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1| Alteration in Metabolism in surgical px (Stress (Response to trigger …
1| Alteration in Metabolism in surgical px
Baseline composition
Glycogen
Protein
Shouldn't be fuel
Forms structure
Converted to glucose
Fat
Nitrogen balance
:red_cross:
Positive (GH, Insulin, Androgens)
Growth
Pregnancy
Recovery from illness
Negative (Corticosteroids, T4)
Starvation
Illness
Injury
Protein depletion results in
:red_cross:
Bad healing
Bad immunity (mucosal barrier)
Bad respiration (pneumonia)
Determinants
: Age
Less muscle
More fat
Less strength
Determinant
: Gender
Lean body mass
Nitrogen loss more male
To promote healing
Nutrition
Vitamin A/E
No infection
Stress
Triggers
:red_cross:
Volume loss
Pain/Fear
Trauma
Infection
Responses
:red_cross:
Physiological (Metab/Hormon/Immun/Haem)
Psychologcial (Malaise)
Behavioural (Reluctance to move)
Response to trigger
:red_cross:
Volume loss
Pressure/Stretch receptors
HR/SV inc
RAAS
Tissue damage (Most impt)
:red_cross:
Neural pathway to hypothalamus
Inc glucagon, Dec insulin
Inc cortisol, Inc catecolamines
Pain & Fear
Inc catecholamine
Fight or flight
Elective Surgery vs Trauma
:red_cross:
Minimal tissue damage
Minimal volume loss
Minimal fear/pain
Minimal infection
Cytokine confined to wound
Starvation vs Injury
:red_cross:
BMR: Low vs high
Mediators: Low vs high
Fuel: Fat vs Mixed
Ketone: High vs Low
Adrenergic corticoid responses
:red_cross:
Neurohormonal
Catecholamines
Glucagon
Glucocorticoid/ACTH
RAAS
Decrease insulin/androgen
Inflammatory (Cytokine local/systemic)
:red_cross:
Wound healing
Angiogensis
WBC migration
Fibroblast
Fever/Vasodilation/Hypotension
SIRS
Stressed State 1-3days in elective
:red_cross:
Altered glucose metabolism (hyperglycemia)
Altered protein metabolism (muscle protein)
Altered fat metabolism
1L 5% dextrose is sufficient till 5-7days in elective