases.
Nutrition in Acute Pancreatitis (According to ESPEN guidelines 2002 and ACG g...Jibran Mohsin
This presentation compares the European Society of Parenteral & Enteral Nutrition (ESPEN) 2002 guidelines and American College of Gastroenterology (ACG) 2013 guidelines regarding nutrition in patients of acute pancreatitis
MEDICAL NUTRITION THERAPY FOR METABOLIC STRESSDewi Sophia
This document discusses various topics related to nutrition support for critically ill patients. It covers causes of injury and metabolic stress, phases of the stress response, differences between starvation and stress-induced metabolic changes, major causes of death, and considerations for providing nutrition support to critically ill patients with conditions like infection, trauma, burns, and obesity or undergoing surgery. Key points emphasized include the importance of early initiation of nutrition support to minimize complications, meeting calorie and protein needs while avoiding overfeeding, and managing fluid, electrolytes and glycemic control.
This document discusses glycemic index (GI), a measure of how foods affect blood glucose levels. It provides details on GI determination, factors that influence GI values, benefits of a low GI diet, and recommendations. Specifically, it finds that a low GI diet is associated with lower blood glucose and HbA1c levels, improved lipid profiles, weight control, and decreased risk of heart disease and diabetes. The take home message encourages choosing high-fiber whole grains and fruits/veggies while limiting refined sugars and large portions of high GI foods.
The document discusses nutrition and HIV/AIDS. It notes that adequate nutrition is important for health for all individuals, including those with HIV/AIDS, but that HIV and malnutrition are interconnected - HIV can cause malnutrition and malnutrition can worsen HIV. Good nutrition can help manage HIV symptoms and reduce susceptibility to opportunistic infections. The document outlines recommendations for nutritional assessments and counseling for people living with HIV/AIDS.
This document discusses the relationship between HIV/AIDS and nutrition. It notes that HIV contributes to and is affected by nutritional status, and that malnutrition increases the severity of HIV/AIDS. Poor nutrition can accelerate the progression of the disease and reduce the effectiveness of medications. The document recommends that people with HIV/AIDS consume a diet that is higher in calories, protein, and micronutrients in order to support the immune system and increase quality of life. Regular nutritional assessments and customized diets are important for managing the disease.
The document discusses liver disease and nutrition. It begins by reviewing the functions of the liver and various liver diseases. It then discusses nutritional features of end-stage liver disease and nutritional assessment and management guidelines. Specific topics covered include neurological symptoms associated with liver disease, nutritional assessment tools for patients with end-stage liver disease, daily energy expenditure calculation methods, progression of liver disease, and ESPEN guidelines on enteral and parenteral nutrition for various liver diseases.
Nutrition in Acute Pancreatitis (According to ESPEN guidelines 2002 and ACG g...Jibran Mohsin
This presentation compares the European Society of Parenteral & Enteral Nutrition (ESPEN) 2002 guidelines and American College of Gastroenterology (ACG) 2013 guidelines regarding nutrition in patients of acute pancreatitis
1) Cancer is a leading cause of death globally and in Kenya, responsible for 13% and 7% of total annual mortality respectively.
2) The most common cancers in Kenya are breast, cervical, and prostate cancers. Cancer incidence is rising, with over 28,000 new cases and 22,000 deaths annually in Kenya.
3) Nutrition and lifestyle factors like diet, physical activity, alcohol consumption, and obesity are strongly linked to cancer risk. Maintaining a healthy weight, eating mostly plant-based foods, limiting red meat and alcohol, and staying physically active can help prevent cancer.
Diet treatment in liver cirrhosis - di Vincenzo Ostilio PalmieriMedOliveOil
Dieta nella cirrosi epatica - di Vincenzo Ostilio Palmieri. 21 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
This document discusses nutritional assessment and management in surgical patients. It begins with an outline of the topics to be covered, including nutritional assessment, requirements, interventions, and disease-specific nutrition. Various methods of nutritional assessment are described, such as clinical history, physical exam, laboratory tests, and calculations of energy expenditure. Enteral and parenteral nutrition are presented as interventions, with details on their indications, delivery methods, and complications. The goal of nutritional support is to meet metabolic needs in patients who cannot maintain adequate intake orally.
Presentation gives an overview of the inter-relationship between nutrition and pharmacy. Its importance is an imperative consideration in patient care. The presentation begins with an introduction to both areas but then focuses on specific drug-nutrient interactions with specific drug categories.
This document provides an overview of nutrition in surgical patients. It discusses the basics of nutrition including caloric and protein requirements. The importance of nutrition for surgical patients is described along with the complications of malnutrition like infection and poor wound healing. Methods of nutritional assessment involving history, exams, and labs are outlined. Both enteral and parenteral nutrition are covered, including indications, contraindications, administration methods, and potential complications. The take home messages emphasize the importance of meeting caloric needs to avoid complications, using enteral nutrition when possible, and closely monitoring patients on nutrition support.
Nutritional assessment in chronic liver diseaseShaimaa Elkholy
Protein Energy Malnutrition (PEM) is highly prevalent among patients with chronic liver disease. One of the problems is how to assess these patients nutritionally. yet no standard golden rule for their nutritional assessment.
Daily minimum nutritional requirements of the critically illRalekeOkoye
The document discusses the daily minimum nutritional needs of critically ill patients. It defines key terms like critically ill patient and malnutrition. It describes the nutritional changes, assessment of nutritional state, and predictors of outcome during critical illness. It provides guidelines for calculating nutritional requirements including carbohydrates, proteins, fats, vitamins, and minerals. It discusses enteral nutrition as the preferred route of administration when possible, and provides guidelines for safe enteral feeding including early initiation and proper tube positioning.
The document provides an overview of nutritional support in critical illness, including definitions, history, assessment, guidelines, and types of nutrition support such as enteral and parenteral nutrition. It discusses screening patients, performing nutritional assessments, determining caloric and protein needs based on stress level and condition, selecting appropriate enteral formulas, initiating and managing enteral feeds, and ordering and administering parenteral nutrition including determining fluid volumes, electrolytes, and other additives.
Dr. Asif Mian Ansari presented on nutritional requirements for surgical patients. Major points included:
1) Malnutrition can complicate surgical outcomes as nutritional needs are increased during stress and recovery requires an anabolic state.
2) Formulas to calculate basal metabolic rate and increased needs during stress or infection were provided.
3) Guidelines for caloric and protein intake for normal and surgical patients depending on stress level were outlined.
4) Enteral nutrition is preferred over parenteral nutrition when possible due to lower risk of complications.
Nutrition and liver diseases by Dr.P.Nazninazni peerkhan
This document discusses nutrition and liver diseases. It begins by providing an overview of liver anatomy and functions. The liver plays a key role in metabolizing nutrients, storing vitamins and minerals, filtering blood, and converting ammonia to urea. Chronic liver diseases can develop from viral infections, alcohol use, toxins, and autoimmune conditions. Cirrhosis is a common end-stage result, severely damaging liver structure and function. Malnutrition is common in cirrhosis patients due to reduced food intake and absorption. Treatment focuses on meeting calorie, protein, sodium, fluid and vitamin needs. Jaundice and hepatitis are also discussed, including causes, symptoms and dietary recommendations like hydration and avoiding alcohol.
The document discusses definitions and classifications of obesity according to various medical references and the WHO. It provides the WHO classification of BMI ranges from underweight to super obese. It also discusses factors that contribute to obesity including genetics, lifestyle, environment and various hormones and brain regions involved in regulating appetite and energy balance. Surgical procedures for treating obesity such as gastric bypass are also mentioned.
This document outlines Session 5 of a training manual on nutrition and HIV/AIDS. The session discusses the relationship between nutrition and HIV infection, important symptoms and their nutritional implications, and dietary management strategies. Good nutrition is important at all stages of HIV/AIDS as it strengthens the immune system and reduces vulnerability to opportunistic infections. The session provides guidelines on managing common symptoms like diarrhea, nausea and fever through dietary modifications and maintaining adequate fluid and nutrient intake.
Chapter 18 Nutrition and Lower Gastrointestinal Disorders KellyGCDET
This document discusses common intestinal problems including constipation, intestinal gas, and diarrhea. It describes their causes and treatments, including dietary and lifestyle interventions as well as medical treatments. It also covers malabsorption disorders caused by conditions like pancreatic disorders, bacterial overgrowth, and celiac disease. Nutrition therapy focuses on managing symptoms through specialized diets and supplements to address nutrient deficiencies.
