This document provides an overview of energy production and metabolism in intensive care unit (ICU) patients. It discusses:
- How ATP is generated from substrates like glucose, lipids, and amino acids through glycolysis and oxidative phosphorylation.
- How critical illness can decrease ATP content and affect mitochondria and the respiratory chain.
- Methods for measuring a patient's energy expenditure including indirect calorimetry and factors that can influence these measurements.
- How nutrition support can help meet energy needs while avoiding overfeeding and supporting endogenous repair mechanisms.
- The role of adequate protein intake in preserving muscle mass and improving clinical outcomes.
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.
The document discusses the basis of nutritional support for critically ill patients, outlining factors that can lead to malnutrition in intensive care and the consequences of malnutrition. It covers methods for assessing nutritional status and determining nutritional requirements. Guidelines are provided on enteral and parenteral nutrition support based on a patient's condition and clinical setting.
This document discusses nutrition and metabolism in injured or stressed patients. It covers several topics:
1. Injury causes an increase in energy requirements and metabolism. Insulin resistance occurs after injury.
2. Protein from skeletal muscle breakdown is an important fuel source. Amino acids like glutamine are conditionally essential.
3. Nutritional assessments evaluate dietary intake, anthropometrics, and biomarkers to identify deficiencies.
4. Various feeding methods can be used to meet increased caloric and protein needs in stressed patients. Maintaining proper nutrition supports healing and recovery from injury or illness.
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.
П. Сутерс "Проявления инсулинорезистентности и гликемический контроль в интен...rnw-aspen
Доклад с 15 Межрегиональной научно-практической конференции "Искусственное питание и инфузионная терапия больных в медицине критических состояний" 21-22 мая 2015 г
The document discusses the normal biology and function of pancreatic beta cells in regulating blood glucose levels through insulin secretion. It describes how beta cells adapt to changing insulin needs by altering the function of individual cells and beta cell mass. Beta cell mass is a dynamic process regulated by replication, apoptosis, neogenesis, hypertrophy and necrosis. Studies have shown that obese individuals have greater beta cell mass and volume compared to lean individuals due to increased insulin demand. Animal models also demonstrate that insulin resistance leads to both beta cell replication and neogenesis to increase beta cell mass.
Total enteral nutrition and total parenteral nutrition in critically ill pat...Prof. Mridul Panditrao
This document discusses total enteral and parenteral nutrition in critically ill patients. It begins by outlining normal energy and protein requirements, then discusses the prevalence and consequences of malnutrition in hospitalized patients. It describes the metabolic response to critical illness and trauma as having an "ebb phase" and "flow phase". The document advocates for early initiation of nutritional support via the enteral route when possible using techniques like post-pyloric feeding tubes, but notes total parenteral nutrition may be needed if enteral nutrition is not tolerated. It provides guidelines on calculating protein and calorie needs and discusses considerations, benefits, risks and protocols for both enteral and parenteral nutrition.
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.
The document discusses the basis of nutritional support for critically ill patients, outlining factors that can lead to malnutrition in intensive care and the consequences of malnutrition. It covers methods for assessing nutritional status and determining nutritional requirements. Guidelines are provided on enteral and parenteral nutrition support based on a patient's condition and clinical setting.
This document discusses nutrition and metabolism in injured or stressed patients. It covers several topics:
1. Injury causes an increase in energy requirements and metabolism. Insulin resistance occurs after injury.
2. Protein from skeletal muscle breakdown is an important fuel source. Amino acids like glutamine are conditionally essential.
3. Nutritional assessments evaluate dietary intake, anthropometrics, and biomarkers to identify deficiencies.
4. Various feeding methods can be used to meet increased caloric and protein needs in stressed patients. Maintaining proper nutrition supports healing and recovery from injury or illness.
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.
П. Сутерс "Проявления инсулинорезистентности и гликемический контроль в интен...rnw-aspen
Доклад с 15 Межрегиональной научно-практической конференции "Искусственное питание и инфузионная терапия больных в медицине критических состояний" 21-22 мая 2015 г
The document discusses the normal biology and function of pancreatic beta cells in regulating blood glucose levels through insulin secretion. It describes how beta cells adapt to changing insulin needs by altering the function of individual cells and beta cell mass. Beta cell mass is a dynamic process regulated by replication, apoptosis, neogenesis, hypertrophy and necrosis. Studies have shown that obese individuals have greater beta cell mass and volume compared to lean individuals due to increased insulin demand. Animal models also demonstrate that insulin resistance leads to both beta cell replication and neogenesis to increase beta cell mass.
