5 Written Questions

1. -indirect calorimetrey is best
   -increased needs in sepsis trauma, catabolic illness
   -Pro: 1.5-2.0 g/kg (rapid turnover)
   -check UUN: measures pro catabolism. Want positive nitrogen balance.
2. Infection + 2 or more components of SIRS
3. -Use of indirect calorimetry
   -pro needs: 2.5-3.0g/kg BW
   -monitor BUN and CR
   -Arginine may improve cell mediated immunity and wound healing
   -Glutamin may enhance ability of certain neutrophils to kill some bacteria
   -Monitor N balance
4. infection + 2 SIRS + organ dysfunction + Hypotension
5. • Widespread inflammation that occurs with infection, trauma, not at site of infection/trauma
   • Can cause multiple organ dysfunction syndrome (MODS)
   o Lung failure  liver  intestine  kidney  hematologic  heart
   o CNS dysfunction can occur at any time
   • Whole body pro-inflammatory response in the body
   • Associated with sepsis
   Early MODS

5 Matching Questions

1. Metabolic response: Anabolic Phase
2. Acute Stress
3. 3 phases of ARDS
4. ARDS: Exudative Phase
5. Severe Sepsis

1. a Infection + 2 SIRS + organ dysfunction
2. b Exudative, proliferative, and fibrotic
3. c Body can handle
4. d  1st few days
    Damage to endothelial & epithelial layers of alveoli leading to impaired gas exchange 
   • Acute inflammation
   • Pulmonary edema
   • Atelectasis (collapsed lungs)
   • Reduced lung compliance
   • ↑ work of breathing
   • *Give surfactant to reduce over workload of the lungs
5. e  Characterized by:
   • Repletion of LBM & adipose tissue
   • Catabolic hormones & EE begin to ↓
    Pts remain significantly hypermetabolic
    The inability to meet energy & protein needs can lead to delays in wound healing, infectious complications & debilitation
    Can last for months
    *Still need increased energy & pro to replete
    BG has relation to wounds: If have ↑ BG, longer to heal

5 Multiple Choice Questions

1. -Glycogen quickly depleted
   -LBM broken down, Gluconeogenesis.
   -Liver uses Alanine.
   -Muscles use BCAA. (By product urea).
   -Kidney uses Glutamine. (byproduct NH3)
   1. Prolonged starvation
   2. Starvation
   3. Acute Stress
   4. Early starvation
2.  Systemic process
    Sepsis
    Trauma
    Pancreatitis
    Fat emboli
    Shock/Hypoperfusion
   1. ARDS: Nutrient Needs
   2. ARDS etiology (Direct Injury)
   3. ARDS: Proliferative Phase
   4. ARDS etiology (indirect injury)
3. o ↑ Metabolic rate
   o Hyperglycemia
   o ↑ Glucagon = ↑ Gluconeogenesis
   o ↑ Cortisol = ↑ Gluconeogenesis
   o ↑ ACTH = ↑ Lipolysis, AA mobilization, glucagon release, inhibits insulin, prosynthesis, hyperglycemia
   o ↑ Growth hormone
    * ACTH: Acetocorticotrophic hormone
    *NOTE: Glucagon = catabolic; Insulin= Anabolic
   1. Catecholamines cause...
   2. 3 phases of ARDS
   3. Metabolic Cart:
   4. Metabolic cart
4. metabolic rate increases
   1. Acute Stress
   2. Prolonged stress
   3. Prolonged starvation
   4. Stress
5. • Measures:
   o O2 consumption (VO2)
   o CO2 production (VCO2)
   • Calculates REE - Weir equation
   • Determines substrate utilizarion
   1. Metabolic Cart:
   2. Metabolic cart
   3. Sepsis
   4. Septic Shock

5 True/False Questions

1. Starvation → -Preserve LBM
   -consume hepatic glycogen, FA

   True        False

2. Sepsis → -Preserve hepatic mass
   -LBM loss---> AA fuel: hepatic acute phase proteins, gluconeogenesis
   -Hyperglycemia

   True        False

3. Metabolic cart → -Measures O2 consumption and CO2 production
   -Calculates REE-weir equation
   -Determines Substrate utilization (RQ)

   True        False

4. Metabolic response:Stress phase (ebb phase) →  Characterized by:
   • ↑ Energy expenditure
   • Hypercatabolism
   • Proteolysis Gluconeogenesis
   • Protein catabolism
    Immunologic response also contributes to ↑ catabolism
   • ↑ Pro-inflammatory cytokines, TNF, IL-1, IL-6
    Occurs after resuscitation & usually lasts 7-10 days

   True        False

5. Stress → o ↑ Glucose uptake in peripheral tissues
   o ↑Lactate production  Gets recycled by Cori cycle  Lactate becomes Glu
   o Anaerobic Glycolysis

   True        False