This document discusses obesity and related topics including:
- Definitions of obesity and measurements like BMI and waist circumference.
- The global scale of obesity and trends over time showing rising rates.
- Common causes of obesity including changes to food environment, diet, and physical activity levels.
- Endocrine factors that can contribute to obesity like hormones that regulate hunger.
- Health complications of obesity such as increased risk of diabetes, cardiovascular disease, and some cancers.
- Approaches to obesity management including diet, exercise, drugs, and bariatric surgery. Evidence is presented on effectiveness of different options.
- The relationship between obesity and diabetes including impact of weight gain from diabetes medications and potential benefits of new incre
The document discusses the relationship between nutrition and infection. It notes that historically, the interaction between the two was not well recognized. However, studies demonstrated that infection can lead to malnutrition, and malnutrition increases susceptibility to infection, creating a vicious cycle. The effects of malnutrition on resistance to infection include reduced immune function and antibody production. Infection also affects nutritional status through increased nutrient needs, reduced intake and absorption, and increased losses. The interactions between the two are complex and bidirectional.
Diabetes occurs when there is inadequate insulin production or absorption into cells. Insulin is needed to metabolize glucose for energy at a cellular level. Lack of glucose metabolism leads to alternative metabolism of fat and protein, causing symptoms like frequent urination, thirst, and hunger. Chronic high blood glucose can damage organs over time. The goal is glycemic control to prevent complications through lifestyle changes, medication, and monitoring blood sugar levels.
The Anti-Inflammatory Diet ( Krause’s Book 14th Edition)Batoul Ghosn
The presentation contains the content of the Anti-Inflammatory diet discussed in the Krause’s Book 14th Edition - Index part. For more information about the linked chapter of this presentation, you can search for ( Pathophysiology of Chronic Diseases & Anti-Inflammatory DIet ) via slide share.
Obesity is a chronic disease characterized by excessive body fat accumulation that exceeds ideal body weight by 20%. It is caused by an imbalance between caloric intake and energy expenditure influenced by genetic, environmental, and social factors. Obesity management requires a long-term, flexible approach that may include dietary changes, lifestyle modifications, physical activity, drug therapy, and surgery, with the goal of modest and sustained weight loss of 5-10% to improve health outcomes rather than focus on achieving an ideal weight.
This document discusses nutrition in surgical patients. It begins by outlining the goals of nutritional support, which include identifying patients at risk of malnutrition, preventing or reversing catabolism, and meeting energy requirements. It then covers topics like malnutrition, nutritional assessment tools, estimating energy needs, and administration of enteral and parenteral nutrition. The key points are that nutritional support should begin preoperatively for high-risk patients or if oral intake won't resume within 7 days post-op, and the enteral route is preferred over parenteral nutrition when possible.
This document provides an overview of nutritional assessment. It discusses the goals of assessment as identifying malnutrition, obesity, and devising treatment plans. Assessment includes clinical history, physical exam, screening tools, anthropometrics, lab tests, and body composition analysis. Specific assessment measures are described in detail such as the subjective global assessment screening tool, body mass index, serum proteins, and creatinine tests. The document provides reference values and factors that influence various assessment markers.
Nutritional issues in sepsis, trauma & burn patientsSaurabh Debnath
This document discusses the nutritional needs of patients with sepsis, trauma, or burns who are in a hypermetabolic state with high metabolic demands. It outlines the objectives of nutritional support which are to detect and correct any preexisting malnutrition, prevent further protein-calorie malnutrition, and optimize the patient's metabolic state through fluid and electrolyte management. The goals are to meet the high substrate demands to support hypermetabolism and prevent catabolism while reversing any malnutrition.
Trauma causes physical damage and metabolic stress. Early enteral nutrition within 72 hours of injury decreases sepsis risk, while total enteral nutrition preserves gut function and immunity. For severe trauma, an immune-enhancing diet with higher protein of 2.2-2.5 g/kg daily for a week may reduce infections. Severe head trauma increases energy expenditure and protein breakdown while impairing immunity. Early enteral nutrition can improve outcomes if given after intracranial pressure is controlled, while overfeeding must be avoided to prevent increased intracranial pressure from excess nutrient processing.
1) Cancer is a leading cause of death globally and in Kenya, responsible for 13% and 7% of total annual mortality respectively.
2) The most common cancers in Kenya are breast, cervical, and prostate cancers. Cancer incidence is rising, with over 28,000 new cases and 22,000 deaths annually in Kenya.
3) Nutrition and lifestyle factors like diet, physical activity, alcohol consumption, and obesity are strongly linked to cancer risk. Maintaining a healthy weight, eating mostly plant-based foods, limiting red meat and alcohol, and staying physically active can help prevent cancer.
Diet treatment in liver cirrhosis - di Vincenzo Ostilio PalmieriMedOliveOil
Dieta nella cirrosi epatica - di Vincenzo Ostilio Palmieri. 21 giugno 2012. Corso di formazione "valore nutrizionale e salutistico di prodotti agroalimentari” - Università degli studi di Bari.
This document discusses nutritional assessment and management in surgical patients. It begins with an outline of the topics to be covered, including nutritional assessment, requirements, interventions, and disease-specific nutrition. Various methods of nutritional assessment are described, such as clinical history, physical exam, laboratory tests, and calculations of energy expenditure. Enteral and parenteral nutrition are presented as interventions, with details on their indications, delivery methods, and complications. The goal of nutritional support is to meet metabolic needs in patients who cannot maintain adequate intake orally.
Presentation gives an overview of the inter-relationship between nutrition and pharmacy. Its importance is an imperative consideration in patient care. The presentation begins with an introduction to both areas but then focuses on specific drug-nutrient interactions with specific drug categories.
This document provides an overview of nutrition in surgical patients. It discusses the basics of nutrition including caloric and protein requirements. The importance of nutrition for surgical patients is described along with the complications of malnutrition like infection and poor wound healing. Methods of nutritional assessment involving history, exams, and labs are outlined. Both enteral and parenteral nutrition are covered, including indications, contraindications, administration methods, and potential complications. The take home messages emphasize the importance of meeting caloric needs to avoid complications, using enteral nutrition when possible, and closely monitoring patients on nutrition support.
Nutritional assessment in chronic liver diseaseShaimaa Elkholy
Protein Energy Malnutrition (PEM) is highly prevalent among patients with chronic liver disease. One of the problems is how to assess these patients nutritionally. yet no standard golden rule for their nutritional assessment.
Daily minimum nutritional requirements of the critically illRalekeOkoye
The document discusses the daily minimum nutritional needs of critically ill patients. It defines key terms like critically ill patient and malnutrition. It describes the nutritional changes, assessment of nutritional state, and predictors of outcome during critical illness. It provides guidelines for calculating nutritional requirements including carbohydrates, proteins, fats, vitamins, and minerals. It discusses enteral nutrition as the preferred route of administration when possible, and provides guidelines for safe enteral feeding including early initiation and proper tube positioning.
The document provides an overview of nutritional support in critical illness, including definitions, history, assessment, guidelines, and types of nutrition support such as enteral and parenteral nutrition. It discusses screening patients, performing nutritional assessments, determining caloric and protein needs based on stress level and condition, selecting appropriate enteral formulas, initiating and managing enteral feeds, and ordering and administering parenteral nutrition including determining fluid volumes, electrolytes, and other additives.
Dr. Asif Mian Ansari presented on nutritional requirements for surgical patients. Major points included:
1) Malnutrition can complicate surgical outcomes as nutritional needs are increased during stress and recovery requires an anabolic state.
2) Formulas to calculate basal metabolic rate and increased needs during stress or infection were provided.
3) Guidelines for caloric and protein intake for normal and surgical patients depending on stress level were outlined.
4) Enteral nutrition is preferred over parenteral nutrition when possible due to lower risk of complications.