Total enteral nutrition and total parenteral nutrition in critically ill pat...Prof. Mridul Panditrao
This document discusses total enteral and parenteral nutrition in critically ill patients. It begins by outlining normal energy and protein requirements, then discusses the prevalence and consequences of malnutrition in hospitalized patients. It describes the metabolic response to critical illness and trauma as having an "ebb phase" and "flow phase". The document advocates for early initiation of nutritional support via the enteral route when possible using techniques like post-pyloric feeding tubes, but notes total parenteral nutrition may be needed if enteral nutrition is not tolerated. It provides guidelines on calculating protein and calorie needs and discusses considerations, benefits, risks and protocols for both enteral and parenteral nutrition.
The document discusses endocrine issues in critical illness, including the stress response and its effects on glucose levels and insulin resistance. It presents evidence that tight glycemic control with intensive insulin therapy reduces mortality in critically ill patients. The text also examines glucocorticoid physiology and biosynthesis, noting that adrenal insufficiency is common in sepsis and ICU patients. Studies demonstrate improved outcomes with hydrocortisone replacement in patients with septic shock or adrenal insufficiency.
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,
MEMORIAS TRABAJOS LIBRES
Conferencia Científica Anual sobre Síndrome Metabólico 2015
Efecto comparativo de cuatro modelos de dieta con diferente cantidad y tipo de grasa sobre la disfunción del tejido adiposo en pacientes con síndrome metabólico en estado postprandial
PhD María Eugenia Meneses*, PhD Antonio Camargo-García*, PhD Cristina Cruz-Teno*, PhD Yolanda Jiménez-Gómez**, PhD Pablo Pérez-Martínez*, PhD Javier Delgado-Lista*, PhD María del Mar Malagón-Poyato**, PhD Francisco Pérez-Jiménez*, PhD Helen Roche***, PhD José López-Miranda*
* Unidad de Lípidos y Arteriosclerosis, Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España y CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, ** Departamento de Biología Celular, Fisiología e Inmunología. IMIBIC, (CIBEROBN).Universidad de Córdoba, España, *** Nutrigenomics Research Group, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Republic of Ireland
1. Enteral nutrition is preferred over parenteral nutrition for surgical patients who can tolerate enteral feeding as it decreases complications and helps maintain gut function.
2. There are various enteral formula options depending on a patient's needs including standard, immune-enhancing, high calorie/protein, and organ-specific formulas.
3. Enteral access can be achieved through nasogastric/nasojejunal tubes, percutaneous endoscopic gastrostomy, or in some cases parenteral nutrition is required if enteral feeding is not possible. The goal is to meet energy and protein demands to support healing without overfeeding.
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.
Nutritional needs and weight loss after brain injuryjames young
This document discusses nutritional needs and weight loss after brain injury. It notes that brain injury causes metabolic changes that increase energy demands and protein turnover, leading to hypermetabolism. Early studies found better outcomes with early initiation of feeding within 5-7 days. Indirect calorimetry is considered the gold standard to measure energy needs but variability exists. The hypermetabolic state causes breakdown of muscle proteins and weight loss. Hormonal changes also contribute to hypermetabolism. Protein and calorie requirements are often much higher than normal after brain injury. Both gastric and post-pyloric enteral feedings are used but post-pyloric has less risk of aspiration. Parenteral feeding is reserved for when ent
PowerPoint. Nonradioactive iodine competes with radioactive iodine. This has implications for the use of recombinant human TSH (rhTSH) when preparing differentiated thyroid cancer patients for radioiodine scanning with continued levothyroxine, because the latter contains iodine.
The document discusses steroids used in pediatrics. It covers the anatomy and physiology of the adrenal glands, steroid biosynthesis and the HPA axis. It compares steroid preparations and their potency. The actions, adverse effects, and uses of steroids in neonates and older children are described. Prevention and treatment of side effects are also covered.
This document describes a study that aimed to test the hypothesis that the non-protein calorie to nitrogen ratio (NPC/N ratio) is a determinant of clinical outcomes in critically ill patients. The study analyzed data from 69 patients with esophageal cancer who were admitted to the ICU after surgery. The patients were divided into groups based on their median energy, protein intake, and NPC/N ratio values. Outcomes like ICU length of stay, highest CRP levels, and insulin doses were compared between the groups. Logistic regression was also used to analyze relationships between variables and shorter ICU stays. The results found that patients with a protein intake below 0.48 g/kg/day had a significantly shorter ICU stay. Those with an NPC
The document discusses parenteral nutrition for critically ill patients. It begins by noting the high prevalence of malnutrition in ICUs and challenges in predicting metabolic needs. It then covers the indications for and types of parenteral nutrition, including total and peripheral parenteral nutrition. Practical considerations for intravenous site selection and formulations are discussed. The requirements and recommendations for energy, fluids, carbohydrates, proteins, fats, electrolytes, trace elements and vitamins are provided. Finally, preparations of single and multi-nutrient parenteral nutrition solutions are described.
