nutrition and malnutrition, metabolic response to trauma

about nutrition in surgical patients

1. Develops when the body does not get the right amount of macronutrients, vitamins, and minerals it needs to maintain healthy tissues and organ function Malnutrition is common. It occurs in about 30% of surgical patients with gastrointestinal disease and in up to 60% of those in whom hospital stay has been prolonged because of postoperative complications.

2. Metabolic response to starvation ● Low plasma insulin ● High plasma glucagon ● Hepatic glycogenolysis ● Protein catabolism ● Hepatic gluconeogenesis ● Lipolysis : mobilisation of fat stores (increased fat oxidation) – overall decrease in protein and carbohydrate oxidation ● Adaptive ketogenesis ● Reduction in resting energy expenditure (from approximately 25–30 kcal/kg per day to 15–20 kcal/kg per day

3. Metabolic response to trauma and sepsis ● Increased counter-regulatory hormones: adrenaline, noradrenaline , cortisol , glucagon and growth hormone ● Increased energy requirements (up to 40 kcal/kg per day) ● Increased nitrogen requirements ● Insulin resistance and glucose intolerance ● Preferential oxidation of lipids ● Increased gluconeogenesis and protein catabolism ● Loss of adaptive ketogenesis ● Fluid retention with associated hypoalbuminaemia

4. NUTRITIONAL ASSESSMENT Laboratory techniques Body weight and anthropometry Clinical

5. M alnutrition U niversal S creening T ool

6. FLUID AND ELECTROLYTES

7. Loss of fluids Lungs . About 400 mL of water is lost in expired air each 24 hours. Skin . In a temperate climate, skin (i.e. sweat) losses are between 600 and 1000 mL /day. Faeces . Between 60 and 150 mL of water are lost daily. Urine . The normal urine output is approximately 1500  mL / day and, provided that the kidneys are healthy, the specific gravity of urine bears a direct relationship to volume. A minimum urine output of 400 mL /day is required to excrete the end products of protein metbolism .