Nutrition and liver diseases by Dr.P.Nazninazni peerkhan
This document discusses nutrition and liver diseases. It begins by providing an overview of liver anatomy and functions. The liver plays a key role in metabolizing nutrients, storing vitamins and minerals, filtering blood, and converting ammonia to urea. Chronic liver diseases can develop from viral infections, alcohol use, toxins, and autoimmune conditions. Cirrhosis is a common end-stage result, severely damaging liver structure and function. Malnutrition is common in cirrhosis patients due to reduced food intake and absorption. Treatment focuses on meeting calorie, protein, sodium, fluid and vitamin needs. Jaundice and hepatitis are also discussed, including causes, symptoms and dietary recommendations like hydration and avoiding alcohol.
The document discusses definitions and classifications of obesity according to various medical references and the WHO. It provides the WHO classification of BMI ranges from underweight to super obese. It also discusses factors that contribute to obesity including genetics, lifestyle, environment and various hormones and brain regions involved in regulating appetite and energy balance. Surgical procedures for treating obesity such as gastric bypass are also mentioned.
This document outlines Session 5 of a training manual on nutrition and HIV/AIDS. The session discusses the relationship between nutrition and HIV infection, important symptoms and their nutritional implications, and dietary management strategies. Good nutrition is important at all stages of HIV/AIDS as it strengthens the immune system and reduces vulnerability to opportunistic infections. The session provides guidelines on managing common symptoms like diarrhea, nausea and fever through dietary modifications and maintaining adequate fluid and nutrient intake.
Chapter 18 Nutrition and Lower Gastrointestinal Disorders KellyGCDET
This document discusses common intestinal problems including constipation, intestinal gas, and diarrhea. It describes their causes and treatments, including dietary and lifestyle interventions as well as medical treatments. It also covers malabsorption disorders caused by conditions like pancreatic disorders, bacterial overgrowth, and celiac disease. Nutrition therapy focuses on managing symptoms through specialized diets and supplements to address nutrient deficiencies.
This document discusses obesity and related topics including:
- Definitions of obesity and measurements like BMI and waist circumference.
- The global scale of obesity and trends over time showing rising rates.
- Common causes of obesity including changes to food environment, diet, and physical activity levels.
- Endocrine factors that can contribute to obesity like hormones that regulate hunger.
- Health complications of obesity such as increased risk of diabetes, cardiovascular disease, and some cancers.
- Approaches to obesity management including diet, exercise, drugs, and bariatric surgery. Evidence is presented on effectiveness of different options.
- The relationship between obesity and diabetes including impact of weight gain from diabetes medications and potential benefits of new incre
The document discusses the relationship between nutrition and infection. It notes that historically, the interaction between the two was not well recognized. However, studies demonstrated that infection can lead to malnutrition, and malnutrition increases susceptibility to infection, creating a vicious cycle. The effects of malnutrition on resistance to infection include reduced immune function and antibody production. Infection also affects nutritional status through increased nutrient needs, reduced intake and absorption, and increased losses. The interactions between the two are complex and bidirectional.
Diabetes occurs when there is inadequate insulin production or absorption into cells. Insulin is needed to metabolize glucose for energy at a cellular level. Lack of glucose metabolism leads to alternative metabolism of fat and protein, causing symptoms like frequent urination, thirst, and hunger. Chronic high blood glucose can damage organs over time. The goal is glycemic control to prevent complications through lifestyle changes, medication, and monitoring blood sugar levels.
The Anti-Inflammatory Diet ( Krause’s Book 14th Edition)Batoul Ghosn
The presentation contains the content of the Anti-Inflammatory diet discussed in the Krause’s Book 14th Edition - Index part. For more information about the linked chapter of this presentation, you can search for ( Pathophysiology of Chronic Diseases & Anti-Inflammatory DIet ) via slide share.
Obesity is a chronic disease characterized by excessive body fat accumulation that exceeds ideal body weight by 20%. It is caused by an imbalance between caloric intake and energy expenditure influenced by genetic, environmental, and social factors. Obesity management requires a long-term, flexible approach that may include dietary changes, lifestyle modifications, physical activity, drug therapy, and surgery, with the goal of modest and sustained weight loss of 5-10% to improve health outcomes rather than focus on achieving an ideal weight.
This document discusses nutrition in surgical patients. It begins by outlining the goals of nutritional support, which include identifying patients at risk of malnutrition, preventing or reversing catabolism, and meeting energy requirements. It then covers topics like malnutrition, nutritional assessment tools, estimating energy needs, and administration of enteral and parenteral nutrition. The key points are that nutritional support should begin preoperatively for high-risk patients or if oral intake won't resume within 7 days post-op, and the enteral route is preferred over parenteral nutrition when possible.
This document provides an overview of nutritional assessment. It discusses the goals of assessment as identifying malnutrition, obesity, and devising treatment plans. Assessment includes clinical history, physical exam, screening tools, anthropometrics, lab tests, and body composition analysis. Specific assessment measures are described in detail such as the subjective global assessment screening tool, body mass index, serum proteins, and creatinine tests. The document provides reference values and factors that influence various assessment markers.
Nutritional issues in sepsis, trauma & burn patientsSaurabh Debnath
This document discusses the nutritional needs of patients with sepsis, trauma, or burns who are in a hypermetabolic state with high metabolic demands. It outlines the objectives of nutritional support which are to detect and correct any preexisting malnutrition, prevent further protein-calorie malnutrition, and optimize the patient's metabolic state through fluid and electrolyte management. The goals are to meet the high substrate demands to support hypermetabolism and prevent catabolism while reversing any malnutrition.
Trauma causes physical damage and metabolic stress. Early enteral nutrition within 72 hours of injury decreases sepsis risk, while total enteral nutrition preserves gut function and immunity. For severe trauma, an immune-enhancing diet with higher protein of 2.2-2.5 g/kg daily for a week may reduce infections. Severe head trauma increases energy expenditure and protein breakdown while impairing immunity. Early enteral nutrition can improve outcomes if given after intracranial pressure is controlled, while overfeeding must be avoided to prevent increased intracranial pressure from excess nutrient processing.
Insulin and glucagon work together to maintain blood glucose levels between 3.3-6.1 mmol/L. Insulin is produced by the pancreas and facilitates glucose uptake and storage, while inhibiting gluconeogenesis. Glucagon is also produced by the pancreas and has opposing effects, stimulating gluconeogenesis and glycogenolysis to increase blood glucose. In starvation, glycogen stores are depleted after 2 days and fatty acids and ketone bodies provide energy, with gluconeogenesis enhanced after 24 days to supply glucose to vital organs.
The document summarizes the metabolic response to trauma and injury. It describes the ebb and flow phases identified by Cuthbertson in the 1930s. The ebb phase lasts less than 24 hours and aims to conserve circulating volume and energy stores. The flow phase lasts 3-10 days and involves mobilizing stores for repair through hypermetabolism, increased protein breakdown, and insulin resistance. Nutritional, hormonal, and biologic interventions can help attenuate this catabolic response to injury and promote anabolism.
The document summarizes ketone body metabolism. It describes that ketone bodies (acetoacetate, β-hydroxybutyrate, and acetone) are produced from acetyl-CoA in the liver during periods of low blood glucose and fatty acid breakdown. They can be used as an energy source by other tissues like the brain and heart. The key enzymes and reactions involved in ketone body production and interconversion are also outlined.
The document presents a case study and nutrition care plan for a 49-year-old male patient admitted to the ICU with 17% mixed thickness burns. It includes the patient's anthropometric and biochemical data, a nutrition diagnosis of protein losses related to burns, and an enteral nutrition regime designed to provide 2600 kcal and 120g of protein per day using Enercal Plus and Myotein formulas administered through a feeding tube.
The document discusses ketone bodies, their production through ketogenesis in the liver from acetyl-CoA, and their utilization as an energy source by extrahepatic tissues. It notes that ketone body production is regulated by lipolysis in adipose tissue and the availability of acetyl-CoA. Conditions like starvation and uncontrolled diabetes can result in diabetic or starvation ketoacidosis if ketone bodies are produced in excess, overwhelming the body's pH buffering mechanisms and leading to metabolic acidosis.
Educators were presented with information about eating disorders including their prevalence, diagnosis, physical and psychological effects, risk factors, and cognitive distortions associated with them. The presentation aimed to help educators achieve a realistic understanding of eating disorders, identify early warning signs, and discuss strategies for supporting students with eating disorders and their families. Educators were encouraged to take any warning signs seriously, intervene early, and error on the side of caution when identifying and referring at-risk students.