The document summarizes research on the role of fructose and insulin resistance in obesity from an evolutionary perspective. It discusses how:
1) Fructose consumption leads to insulin resistance and hyperinsulinemia, which antagonizes leptin and promotes energy storage.
2) This would have provided an evolutionary advantage by allowing for seasonal weight gain and energy storage when fruit was abundant before winter.
3) However, in modern diets with year-round fructose availability from added sugars, it causes chronic rather than seasonal insulin resistance and obesity.
Turbo Metabolism
Weight loss has got to be the most frustrating experience for many people, young and old alike. Eating foods that are just horrible, denying yourself foods you truly love and enjoy. Exercising, even though you absolutely hate exercising, and end up stiff as a board with no results. Finally Learn amazing secrets that will increase your metabolism, allowing your body to turn into a fat burning furnace day after day!
http://rapbank.com/go/5835/75255
Bulletproof conf 2014 dominic d agostino ketones finalDominic D'Agostino
This document summarizes a presentation by Dr. Dominic D'Agostino on metabolic therapies including ketosis and exogenous ketones. It discusses how ketones can provide resilience against conditions like hypoglycemia, seizures, and cancer. Experiments show that ketone supplementation can increase muscle power and reduce oxygen consumption during exercise at a fixed workload. Overall, the presentation explores how ketone bodies and ketosis may enhance health, performance, and protect against disease.
This document discusses obesity and energy balance regulation in the body. It covers topics such as the definition of BMI, types of adipose tissue, health risks of obesity, and trends in obesity worldwide. It then discusses factors contributing to the current obesogenic environment like increased food availability and decreased physical activity. The remainder of the document details the biological mechanisms of energy homeostasis, including hormones like leptin that regulate appetite and metabolism, as well as brain centers involved in energy balance. Potential future therapies for obesity that target these biological pathways are also mentioned.
Sugarcane Ash and Sugarcane Ash-Derived Silica Nanoparticles Alter Cellular M...Arthur Stem
Multiple epidemics of chronic kidney disease of an unknown etiology (CKDu), primarily in young healthy agricultural workers, have emerged in agricultural communities around the world. It is proposed that heat stress, dehydration and/or toxicant exposures may be a cause of this emerging disease. We have hypothesized that the harvest and burning of sugarcane leading to inhalation of sugarcane ash may contribute to development of CKDu. Sugarcane stalks consist of ~80% amorphous silica and we have demonstrated that following burning of sugarcane, nano-sized silica particles (~200 nm) are generated.
1) The document discusses combining the ketogenic diet and hyperbaric oxygen therapy to treat cancer. Experiments on mice with metastatic cancer showed that the combination of these therapies significantly inhibited tumor growth and spread and doubled survival time compared to other treatments.
2) The ketogenic diet starves cancer cells of their preferred fuel (glucose) and forces the body to burn fat and produce ketone bodies instead, which cancer is less able to use as an energy source. Hyperbaric oxygen therapy increases oxygen in tissues and blood, creating oxidative stress selectively toxic to cancer cells.
3) Preliminary results suggest this metabolic therapy may provide a non-toxic and cost-effective way to potentially treat aggressive late-stage cancers,
Total parenteral nutrition (TPN) involves providing patients with essential nutrients intravenously when they cannot eat normally. It is indicated when oral feeding is not possible due to conditions that prevent digestion or absorption of nutrients from food. TPN can be administered either peripherally or centrally depending on the patient's needs and condition. Close monitoring is required when a patient is on TPN to avoid complications like infection, metabolic imbalances, and overfeeding. Nutrition is an important part of medical treatment that should not be neglected for critically ill patients.
An analysis of metabolic fluxes in contracting human muscleGreg Crowther
This document summarizes research on analyzing metabolic fluxes in human muscle using phosphorus NMR spectroscopy. It discusses:
1. Why studying cellular metabolism in muscle is important, as it can provide insights into whole-body health and lead to medical advances.
2. How phosphorus NMR spectroscopy combined with force measurements can quantify metabolic fluxes non-invasively in vivo by monitoring changes in phosphocreatine and pH levels.
3. Findings that both elevated metabolite levels and a muscle activation factor like calcium are needed to initiate and sustain high glycolysis rates in muscle.
This document summarizes the results of an umbrella review of screening tools for predicting risk and outcomes in frail older adults. Several screening tools were evaluated across multiple systematic reviews for their reliability, validity, diagnostic accuracy, and predictive ability. The Frailty Index and gait speed screening tools demonstrated good predictive ability for future disability, while results for tools used in emergency departments were less reliable. Further research is needed to establish generalizability and use of screening tools for prevention and assessing intervention outcomes.
This document discusses hyperthermia, also known as heat injury or heat illness. It defines hyperthermia as a condition caused by prolonged exposure to high temperatures that overwhelms the body's ability to regulate its temperature. The document outlines the causes and risk factors, pathogenesis, clinical presentation including heat cramps, heat exhaustion and heat stroke, diagnosis, treatment including hypothermia therapy, and prevention of hyperthermia. Traditional Chinese medicine approaches for prevention and treatment such as heat-clearing drinks and medicines are also discussed.
The document discusses endocrine issues in critical illness, including the stress response and its effects on glucose levels and insulin resistance. It presents evidence that tight glycemic control with intensive insulin therapy reduces mortality in critically ill patients. The text also examines glucocorticoid physiology and biosynthesis, noting that adrenal insufficiency is common in sepsis and ICU patients. Studies demonstrate improved outcomes with hydrocortisone replacement in patients with septic shock or adrenal insufficiency.
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,
MEMORIAS TRABAJOS LIBRES
Conferencia Científica Anual sobre Síndrome Metabólico 2015
Efecto comparativo de cuatro modelos de dieta con diferente cantidad y tipo de grasa sobre la disfunción del tejido adiposo en pacientes con síndrome metabólico en estado postprandial
PhD María Eugenia Meneses*, PhD Antonio Camargo-García*, PhD Cristina Cruz-Teno*, PhD Yolanda Jiménez-Gómez**, PhD Pablo Pérez-Martínez*, PhD Javier Delgado-Lista*, PhD María del Mar Malagón-Poyato**, PhD Francisco Pérez-Jiménez*, PhD Helen Roche***, PhD José López-Miranda*
* Unidad de Lípidos y Arteriosclerosis, Servicio de Medicina Interna, IMIBIC/Hospital Universitario Reina Sofía/Universidad de Córdoba, Córdoba, España y CIBER Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, ** Departamento de Biología Celular, Fisiología e Inmunología. IMIBIC, (CIBEROBN).Universidad de Córdoba, España, *** Nutrigenomics Research Group, UCD Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Republic of Ireland
1. Enteral nutrition is preferred over parenteral nutrition for surgical patients who can tolerate enteral feeding as it decreases complications and helps maintain gut function.
2. There are various enteral formula options depending on a patient's needs including standard, immune-enhancing, high calorie/protein, and organ-specific formulas.
3. Enteral access can be achieved through nasogastric/nasojejunal tubes, percutaneous endoscopic gastrostomy, or in some cases parenteral nutrition is required if enteral feeding is not possible. The goal is to meet energy and protein demands to support healing without overfeeding.
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.
Nutritional needs and weight loss after brain injuryjames young
This document discusses nutritional needs and weight loss after brain injury. It notes that brain injury causes metabolic changes that increase energy demands and protein turnover, leading to hypermetabolism. Early studies found better outcomes with early initiation of feeding within 5-7 days. Indirect calorimetry is considered the gold standard to measure energy needs but variability exists. The hypermetabolic state causes breakdown of muscle proteins and weight loss. Hormonal changes also contribute to hypermetabolism. Protein and calorie requirements are often much higher than normal after brain injury. Both gastric and post-pyloric enteral feedings are used but post-pyloric has less risk of aspiration. Parenteral feeding is reserved for when ent
PowerPoint. Nonradioactive iodine competes with radioactive iodine. This has implications for the use of recombinant human TSH (rhTSH) when preparing differentiated thyroid cancer patients for radioiodine scanning with continued levothyroxine, because the latter contains iodine.
The document discusses steroids used in pediatrics. It covers the anatomy and physiology of the adrenal glands, steroid biosynthesis and the HPA axis. It compares steroid preparations and their potency. The actions, adverse effects, and uses of steroids in neonates and older children are described. Prevention and treatment of side effects are also covered.
This document describes a study that aimed to test the hypothesis that the non-protein calorie to nitrogen ratio (NPC/N ratio) is a determinant of clinical outcomes in critically ill patients. The study analyzed data from 69 patients with esophageal cancer who were admitted to the ICU after surgery. The patients were divided into groups based on their median energy, protein intake, and NPC/N ratio values. Outcomes like ICU length of stay, highest CRP levels, and insulin doses were compared between the groups. Logistic regression was also used to analyze relationships between variables and shorter ICU stays. The results found that patients with a protein intake below 0.48 g/kg/day had a significantly shorter ICU stay. Those with an NPC
The document discusses parenteral nutrition for critically ill patients. It begins by noting the high prevalence of malnutrition in ICUs and challenges in predicting metabolic needs. It then covers the indications for and types of parenteral nutrition, including total and peripheral parenteral nutrition. Practical considerations for intravenous site selection and formulations are discussed. The requirements and recommendations for energy, fluids, carbohydrates, proteins, fats, electrolytes, trace elements and vitamins are provided. Finally, preparations of single and multi-nutrient parenteral nutrition solutions are described.
The document summarizes research on the role of fructose and insulin resistance in obesity from an evolutionary perspective. It discusses how:
1) Fructose consumption leads to insulin resistance and hyperinsulinemia, which antagonizes leptin and promotes energy storage.