This document discusses shock, including definitions, types, stages, assessment, and management. It defines shock as inadequate perfusion and oxygenation of cells. The main types of shock discussed are cardiogenic, obstructive, hypovolemic, and distributive. Assessment involves the ABCs with consideration of exposure for trauma. Management aims to optimize oxygen content, cardiac output, blood pressure, and regional blood flow. Case examples demonstrate application to patients with hemorrhagic, cardiogenic, septic, neurogenic, and pancreatitis-associated shock.
This document provides an overview of nutrition, including the essential nutrients, dietary guidelines, and eating patterns. It discusses the major macronutrients (carbohydrates, proteins, fats) and micronutrients (vitamins, minerals) required for human health. Recommendations include balancing calories with physical activity to maintain a healthy weight, focusing on nutrient-dense foods like vegetables, fruits, whole grains and reducing sodium, saturated fats and added sugars. Healthy eating patterns emphasized include MyPlate, DASH and Mediterranean diets. Factors affecting food choices in different populations are also reviewed.
Trauma wounds victims by disconnecting them from themselves, others, and God. It shatters their sense of self and undermines their belief in a meaningful and safe world. Trauma destroys trust and leaves victims feeling abandoned. Without proper care, this can lead to disorders like PTSD, depression, substance abuse, and more. For healing, helpers must focus on reconnecting victims to themselves, others, and God by rebuilding trust, autonomy, competence and safe relationships through empowering experiences.
Este documento presenta información sobre la terapia médico nutricional en la lesión renal aguda. Explica la fisiología y anatomía renal, las funciones del riñón, las causas de la lesión renal aguda incluyendo factores prerenales, renales y postrenales, y clasificaciones como RIFLE y AKIN para evaluar la gravedad de la lesión. El objetivo es proporcionar una guía sobre el cuidado nutricional del paciente con lesión renal aguda.
Hello friends ,this presentation is all about ketone bodies .this will help you to understand what are ketone bodies and their functioning .it will benefit specially bpharmacy students.
1. The document discusses the metabolic response to injury, which involves complex physiological and hormonal changes aimed at restoring homeostasis following trauma.
2. It describes the phases of the metabolic response as including an initial "ebb" phase aimed at conserving energy, followed by a "flow" or catabolic phase involving increased metabolism and breakdown of proteins and fat to mobilize energy stores.
3. Key elements of the catabolic flow phase include hypermetabolism, increased protein breakdown in skeletal muscle and liver, insulin resistance, and changes in body composition with loss of muscle mass. Mediators include stress hormones and cytokines.
Ketone bodies (acetoacetate, beta-hydroxybutyrate, and acetone) are water-soluble molecules produced by the liver from fatty acids during periods of low food intake (fasting or starvation), prolonged intense exercise, and uncontrolled diabetes. The liver exports ketone bodies to be used as an energy source by the brain, heart, and skeletal muscles in place of glucose. Ketone body production is regulated by controlling fatty acid release from adipose tissue, fatty acid oxidation in the liver, and partitioning of acetyl-CoA between ketogenesis and the citric acid cycle. Excessive ketone body accumulation can overwhelm acid-base buffering mechanisms and lead to ketoacidosis, as
Pressure ulcers in a spinal cord injury patientdoherlil
A 34-year-old paraplegic male with a history of type 1 diabetes, pressure ulcers, and transverse myelitis was admitted for a UTI and had severe pressure ulcers including a stage IV sacral ulcer and unstageable scrotal ulcer that were complicated by osteomyelitis and poor social support despite receiving home health services.
Seminar on head injury and spinal cord injuryUma Binoy
This seminar discusses head injury and spinal cord injury. It defines head injury as any trauma that leads to injury of the scalp, skull, or brain, ranging from minor to serious. Spinal cord injury damages the spinal cord or nerves and causes permanent changes below the site of injury. Causes of head and spinal injuries are discussed as well as symptoms, assessments, treatments including medications and surgery, nursing care, and prevention strategies.
This document summarizes the systemic response to injury and infection in the body. It discusses how injuries trigger neuroendocrine and inflammatory responses to restore homeostasis. The response has two phases - an initial pro-inflammatory response to fight infection, followed by an anti-inflammatory phase to prevent excessive inflammation and restore homeostasis. It provides details on the hormones, cytokines and other mediators involved in this response, including their effects on various organ systems.
This document provides an overview of basic trauma life support. It defines trauma as any bodily injury caused by external energy sources. The primary survey involves a quick assessment of the patient's airway, breathing, circulation, disability, and exposure to identify life-threatening issues. The secondary survey involves a more focused physical exam and history to identify hidden injuries. Key skills covered include spinal immobilization, bleeding control techniques, wound management principles like RICE, and splinting. The overall goal is to rapidly identify and treat life-threatening injuries before transporting the patient to definitive care.
This document outlines critical care nutrition and metabolic response to stress and injury. It discusses how critical illness leads to catabolism and increased nutritional needs. Early enteral nutrition is preferred over total parenteral nutrition when possible due to lower risks of infection. Glutamine supplementation, especially at higher intravenous doses, may reduce mortality, infections, and length of stay in critically ill patients.
Dentistry L8 METABOLIC RESPONSE TO TRAUMA-1.pptxbgjn55kymp
The metabolic response to trauma involves complex metabolic changes mediated by the neuroendocrine system to reduce the effects of injury and return the body to its preinjury state. It occurs in three phases: the ebb phase aims to conserve energy in the initial 24-48 hours after trauma; the flow phase is catabolic for about 7 days due to increased hormones that cause weight loss; and the anabolic recovery phase lasts 2-4 weeks to replace losses and restore the body's preinjury condition.
Dentistry L8 METABOLIC RESPONSE TO TRAUMA-1.pptxbgjn55kymp
The metabolic response to trauma involves complex metabolic changes mediated by the neuroendocrine system to reduce the effects of injury and return the body to its preinjury state. It occurs in three phases: the ebb phase aims to conserve energy in the initial 24-48 hours after trauma; the flow phase is catabolic for about 7 days due to increased stress hormones which cause weight loss; and the anabolic recovery phase lasts 2-4 weeks to replace losses and restore the body's preinjury condition.
08.Metaboliasfasdfc Response to Trauma.pptKhaerulFadly6
The metabolic response to injury leads to increased energy expenditure and protein catabolism. This response is mediated by the acute inflammatory response, the endothelium, nerve stimulation, and hormones from the endocrine system. The consequences include limiting injury, initiating repair, and mobilizing substrates. Compared to starvation, trauma does not allow the body to conserve fuels and proteins. The severity of injury determines the degree of metabolic response. Nutrition can modify this response by providing adequate calories, protein, vitamins, and minerals tailored to the patient's needs and stress level.
The document discusses the metabolic response that occurs following injury or trauma to the body. It describes how there is an initial ebb phase characterized by shock, followed by a longer flow phase with increased metabolism and hormone levels. The metabolic response aims to restore homeostasis but can also cause organ damage. Factors like infection, nutrition, and inflammation can modify this response. Managing the response through fluid resuscitation, oxygen delivery, and minimizing stressors can improve outcomes.
metabolc response by martha, alfred and pascal.pptxAidenJosephat
Following injury or trauma, the body undergoes a metabolic response involving two phases - an initial "ebb phase" lasting 24-48 hours where metabolic rate decreases to conserve energy, followed by a "flow phase" where metabolism increases to aid recovery. During the flow phase, hormones and cytokines induce catabolism, breaking down skeletal muscle and liver proteins which leads to loss of fat and muscle mass over 3-10 days. This hypermetabolic state involves insulin resistance and alters body composition through the mobilization of energy stores for repair.
Relationship between trauma and diseasesSaid Dessouki
The document discusses the relationship between trauma and diseases. It covers several key points:
1) Trauma can indirectly impact diseases by activating or accelerating latent conditions, especially if accompanied by infection, reduced exercise, weight gain or overeating.
2) Major injuries are associated with an inflammatory response that can lead to multiple organ failure and death if not properly treated.
3) The metabolic response to trauma involves neuroendocrine and immune system changes that mobilize energy stores and substrates. This response aims to aid recovery but can damage distant organs if severe.
4) Specific diseases that can be impacted by trauma include post-traumatic stress disorder, diabetes, rhabdomyolysis (muscle breakdown),
This PPT describes about the Metabolic response to injury as given in Bailey & Love - 26th edition. It will be very useful for Final year MBBS students.