2) This would have provided an evolutionary advantage by allowing for seasonal weight gain and energy storage when fruit was abundant before winter.
3) However, in modern diets with year-round fructose availability from added sugars, it causes chronic rather than seasonal insulin resistance and obesity.
Turbo Metabolism
Weight loss has got to be the most frustrating experience for many people, young and old alike. Eating foods that are just horrible, denying yourself foods you truly love and enjoy. Exercising, even though you absolutely hate exercising, and end up stiff as a board with no results. Finally Learn amazing secrets that will increase your metabolism, allowing your body to turn into a fat burning furnace day after day!
http://rapbank.com/go/5835/75255
Bulletproof conf 2014 dominic d agostino ketones finalDominic D'Agostino
This document summarizes a presentation by Dr. Dominic D'Agostino on metabolic therapies including ketosis and exogenous ketones. It discusses how ketones can provide resilience against conditions like hypoglycemia, seizures, and cancer. Experiments show that ketone supplementation can increase muscle power and reduce oxygen consumption during exercise at a fixed workload. Overall, the presentation explores how ketone bodies and ketosis may enhance health, performance, and protect against disease.
This document discusses obesity and energy balance regulation in the body. It covers topics such as the definition of BMI, types of adipose tissue, health risks of obesity, and trends in obesity worldwide. It then discusses factors contributing to the current obesogenic environment like increased food availability and decreased physical activity. The remainder of the document details the biological mechanisms of energy homeostasis, including hormones like leptin that regulate appetite and metabolism, as well as brain centers involved in energy balance. Potential future therapies for obesity that target these biological pathways are also mentioned.
Sugarcane Ash and Sugarcane Ash-Derived Silica Nanoparticles Alter Cellular M...Arthur Stem
Multiple epidemics of chronic kidney disease of an unknown etiology (CKDu), primarily in young healthy agricultural workers, have emerged in agricultural communities around the world. It is proposed that heat stress, dehydration and/or toxicant exposures may be a cause of this emerging disease. We have hypothesized that the harvest and burning of sugarcane leading to inhalation of sugarcane ash may contribute to development of CKDu. Sugarcane stalks consist of ~80% amorphous silica and we have demonstrated that following burning of sugarcane, nano-sized silica particles (~200 nm) are generated.
1) The document discusses combining the ketogenic diet and hyperbaric oxygen therapy to treat cancer. Experiments on mice with metastatic cancer showed that the combination of these therapies significantly inhibited tumor growth and spread and doubled survival time compared to other treatments.
2) The ketogenic diet starves cancer cells of their preferred fuel (glucose) and forces the body to burn fat and produce ketone bodies instead, which cancer is less able to use as an energy source. Hyperbaric oxygen therapy increases oxygen in tissues and blood, creating oxidative stress selectively toxic to cancer cells.
3) Preliminary results suggest this metabolic therapy may provide a non-toxic and cost-effective way to potentially treat aggressive late-stage cancers,
Total parenteral nutrition (TPN) involves providing patients with essential nutrients intravenously when they cannot eat normally. It is indicated when oral feeding is not possible due to conditions that prevent digestion or absorption of nutrients from food. TPN can be administered either peripherally or centrally depending on the patient's needs and condition. Close monitoring is required when a patient is on TPN to avoid complications like infection, metabolic imbalances, and overfeeding. Nutrition is an important part of medical treatment that should not be neglected for critically ill patients.
An analysis of metabolic fluxes in contracting human muscleGreg Crowther
This document summarizes research on analyzing metabolic fluxes in human muscle using phosphorus NMR spectroscopy. It discusses:
1. Why studying cellular metabolism in muscle is important, as it can provide insights into whole-body health and lead to medical advances.
2. How phosphorus NMR spectroscopy combined with force measurements can quantify metabolic fluxes non-invasively in vivo by monitoring changes in phosphocreatine and pH levels.
3. Findings that both elevated metabolite levels and a muscle activation factor like calcium are needed to initiate and sustain high glycolysis rates in muscle.
This document summarizes the results of an umbrella review of screening tools for predicting risk and outcomes in frail older adults. Several screening tools were evaluated across multiple systematic reviews for their reliability, validity, diagnostic accuracy, and predictive ability. The Frailty Index and gait speed screening tools demonstrated good predictive ability for future disability, while results for tools used in emergency departments were less reliable. Further research is needed to establish generalizability and use of screening tools for prevention and assessing intervention outcomes.
This document discusses hyperthermia, also known as heat injury or heat illness. It defines hyperthermia as a condition caused by prolonged exposure to high temperatures that overwhelms the body's ability to regulate its temperature. The document outlines the causes and risk factors, pathogenesis, clinical presentation including heat cramps, heat exhaustion and heat stroke, diagnosis, treatment including hypothermia therapy, and prevention of hyperthermia. Traditional Chinese medicine approaches for prevention and treatment such as heat-clearing drinks and medicines are also discussed.