Trauma triggers a complex metabolic response aimed at returning the body to homeostasis. This response involves two phases - an initial "ebb phase" characterized by hypometabolism followed by a "flow phase" of hypermetabolism. The hypermetabolic response is mediated by neuroendocrine and inflammatory factors like cortisol, catecholamines, cytokines and growth hormones which increase glucose and lipid metabolism while breaking down skeletal muscle. Understanding and limiting factors like hypothermia, edema and immobilization can reduce complications from this metabolic response.
Metabolic response to trauma - In Perspective of Maxillofacial SurgeryMaxfac Center
Metabolic responses that occur following trauma and its clinical implications to minimize morbidity and mortality.
Mentor: Dr Saikat Saha MDS, OMFS, SIliguri, West Bengal, India
Address: MAXFAC Center for Oral and Maxillofacial and Head & Neck Surgery, Siliguri
Email : maxfacmail@gmail.com
The document discusses the metabolic response to trauma. It begins with an overview of homeostasis and the normal metabolism of carbohydrates, proteins, lipids, and other substrates to maintain homeostasis. It then describes the body's response to traumatic stress, including the neuroendocrine response to pain which increases stress hormones and blood glucose levels. The inflammatory response to tissue damage is also summarized, along with the acute phase protein response in the liver. Finally, it discusses the metabolic response in the "ebb phase" which aims to conserve blood volume and glucose through vasoconstriction and decreased metabolism in non-vital tissues.
This document discusses alterations in skeletal muscle and hepatic protein metabolism during periods of stress and injury. It notes that skeletal muscle accounts for over 50% of daily protein turnover but has a low turnover rate, while the liver has a smaller mass but higher turnover. During stress and injury, protein metabolism shifts away from peripheral tissues like muscle towards central organs. This causes muscle wasting mainly through increased ubiquitin-proteasome pathway activation and decreased protein synthesis. The liver undergoes an acute phase response characterized by increased positive acute phase reactants and decreased negative reactants like albumin. Avoiding factors like starvation, hypothermia, and immobility can help limit the stress response and protein breakdown following injury.
The document discusses the metabolic response to trauma in three phases: ebb, flow, and anabolic. The ebb phase is characterized by decreased metabolism and energy expenditure. The flow phase sees increased metabolism and catabolism as the body mobilizes resources. The anabolic phase involves tissue repair and recovery of lost mass. Key hormonal and inflammatory responses that regulate metabolism are also described, including increased catecholamines, cortisol, cytokines and the stress response they induce.
1. The document discusses the systemic metabolic response to injury, including the hormonal and cytokine responses. It describes how the central nervous system, hormones like cortisol and catecholamines, cytokines, and other inflammatory mediators regulate the inflammatory response to trauma or infection.
2. Key aspects of surgical metabolism are discussed, including the sources of calories during fasting from fat, protein, and carbohydrates. The process of gluconeogenesis and protein catabolism during periods of starvation are summarized.
3. Healthy patients undergoing uncomplicated surgery can remain fasting from food for up to 10 days before significant protein catabolism occurs.
The body responds to stress and injury through metabolic and inflammatory responses known as the ebb and flow phases. In the initial ebb phase, metabolism decreases to conserve energy and resources. The subsequent flow phase involves increased metabolism and inflammation to restore function and fight infection. Prolonged or excessive response can lead to organ dysfunction or failure through effects like fluid shifts, immune imbalance, and metabolic changes that impact protein, carbohydrate and fat metabolism. Factors like severity of injury, infection, fluid status, and nutrition influence the response and clinical outcomes.
This document discusses homeostasis and the body's metabolic response to injury. It covers several key points:
1. Homeostasis aims to maintain constant internal conditions. Injury triggers a metabolic response involving hormones, cytokines, and cells to restore homeostasis.
2. The response has acute and chronic phases. The acute phase involves increased catabolism to provide energy, while the chronic phase sees increased anabolism to aid recovery.
3. Physiological changes include increased heart rate and breathing as well as weight loss. Clinical signs are fever, inflammation, and loss of appetite. Laboratory findings show immune cell changes and altered protein and glucose levels.
4. Factors like hypothermia, pain, starvation,
This document discusses nutritional support for patients in the intensive care unit (ICU). It covers reasons for nutritional support like limiting catabolism and increasing survival. It describes assessing patients and calculating calorie and protein needs using formulas like Harris-Benedict and Ireton-Jones. Enteral nutrition is preferred over total parenteral nutrition when possible due to lower infection risks. Early enteral nutrition within 24-48 hours is associated with better outcomes. Overfeeding can cause complications so goals are tailored to patient stress level and condition.
metabolic response to the disease .pptxdeepak160452
1. Injury causes a metabolic stress response with multiple stages. Initially pro-inflammatory cytokines are released locally, then systemically if the injury is severe enough to cause SIRS.
2. This leads to a hypermetabolic "flow" phase involving increased heart rate, temperature and catabolism. Muscle and liver protein are broken down, increasing urinary nitrogen and acute phase proteins.
3. The response aims to mobilize energy stores for repair but can become dysregulated, causing further damage. Avoiding dehydration, fasting and infection can help limit the response's severity.
Similar to 2.mnt for metabolic stress burn... (20)
Mr. S is a 59-year old man diagnosed with stage 1 COPD who has experienced weight loss from 68kg to 59kg. He was referred to a dietitian for a diet consultation to address his poor appetite and malnutrition. The dietitian assessed his nutrition status and designed a 2,200 calorie diet plan focusing on small, frequent meals high in calories, protein, and antioxidants to support his lung function and delay COPD progression.
Mr. TEC is a 62-year-old Chinese man admitted to the oncology ward due to metastatic adenocarcinoma neck cancer. He has experienced weight loss and dysphagia. A nutritional plan is developed to provide adequate calories and nutrients through enteral nutrition via 6 feedings per day of a specialized formula. The plan will be gradually increased over 4 steps to reach goals of 2442 kcal, 133.2 g protein, and 399.9 g carbs to support weight gain and prevent further malnutrition.
A 16-year-old Indian boy was admitted to the hospital with an acute subdural hematoma following a motor vehicle accident. He underwent a decompressive craniectomy and was referred for enteral tube feeding. A feeding regimen was developed to provide adequate calories and protein to promote recovery, consisting of incremental increases in feeding volume up to 150ml given 8 times per day via Ryle's tube. MCT oil was also prescribed to boost calories without increasing protein. The goal was to preserve lean body mass and improve healing through optimized nutrition support.
1 scoop myotein in 2 times feeding per day
Calories = 6(42kcal) x 6 + 2(30.1) = 1566.2 kcal/day
Protein = 6(1.7g) x 6 + 2(5g) = 72.4 g/day
Total CHO = 6(5.1g) x 6 = 183.6g/day
Total Fat = 6(1.6g) x 6 = 57.6g/day
3. Flush with 30ml of water
Gradually increase feeding amount based on tolerance.
Monitoring and Evaluation
1. Daily monitoring of:
- Intake and output
RK is a 25-year old man who suffered multiple injuries including fractures and head trauma in a motor vehicle accident. He has been unconscious and receiving nutrition via a nasogastric tube. The plan is to insert a PEG tube. A 6-step plan is outlined to gradually increase nutrition from the PEG tube to meet RK's estimated daily energy needs of 3100 calories and protein needs of 128 grams. Education for caregivers is also included on proper PEG tube feeding and hygiene.
This document provides definitions and information about HIV/AIDS including:
- Definitions of HIV and AIDS
- Global and regional statistics on HIV/AIDS prevalence and deaths
- Modes of HIV transmission and risk factors
- Stages of HIV infection from acute to symptomatic disease
- Diagnosis and treatment of HIV/AIDS
- Nutritional complications and the role of dietitians in HIV/AIDS care
The document discusses nutrition support and the conditions that require specialized nutrition through enteral or parenteral means. It covers the indications, contraindications, advantages, and disadvantages of enteral nutrition support through various tube feeding routes and administration methods. The roles and responsibilities of nutrition support dietitians in implementing individualized nutrition care plans are also outlined.
This document summarizes medical nutrition therapy for various pulmonary diseases. It discusses the anatomy and physiology of the respiratory system and mechanics of breathing. It then covers several chronic pulmonary diseases including asthma, bronchopulmonary dysplasia, chronic obstructive pulmonary disease, and cystic fibrosis. For each condition, it describes nutritional implications, recommended nutritional assessments, and medical nutrition therapy goals and strategies.