The document discusses disorders of water and electrolyte metabolism. It covers:
- Water and electrolytes (ions like sodium, potassium, calcium) are important components of body fluids that help regulate cell function and metabolism.
- Homeostasis (balance) of water volume, electrolyte levels, and fluid distribution between intracellular and extracellular compartments is vital. Disorders can result from diseases that cause vomiting, diarrhea, or other fluid/electrolyte imbalances.
- Understanding the pathogenesis (cause) and changes in water and electrolyte disturbances is important for clinical work in treating disorders. Factors like antidiuretic hormone and aldosterone help regulate fluid balance and electrolyte levels in the body
The document summarizes characteristics of a sample of 116 patients, including:
- 71.6% were male and 28.4% were female
- 36.2% were over 45 years old and 63.8% were under 45
- The mean APRI score was 0.92 with a standard deviation of 2.09
- The mean ALT level was 62.36 with a standard deviation of 80.81
- 55% of patients had AFP levels measured, with a mean of 5.79 and standard deviation of 9.3
This document discusses peritoneal dialysis (PD) as a treatment option for elderly patients with end-stage renal disease (ESRD). It notes that while the elderly population is growing, few elderly patients receive PD. The document reviews studies that found no differences in mortality, technique failure rates, or peritonitis rates between elderly and younger PD patients. Quality of life was also similar or better for elderly patients on PD compared to hemodialysis. Factors like assisted care, reduced dialysis prescriptions, and extended care facilities can help improve outcomes and quality of life for elderly patients receiving PD.
The document provides the schedule and program for a hepatitis event being held from July 28-31, 2022. The event includes educational sessions on hepatitis viruses, free liver fibrosis screening and testing for hepatitis B and C, vaccination for hepatitis B, and blood donation. The schedule details the times, locations, speakers and topics for educational seminars, webinars, and screening activities across the 4 days of the event.
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Mr. Brainwash ❤️ Beautiful Girl _ FRANK FLUEGEL GALERIE.pdfFrank Fluegel
Mr. Brainwash Beautiful Girl / Mixed Media / signed / Unique
Year: 2023
Format: 96,5 x 127 cm / 37.8 x 50 inch
Material: Fine Art Paper with hand-torn edges.
Method: Mixed Media, Stencil, Spray Paint.
Edition: Unique
Other: handsigned by Mr. Brainwash front and verso.
Beautiful Girl by Mr. Brainwash is a mixed media artwork on paper done in 2023. It is unique and of course signed by Mr. Brainwash. The picture is a tribute to his own most successful work of art, the Balloon Girl. In this new creation, however, the theme of the little girl is slightly modified.
In Mr. Brainwash’s mixed media artwork titled “Beautiful Girl,” we are presented with a captivating depiction of a little girl adorned in a summer dress, with two playful pigtails framing her face. The artwork exudes a sense of innocence and whimsy, as the girl is shown in a dreamy state, lifting one end of her skirt and looking down as if she were about to dance. Through the use of mixed media, Mr. Brainwash skillfully combines different artistic elements to create a visually striking composition. The vibrant colors and bold brushstrokes bring the artwork to life, evoking a sense of joy and happiness. The attention to detail in the girl’s expression and body language adds depth and character to the piece, allowing viewers to connect with the young protagonist on a personal and emotional level. “Beautiful Girl” is a testament to Mr. Brainwash’s unique artistic style, blending elements of street art, pop art, and contemporary art to create a visually captivating and emotionally resonant artwork.
The use of mixed media in “Beautiful Girl” adds an additional layer of complexity to the artwork. By combining different artistic techniques and materials, such as stencils, spray paint, and collage, Mr. Brainwash creates a dynamic and textured composition that grabs the viewer’s attention. The juxtaposition of different textures and patterns adds depth and visual interest to the piece, while also emphasizing the artist’s eclectic and experimental approach to art-making. The inclusion of collage elements, such as newspaper clippings and torn posters, further enhances the artwork’s urban and contemporary feel. Overall, “Beautiful Girl” is a visually captivating and thought-provoking artwork that showcases Mr. Brainwash’s talent for blending different artistic elements to create a truly unique and engaging piece.