The document contains 6 case studies presenting patients with various medical conditions requiring nutritional support. RK suffered head injuries and was being fed via NG tube. Dietary plans would focus on meeting calorie and protein needs during NG and after PEG tube insertion. AH had cancer and underwent stomach surgery, requiring TPN then transition to EN. Dietary plans would focus on meeting calorie and protein needs during TPN and after transition to EN. Mr. TEC had neck cancer and lost weight due to dysphagia, requiring an EN regime to meet calorie and protein needs.
This document summarizes the A.S.P.E.N. Clinical Guidelines for nutrition support of critically ill children. It discusses the high prevalence of malnutrition among critically ill patients and how failure to provide optimal nutrition support can exacerbate deficiencies and affect outcomes. The guidelines were developed by the American Society for Parenteral and Enteral Nutrition to standardize and improve nutrition care for critically ill children. They review current evidence and best practices for assessing energy needs and providing appropriate enteral or parenteral nutrition support. However, more research is still needed in this area, especially randomized controlled trials in pediatric intensive care units.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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2. Metabolic Stress
Trauma MVA, gunshot, stab wound, falls, burns
Major cause of death and disability
Active systemic response, depend on:
Pt‘s age, previous health status, preexisting diseases,
type of infection, presence of multiple organ
dysfunction syndrome (MODS)
There are many metabolic changes that occur in
patients who are critically ill (eg sepsis, trauma)
3. Important to understand these changes when
implementing nutritional therapy
Once the systemic response is activated, the
physiologic and metabolic changes that follow are
similar and may lead to septic shock
Ebb phase initial response to bodily insult, occur
immediately following injury (short term)
Flow phase neuroendocrine response to
physiologic stress following the ebb phase (long
term)
4. Metabolic response during stress:
Metabolic response to stress (tissue injury, infection) is
divided into the ebb and flow phase
Energy expenditure
Flow Phase
Ebb Phase
Time
5. In the ebb phase, the body ‗shuts down‘ and the
metabolic rate decreases
Leads to hypovolemic shock:
↓ Blood pressure
↓ Cardiac output
↓Body temperature
↓tissue perfusion
↓O2 consumption
↓ metabolic rate
Body‘s protective response (eg to blood loss)
6. However, once the blood pressure is stabilized, the flow (recovery)
phase begins
Divided into 2 response:
Acute Response:
catabolism predominates
glucocorticoids
glucagon
catecholamines
Release cytokines, lipid mediators
Acute phase protein (CRP)
N2 excretion
metabolic rate
O2 consumptions
Impaired fuel utillization
Adaptive Response:
Anabolism predominates
Hormonal response gradually diminished
↓ hypermetabolic rate
Assoc with recovery
Restore body protein
Wound healing
7. Metabolic changes in the stressed (critically ill
patient):
Energy metabolism
Protein metabolism
Carbohydrate metabolism
Fat metabolism
Others
8. In the acute response metabolism is increased which
requires energy
However, the method of producing energy is different
to that of a normal state or in periods of fasting
(simple starvation)
9. Energy production in a normal
(non fasting state)
Usually E is from carbohydrates from normal intake
Complex carbohydrate is broken down into glucose
(preferred substrate for the brain)
Excess carbohydatre mainly converted to fat and
stored in adipose tissue
10. Metabolic Response to Fasting
I II III IV V
GLUCOSE UTILIZED (g/hora)
40 Exogenous
Glycogen
Gluconeogenesis
30
20
10
LEGEND I II III IV V
FUEL FOR GLUCOSE, GLUCOSE,
BRAIN
GLUCOSE GLUCOSE GLUCOSE
KETONES KETONES
Ruderman NB. Annu Rev Med 1975;26:248
13. Starvation vs. Stress
Metabolic response to stress differs from the
responses to starvation.
Starvation = decreased energy expenditure, use of
alternative fuels, decreased protein wasting, stored
glycogen used in 24 hours
Late starvation = fatty acids, ketones, and glycerol
provide energy for all tissues except brain, nervous
system, and RBCs
14. Hypermetabolic state—stress causes accelerated
energy expenditure, glucose production, glucose
cycling in liver and muscle
Hyperglycemia can occur either from insulin
resistance or excess glucose production via
gluconeogenesis and Cori cycle.
Muscle breakdown also accelerated
15. Hormonal Stress Response
Aldosterone—corticosteroid that causes renal
sodium retention
Antidiuretic hormone (ADH)—stimulates renal
tubular water absorption
These conserve water and salt to support circulating
blood volume
16. ACTH—acts on adrenal cortex to release cortisol
(mobilizes amino acids from skeletal muscles)
Catecholamines—epinephrine and norepinephrine
from renal medulla to stimulate hepatic
glycogenolysis, fat mobilization, gluconeogenesis
17. Cytokines
Interleukin-1, interleukin-6, and tumor necrosis factor
(TNF)
Released by phagocytes in response to tissue
damage, infection, inflammation, and some drugs
and chemicals
18. Nutrition Care
Prevent PEM and possible complication of nutrition
support
Nutritional status prior to current illness is an
important predictor of morbidity and mortality
The level of injury will determine the level of
metabolic stress
The Glasgow Coma scale (GCS) score are usually
used in critical ill pt.
19. Nutrition Intervention
Oral route is the preferred route to meet the
requirements
However, for critically ill pt, usually the requirement
only can be met via EN or PN
There is evidence to support early initiation of nutrition
support with specific metabolically stressed : acute
pancreatitis, head injury and burns.
EN should be consider first before PN
20.
21. Definition
Sepsis: an uncontrolled inflammatory response to
infection or trauma (immunosuppressive response to
infection)
Septic shock: hypotension not reversed with fluid
resuscitation and assoc with organ dysfx
SIRS: not necessarily caused by infection, may occur
after major surgery or trauma or with other condition
such as myocardial infraction
MODS: result from the complications of sepsis or
SIRS; define as the present of the altered fx of 2 or >
organs in acutely ill pt
22. Diagnosis of Systemic Inflammatory Response
Syndrome (SIRS):
Site of infection established and at least two of the
following are present:
Body temperature >38° C or <36° C
Heart rate >90 beats/minute
Respiratory rate >20 breaths/min (tachypnea)
PaCO2 <32 mm Hg (hyperventilation)
WBC count >12,000/mm3 or <4000/mm3
Bandemia: presence of >10% bands (immature neutrophils)
in the absence of chemotherapy-induced neutropenia and
leukopenia
May be caused by bacterial translocation
Diagnostic criteria for MODS and pathopysiology refer handout
23. Bacterial Translocation
Changes from acute insult to the gastrointestinal tract
that may allow entry of bacteria from the gut lumen
into the body; associated with a systemic
inflammatory response that may contribute to multiple
organ dysfunction syndrome
Well documented in animals, may not occur to the
same extent in humans
Early enteral feeding is thought to prevent this
24.
25. Factors to Consider in Screening an
ICU Patient:
ICU medical admission
—Diagnosis, nutritional status, organ function,
pharmacologic agents
Postoperative ICU admission
—Type of Surgery, intraoperative complications,
nutritional status, diagnosis, sepsis/SIRS
Burn or trauma admission
—Type of trauma, extent of injury, GI function
26. ASPEN Guidelines
ASPEN (American Society of Parenteral and Enteral
Nutrition)
Objectives of optimal metabolic and nutritional
support in injury, trauma, burns, sepsis:
1. Detect and correct preexisting malnutrition
2. Prevent progressive protein-calorie malnutrition
3. Optimize patient‘s metabolic state by managing fluid
and electrolytes
27. NUTRITIONAL
ASSESSMENT
Traditional methods not adequate/reliable
Urine urea nitrogen (UUN) excretion in gms per day
may be used to evaluate degree of
hypermetabolism:
0 –5 = normometabolism
5 – 10 = mild hypermetabolism (level 1 stress)
10 – 15 = moderate (level 2 stress)
>15 = severe (level 3 stress)
29. Energy
Enough but not too much
Excess calories:
Hyperglycemia
Diuresis – complicates fluid/electrolyte balance
Hepatic steatosis (fatty liver)
Excess CO2 production
Exacerbate respiratory insufficiency
Prolong weaning from mechanical ventilation
30. Predictive Equations for Estimation of
Energy Needs in Critical Care
Harris-Benedict x 1.3-1.5 for stress
ASPEN Guidelines:
25 – 30 calories per kg per day*
Ireton-Jones Equations**
Penn State equations
Swinamer equation
*ASPEN Board of Directors. JPEN 26;1S, 2002
** Ireton-Jones CS, Jones JD. Why use predictive equations for energy
expenditure assessment? JADA 97(suppl):A44, 1997.