1. ESPEN LLL Course
Topic 18 - Nutritional Support in Intensive Care Unit Patients
Energy in the ICU
Module 18.1
M. Hiesmayr, MD, MSc
2. Outline: Energy
• Energy production in human
-quantitative physiology
-regulation & storage
-sensing of deprivation
• Effects of critical illness
•ATP
•Mitochondria & respiratory chain:
•Substrates
• Measurement & strategic
•Estimation
•Measurement
•Kcal & RQ
•special conditions: renal replacement, ECMO
3. Energy = ATP
•ATP
- Exclusive form of energy in humans supported by FAD, NAPD & Creatin
Phosphate
- generated from glycolysis & oxydative phosphorylati
- All macronutrients (glucose, lipids, amino acids) are
- possible substrates but also alcohol and some infused substances like lactate,
acetate, malate and citrate
- 1 mol= 507.18 g
•Units
- Jo ul e: 1 Newton. 1 meter
- Kcal= 4.18 kJ
- Watt= 1 J/second
- (climbing a stair 200 W = 172 Kcal ,
- at rest 80 W = 70 Kcal)
-
4. ATP content in ICU patients
• correlates with severity (norepinephrine)
Brealey D et al (M.Singe r} Lancet 2002; 360: 219-2
7. ATP & ADP in adult human
• ATP very fast recycling!
• Any disturbance of
oxydative
phosphorylation affects
cellular energy
availability
• ATP:ADP ratio in tissue 200:1 ??
8. Exercise increases energy
consumption
Comparison with HBE
Minimal exercise (3/6W) necessitates
more energy than in controls
Extra energy of 30 min exercise: 4.5 I V0 2 or 30 Kcal
Exercise in ICU is often of short duration (fatigue)
Hickmann CE et al lntens Care M ed 2014; 40: 548-55
9. 24 h Fasting & Refeeding
Volume
Glycogen
Lipid
Awad et al Cli n Nutr 2010: 29:538
10. Relative contribution of processes to whole
body energy consumption
• Protein turnover
• Na+/K+ ATPase
• Mitochondrial proton leak
• Triacylglycerol turnover
• Calcium cycling
• Gluconeogenesi s
• Ure agenesis
• Actinomyosin ATPase
• DNA/RNA turnover
• Substrate cycling
20-30%
20-28%
20-25%
<3%
4-10%
5-10%
<3%
<80/o
<20/o
<5%
r
ICU patie nts: Flat batteries = less essential processes reduced
Rolfe OF, Brow n GC. Physiol Rev 1997; 77: 731-58.
Singer M Crit Care 2017; 21 (Suppl 3 ): 309
11. Formula & weight:
a trick to be more precise
Whatever ,,tr ick" is applied > 50% of energy estimates are out of range
Graf S e t a l. Clin Nutr 2017; 36: 224-28
12. - - -
How much energy consumes
an intact organ
Leibel e t al.Met bo lis m 1984; 33:164-170 & Wang et al.
-= Am J Physio l End ocrinol M
etab 2000
; 27 9: E539 - E545
-
14. Mitochondria adapt to stress:
fusion & fission
•Mitochondria division to recover
membrane potential or mitophagy or death
Friedman JR & Nunnari J Nature 2014; 505: 335-34
16. Metabolic rate in sepsis
Kreyman et a l. Cr1tt Ca re Med 1993; 21: 101 2-19
17. Basal energy use versus age & gender
Speakman & Weste rte rp, Am J Clin Nutr 2010; 92: 826-834
18. Step 3: ICU
adaptive nutrition
With Progressive ,,artificial nutrition” (EN/PN) the feeding from inside
the body program is progressively reduced and body loss is reduced
19. Metabolic rate &
temperature in sepsis
None of the sepsis states was associated with an
increase of REE when temperature increased
2 factors: centralisation I proton leakage
Kreymann et al. Crit Care Med 1993; 21: 1012-19
21. ICU treatment modifies energy
production/consumption:
level of sedation
Terao Yet al Crit Care Med 2003; 31: 830-3.
22. A complex city as an analogy
Activity (metabolic) can be determined by observing how much fuel is transported
in and what remains on the train on the way out. Alternatively you observe the
waste (smoke). Observing exported products ignores internal activity.
23. USE of a specific device
for metabolic measurement
VE is determined either with a
mixing chamber or with a
flowmeter breath by breath.
The difficulty is the
Synchronisation of the measured
gas concentrations with the
expiratory flow.
Fi0 2 appears to fluctuate in
some ventilators.
24. Ho rton et al. JAP 20 01; 90 :1 5 5- 16 3
3 days no nutrition:
induced insulin resistance
26. Creatine Phosphate - ATP:
an dual exercise system
Creatine Phosphate:
A battery for 15 seconds
Lactate in muscle
ATP appears less
efficient after 15
seconds because
another energy
provider (CP) was
used initially
Bangsbo J et al A
m J Physiol Endocrinol Metab 280; E956
Lactate release into blood
• I
ATP Production plateau:
After 15 seconds
28. REE vs substrate provision:
outcome at 60 days
Best outcome at substrate
supply for 70% of measured
REE
means that 30% of
substrates are endogenously
produced in the critically ill and
are not suppressed at this
stage of illness
by artificial nutrition provided at
REE .