**Wall J, Ireton-Jones CS, et al. JADA 95(suppl):A24, 1995.
31. Harris-Benedict Equation
(HBE)
Injury Stress Factor
Minor surgery 1.00 – 1.10 Energy requirements for
Long bone fracture 1.15 – 1.30 patient with cancer in bed
Cancer 1.10 – 1.30
HBE = BEE x 1.10 x 1.2
Peritonitis/sepsis 1.10 – 1.30
Severe infection/multiple trauma 1.20 – 1.40
Multi-organ failure syndrome 1.20 – 1.40
Burns 1.20 – 2.00
Activity Activity Factor
Confined to bed 1.2
Out of bed 1.3
ADA: Manual Of Clinical Dietetics. 5th ed. Chicago: American Dietetic Association; 1996
Long CL, et al. JPEN 1979;3:452-456
33. Where:
A = age in years
W = weight (kg)
O = presence of obesity >30% above IBW (0 =
absent, 1 = present)
G = gender (female = 0, male = 1)
T = diagnosis of trauma (absent = 0, present = 1)
B = diagnosis of burn (absent = 0, present = 1)
EEE = estimated energy expenditure
34. Penn State Equation
1998 version: RMR = BMR (1.1) + VE (32) + Tmax
(140) - 5340
2003a version: RMR = BMR (0.85) + VE (33) +
Tmax (175) – 6433
Equations use BMR calculated using the Harris-
Benedict equation, minute ventilation (VE) in liters
per min (L/min), and maximum temperature (Tmax)
in degrees Celsius.
35. Swinamer Equation
EE = 945 (BSA) - 6.4 (age) + 108 (T) + 24.2
(breaths/min) + 81.7 (VT) – 4349
Equation uses body surface area (BSA) in squared
meters (m2), temperature (T) in degrees Celsius,
and tidal volume (VT) in liters per minute (L/min).
36. Estimation of RMR in
Obesity
Harris-Benedict using actual weight x 1.2 (60% of
subjects predicted within 10% of RMR) or an adjusted
weight x 1.3 (67% of subjects predicted within 10% of
RMR) resulted in the most accurate predictions.
Penn State 2003a equation predicts within 10% of
RMR in 61% of subjects, the Penn State 1998
equation predicts within 10% of RMR in 67% of
subjects
Ireton-Jones, 1992 equations predict within 10% of
RMR in 72% of subjects.
37. Recommendations for
Predicting RMR in Critically Ill
Pts
HBE should not be used to predict RMR in critically
ill patients
Ireton-Jones 1997 should not be used to predict
RMR in critically ill patients
Ireton-Jones 1992 may be used to predict RMR in
critically ill pts but errors will occur.
ADA Evidence Analysis Library, 10-06
38. Protein
Stress Level No Stress Moderate Stress Severe Stress
Calorie:Nitrogen Ratio > 150:1 150-100:1 < 100:1
Percent Potein / Total < 15% 15-20% > 20% protein
Calories protein protein
Protein / kg Body Weight 0.8 1.0-1.2 g/kg/day 1.5-2.0
g/kg/day g/kg/day
39. What Weight Do You Use?
Actual weight may be inaccurate in trauma and burn
patients who have been fluid resuscitated
Usual weights may not be available
There is no validation for the common practice of using
an ―adjusted‖ body weight for obese patients when using
Harris-Benedict since Harris-Benedict equations were
derived from studies done on healthy people of all sizes
Ireton-Jones uses actual weight in her equations and
then adjusts for obesity
40. Lean body mass is highly correlated with actual weight in
persons of all sizes
Studies have shown that determination of energy needs
using adjusted body weight becomes increasingly
inaccurate as BMI increases
However, some studies suggest that high protein
hypocaloric feedings in obese patients may be
therapeutically useful
Because overfeeding is more problematic than
underfeeding, could possibly use adjusted weight or 20-21
kcal/kg actual BW in obese pts
41. Specialized Nutrients in Critical
Care
Include supplemental branched chain amino acids,
glutamine, arginine, omega-3 fatty acids, RNA,
others
Most studies used more than one nutrient, making
assessment of efficacy of specific supplements
impossible
Immune-enhancing formulas may reduce infectious
complications in critically ill pts but not alter mortality
Mortality may actually be increased in some
subgroups (septic patients)
42. Timing of Enteral Nutrition and
Critical Illness
If the critically ill patient is adequately fluid
resuscitated, then EN should be started within 24 to
48 hours following injury or admission to the ICU.
Early EN is associated with a reduction in infectious
complications and may reduce LOS.
The impact of timing of EN on mortality has not been
adequately evaluated.
43. Monitoring Response to MNT in
Critical Care Pts: Blood Glucose
Hyperglycemia (up to 200-220 mg/dl) in critically ill
patients was once considered acceptable
Recent studies suggest hyperglycemia is associated with
infection, morbidity, mortality
New goal is to keep BG as close to normal as possible.
Target: <150 mg/dl
Use insulin drip and sliding scale; convert to
subcutaneous insulin as possible
Can use intermediate insulins morning and evening once
feedings are tolerated and stable
44. Survival is decreased in critically ill patients with
hyperglycemia
Controlling BG is associated with fewer infectious
complications in critically ill patients
There is fair evidence that controlling BG values in
critically ill patients leads to a decrease in ICU LOS
Dietitians should promote attainment of strict
glycemic control (80-110mg/dL) to reduce time on
mechanical ventilation in critically ill medical ICU
patients
47. Traumatic Brain Injury (TBI) Severely hypermetabolic
and catabolic
The more severe the head injury, the greater the release
of catecholamines (norepinephrine and epinephrine) and
cortisol and the greater the hypermetabolic response.
release of catecholamines, cortisol, & hypermetabolic
response
Without rapid nutrition support rapid LBM loss and
immunosuppression
Glasgow Coma Scale (GCS) to evaluate pt‘s
consciousness:
Sore 14–15 minor head injury
Score 9 – 13 moderate head injury
48. MNT
Energy:
Use indirect calorimetry when available
Use H/B x 1.4 stress factor
GCS often EE
Take into consideration the IV glucose (provide E) total
cal – the IV glucose E
Protein:
estimated at 1.5 – 2.2 g/kg of body weight
BCAA help to restore plasma AA profile and nitrogen
bal
51. Definition: a result of tissue injury caused by exposure
to heat, chemical, radiation, or electricity
May result from injury to the skin but damage may
extend into muscle and bone.
When the burn injury exceeds 15 to 20% of the total
body surface area (TBSA), it results in systemic
disturbances, including a major stress response,
impaired immunity and extensive fluid redistribution
52.
53.
54. The consequences of these metabolic alterations
include increased gluconeogenesis, increased
proteolysis, increased ureagenesis, sequestration of
micronutrients and altered lipid metabolism
The metabolic response increased physiological
demands placed on the cardiac, pulmonary, renal
and other organ systems, complicates nutritional
support.