Zusman et al. Crit Care 2016; 20: 367
29. 3100 Kcal
on indirect calorimetry
Patient: male 80 kg 185 cm 72 a temp 37.3°C
ruptured AAA repair with large transfusion
- Day 6 in ICU
- Arousable on minimal continuous opiods
- CRP 12 falling
- Pressure support (11mbar) ventilation 9
Liter/'
- Ileus / IAP 15 mbar / GRV 450 ml
- Nearly anuric / CRRT
- Trophic feeding + PN 1500 Kcal/24 hours
• Impossible!
30. ECMO: full double IC
calorimetry for the patient & the
ECMO circuit
90% of gas e xchange via ECMO
Applying the Weir formula on the combined
Data produced a REEcomposite of 1703 kcal/day.
Implementing the manual-derived VO2 and
VCO2 membrane oxygenator characteristics
into the Weir formula retrived a REE of
1729 kcal/day. The Faisy-Fagon and Harris-
Benedict equations yielded REE values of 1373
And 1563 kcal/d. Application of the ESPEN
Guideline estimated REE in our patient at
1675 kcal/d
31. Indirect Calorimetry:
conditions?
- Stability for 30 minutes
- No change in drugs(all ?)
- Vasoactive
- Sedation/pain
- Fluid
• Postprandial/fasted?
• Fi02 < 0.6
• PEEP <14 (PIP???)
• No leak
• No CRRT? 1.5-4°/o underestimation?
• No ECMO?
33. ICU: energy factors
• Sedation
• Pain treatment
• Muscle relaxants
• Antiphlogistic
• Antipyretic
• Shock
• Vasoconstriction
• Organ loss
• Organ
dysfunction
• Awakening
• Dyspnea
• Weaning
• Shivering
• Seizures
• Delirium
• Infla mm a tio n
• Fever
• Wounds
• Organ repair
• Physiotherapy_
34. Learning objectives:
• Protein metabolism in the critically ill
• Higher protein intake increases whole protein content in
the body
• What is the best protein intake during the early or late
period of the acute phase and in the post acute phase for
PICS or rehabilitation
• No strong evidence for high protein administration
(more than 1.3 g/kg/d) in ICU patients
• Disease specific protein thera
py for trauma,renal or frail
and elderly patients
35. Conclusion
• Energy = ATP production is depressed in ICU
patients.
• Substrates (CHO/Lipid/Protein(AA) are the fuel
to produce ATP in oxydative phosphorylation
• Many factors modify energy consumption in
ICU: treatments and organ priorities
• Measurement is better than all formula but
does only suggest the amount of fuel needed in
the actual clinical state
• Extreme amount of fuel can impair endogenous
repair mechanism (mitophagylautophagy)
42. Skeletal muscle quality as assessed by
CT-derived skeletal muscle density is
associated with 6-month mortality in
mechanically ventilated critically ill patients
43. Should We Prescribe More
Protein to Critically Ill Patients?
Heyland DK1,2,3, Stapleton R4, Compher C5
44. What to do to improve
outcome and preserve
muscles?
• Give more?
• Give early?
45.
46. What is early?
• The timing: starting during the
first 72 hours, regardless of the
dose?
• The amount: Early and plenty:
up to 1 g/kg/d within 72 hours
47. Increase in
mortality?
Casaer M P, W il m er A, Hermans G, Wouters PJ, M esott en D, Van den
Berghe G. Role o f disease and macronutrient dose in the random ized
co nt ro ll ed EPaNIC t rial. A post hoc analysis. Am J Respir Crit Care
Med 2013; 187: 247- 255.
48. 60 days mortality: 36% in early and 43% in
late protein administration (p<0.001 for
difference) Cox analysis: HR 0.84, 95% Cl 0.72-
0.98, p=0.01
49. Every 1 g of
protein
increases
Survival by
1%
Resting energy expenditure,calorie and
protein consumptionin critically ill
patients: a retrospective cohort study
Crit Ca re 2016
Oren Zusman1* , Miriam Theilla2,3, Jonathan Cohen2,4, Ilya Kagan2 , Itai Bendavid2 and Pierre Singer2,4
50. Nutr Clin Pract. 2017; 32: 121-5 1275
High protein
Intake > 2
g/kg/day
Recommended
Like in cancer,
Burns,
Nutrition Support for Persistent Inflammation,
Immunosuppression, and Catabolism Syndrome
Frederick A. Moore, MD1 ; Stuart Phillips, PhD2 ; Craig McClain,
MD3 ; Jayshil J. Patel, MD4 ; and Robert Martindale, MD, PhD5
51.
52. Organs with a large turnover may be susceptible to decreased free amino-
acids. Some organs are prioritized in acute illness.
Attaix D,Boirie Y Normal protein homeostasis
Daily protein turnover
in individual organs