Patients with major burn injuries also develop
immune system impairment, which predisposes them
to infection and multi-organ failure (MOF)
55. MNT
Objectives:
Maintain body mass, particularly lean body mass
Prevent starvation and specific nutrient deficiencies
Improve wound healing
Manage infections
Restore visceral and somatic protein losses
Avoid or minimize complications associated with enteral
or parenteral nutrition
56. Energy
Based on size of burn (% TBSA)
Use the Curreri Formula:
ER = 24kcal x kgUBW + 40 kcal x %TBSA (usually
200% REE)
OR
Formula (Xie et al, 1993):
Energy expenditure (kcal/d) = (1000 kcal x BSA [m ]) +
2
(25 x %TBSA)
OR
57. Basal energy expenditure (BEE) per Harris-Benedict equation
Male: BEE = 66 + (13.7 x W) + (5 x H) – (6.8 x age)
Female: BEE = 655 + (9.6 x W) + (1.9 x H) – (4.7 x age)
Adjustments for burn severity
Extent of burn BEE Protein NPE:N ratio
Healthy individual 1.0 g/kg/d 150:1
Moderate burn (15–30% X 1.5 1.5 g/kg/d 100–120:1
TBSA)
Major burn (15–30% TBSA) X1.5–1.8 1.5–2 g/kg/d 100:1
Massive burn (≥ 50%) X1.8–2.1 2–2.3 g/kg/d 100:1
Activity factors: In bed = 1.2 Ambulatory = 1.3 Ventilated = 1.05
58. ER for burned pediatric pts:
Galveston Formula = 1800 kcal/m2 + 2200 kcal/m2
burn
Polk Formula = (<3 y.o) = (60 kcal x wt) + (35kcal x %
TBSA)
Important to remember that a progressive exercise
programme should always be combined with adequate
nutrition to enhance the restoration of muscle mass and
strength
59. CHO
50 to 60% or can be up to 70% of energy
not to exceed 5 to 7 mg/kg/min in parenteral nutrition
CHO need for protein sparing; but excess result in
hyperglacemia, osmotic diuresis, dehydration,
respiratory difficullity
60. Protein:
requirement due to losses via urine, wound,
gluconeogenesis and wound healing
20 -25% of total calories (HBV protein)
Pediatrics 2.5 – 3.0 g/kg (monitor renal fx & fluid
balance)
BCAA‘s & arginine improve wound healing & immunity
Monitor BUN, serum creatinine, & hydration
To estimate wound nitrogen loss:
< 10% open wound = 0.02 g nitrogen/kg/d
11 – 30% open wound = 0.05 g nitrogen/kg/d
> 31 % open wound = 0.12 g nitrogen/kg/d
61. Fats:
Fat supplied at 15% of total energy reduced infectious
morbidity and shortened hospitalization time compared
to 35% of energy requirements being derived from fat.
Increase omega- 3 may improve immune response
(inhibits production of prostaglandins & leukotrienes)
Begin with 15 – 20% [monitor immune response,
feeding tolerance and serum TG (not rise > 10 to 20%
over baseline values)]
62. Hart et al (2001) found that a high-carbohydrate diet,
with 3% fat, 82% carbohydrates and 15% protein,
stimulated protein synthesis, increased endogenous
insulin production and improved lean body mass
accretion compared to high-fat diet.
63. Vitamins & Minerals Supplementation
Evidence-based guidelines for micronutrient
supplementation are limited
Vit C- collagen formation and antioxidant defense in the
immune system and is involved in ATP production (66
mg/kg/h during the first 24 hours)
Vit A – immune fx & epithelialization (1000 IU/1000kcal)
Na & K restore via fluid therapy
Ca depression – reduced with earlier ambulation &
excersize
Supp PO4 & Mg parenterally (to avoid GI irritation)
Zn supp 220mg Zn sulphate ( co fac in Vit E metab)
64. Methods of Nutritional Support
Pt with <20% TBSA burn able to meet the regular
needs with regular hi-cal, hi-protein diet
Use ‗concealed nutrients‘ – add protein to pudding,
milk etc
Pt with major burn & EE require ETF or TPN (if
ileus not fx or do not tolerate TF)
66. MNT
Energy :
H/B x 1.1 x 1.2 (Barco et al, NCP 17;309-313, 2002)
Pt with multi-traumas in addition to SCI may have
higher needs
Protein needs:
2 g/kg (Rodriguez DJ et al, JPEN 15:319-322, 1991)
68. Def: an operative procedure used to diagnose, repair,
or treat an organ tissue. Can be further classify to
major/minor surgery
The sign & symptoms experienced with surgery
depend to the type of procedure.
Pt need to be fasted for 12 hr before surgery
The progress of feeding from NBM/NPO to solid diet
should be done as quickly as possible
The energy and protein should be individualize.
69. MNT
Energy:
HB x 1.0 – 1.3 depend on type of surgery
Will vary with type of surgery, degree of trauma
Use Ireton-Jones 1992 or Penn State if data is
available*
Can use estimate of 25-30 kcals/kg to begin and monitor
response to therapy**
*ADA Evidence Analysis Library, accessed 10-06
**ASPEN Nutrition Support Practice Manual, 2nd Edition, p. 278
Protein:
Minor surgery : 1 -1.1 g/kg
Major Surgery : 1.2 – 1.5 g/kg
70. ASPEN Practice Guidelines Perioperative Nutrition
Support
Preoperative NS should be administered to moderately-
severely malnourished pts undergoing major
gastrointestinal surgery for 7 to 14 days if the operation
can be safely postponed.
PN should not be routinely given in the immediate
postoperative period to patients undergoing major
gastrointestinal procedures.
Postoperative NS should be administered to patients who
will be unable to meet their nutrient needs orally for a
period of 7 to 10 days.
71. Postoperative Nutrition Support
Introduction of solid foods depends on condition of
GI
Oral feeding may be delayed for first 24 – 48 hours
post surgery until return of bowel sounds, passage of
flatus or soft abdomen
Traditional practice has been to progress from clear
liquids, to full liquids, to solid foods
However, there is no physiological reason not to
initiate solid foods once small amounts of liquids are
tolerated
72. Hypocaloric Feedings
Hypocaloric feedings have been recommended in
specific patient populations:
Class III obesity (BMI>40)
Refeeding syndrome
Severe malnutrition
Trauma patients following shock resuscitation
Hemodynamic instability
Acute respiratory distress syndrome or COPD
MODS, SIRS or sepsis
Aggressive protein provision (1.5-2.0 gm/kg/day
73. Although overfeeding surgical patients should be
avoided, prolonged underfeeding may be equally
concerning.
This can compromise immune function, delay wound
healing, exacerbate muscle wasting, and prolong the
recovery of nitrogen balance and visceral protein levels.
However, short-term hypocaloric feeding with 1-2 g of
protein per kilogram per day, particularly in the acute
phase of postoperative stress, may reduce metabolic
complications while supporting a reduction in negative
Editor's Notes
The metabolic response to fasting is an adaptation by the body to preserve protein by using alternative sources of energy.The carbohydrate deposits of the body last about 18 to 20 hours and new glucose is produced through gluconeogenesis of amino acids from the lean body mass. Ruderman NB. Muscle amino acid metabolism and gluconeogenesis. Annu Rev Med 1975;26:248
The initial response to fasting is mediated by a drop in serum insulin and an increase in glucagon. During this period energy is provided mainly by glucose from gluconeogenesis. However, lipolysis generates free fatty acids which are oxidized into ketones. After several days, most of the body organs are using ketones (acetoacetic, propionate, and butyric acids) for energy and gluconeogenesis decreases to half of the early phase. Brain, red blood cells, and nerve tissue still rely partially on glucose for energy.
This slide illustrates nitrogen losses in relation to trauma. With respect to protein, the greater the trauma, the greater the effect on the nitrogen balance. Similar to metabolic rate, patients experience nitrogen losses according to the severity and duration of the trauma.The normal range is indicated by the shaded area. The amount of protein requirement relative to calories increases in patients with metabolic stress.Long CL, et al. JPEN 1979;3:452-456.
G (gender)Female= 2, male = 1T= traumaB burnsO = obesity present =1 absent = 0
Calorie-to-nitrogen ratios can be used to prevent lean body mass from being utilized as a source of energy. Therefore, in the non-stressed patient, less protein is necessary to maintain muscle as compared to the severely stressed patient.
Rules of nine for adult and rules of 7 for chlidrenPercentage of burns
Sequestration -- >The action of forming a chelate or other stable compound with an ion or atom or molecule so that it is no longer available for reactions
1– controlenviroment, temp, maintain fluid, electrolytes balance, control pain, anxiety and covering wound healing2- adequate cal to prevent LOW > 10% UBW, adequate protein, vit & mineral supp.3- acute peptic ulcer of the duodenum resulting as a complication from severe burns when reduced plasma volume leads to sloughing of the gastric mucosa.
To find out nitrogen gms= protein in gms/ 6.25 500 ml of 8.5 amino acid has 42.5gms protein that divided by 6.25= 6.8 gms The calories from dextrose and lipids have 1000 and 510 calories respectively Now divide 1510 non protein calories/ 6.8 =222