Metabolic Stress Metabolic Stress Metabolic stress can place a patient at the highest level of nutritional risk possible Body becomes overwhelmed due to the high level of stress The system is initially overwhelmed and unable to respond appropriately allowing for protein energy malnutrition or PEM to develop Body becomes unable to respond appropriately Protein Energy Malnutrition PEM develops as a result Physiological Response to Starvation Malnutrition Possible Case for metabolic stress Metabolic Stress vs Starvation Metabolic Stress When body is unable to utilize nutrients appropriately or when its nutrition needs are so high that current intake cant meet those needs or demands Starvation Energy Requirements increased o Have increased energy needs during metabolic stress or injury Primary fuel source varied usually protein o Normal adaptation that should occur don t usually occur o Protein source of glucose break down of body muscle and lean body mass don t want because want to preserve o In extreme stress your body will revert to whatever it can to get fuel and energy needed which will be protein o 25 1 comparison of metabolism during normal nutrition state 786 Metabolic nutritional state starvation Energy needs reduced as the body adapts to fewer kcals protein o Adaptation that occurs where overall energy need is reduced as a respond to reduced PO intake or food intake o BMR is reduced fewer calories needed to keep body calories going Primary fuel source is lipids o Prevalently o Ketones allows for the preservation of muscle mass and prevent complication with protein deficiencies o If you don t eat as much as you had BMR drops body goes into storage mode and uses fat as main energy source o Ketones help preserve protein and prevent it from being loss and muscle Physiological Response to Stress mass being depleted Metabolic Stress is the hyper metabolic catabolic response to acute injury or disease Due to diagnosis o Trauma Ex Gun shot wound motor vehicle accident o Closed Head Injury o Severe Inflammation Ex Pancreatitis cancer sepsis hypoxic injury cellular injury which is deprivation of oxygen gangri necrosis of tissue Degree of metabolic stress usually correlates with seriousness of injury injury If highly stressed metabolic stress factor will increase If burn a large part of body more serious than minor head Epidemiology Trauma is the leading cause of death in young people More than 70 of deaths between ages of 15 24 years Caused by physical force falls gunshot wounds drowning stabbing driving accidents by default o 15 24 years in situations that will put them at risk for driving o Not usually considered to have many illness or diseases Etiology Caused by trauma Results in several metabolic consequences Hormone release Acute phase protein synthesis Hypermetabolism Increase reliance on gluconeogenesis Subsequent production of glucose Shifts and fluid balance and decrease in urine output Metabolic Stress Ebb Clinical Manifestations involves a progression through 3 phases how your body will respond immediately after injury occurs and sub sequential days after o Immediately after the injury o Period of 2 48 hours o Characterized by shock your body goes into resulting in hypervolemia and decrease availability of oxygen to the tissues o Decrease blood volume results in decrease cardiac output in urinary output Body in shock Decrease in output Decrease in urinary out put o Goal restore blood flow in organs maintain oxygenation in tissues and stop any hemorrhaging happening internally and externally Flow o as a patient starts to stabilize hemodynamically flow phase begins o characterized by hyper metabolism catabolism altered immune and hormonal response needs increase nutritional needs o body responding to stress Recovery Resolution o Final phase indicates resolution of stress o Body returns to anabolism instead of catabolism o And normal metabolic rates are established o Recovery wont happen for a while can take a very long time to go into recovery phase Stress or injury activate a hormone that indicate the flight or fight response including If injury bad can take months to years depending Hormones glucagon cortisol epinephrine and norepinephrine o Primary purpose to meet immediate energy demands of the body Increased levels of glucagon and increased glucose production from amino acids or gluconeogenesis Cortisol increases gluconeogenesis and free fatty acid FFA mobilization and decreases overall protein synthesis with increase of catabolism of skeletal muscle Catecholamine epinephrine and norepinephrine increase energy availability by stimulate glycogenolysis and increasing the release of fatty acids Hyperglycemia results from glucagon and cortisol release o During stress because regardless of insulin level released under metabolic stress insulin resistance is going to diminish the effectiveness of the insulin o Cells close up and fickle receptors that allow insulin and glucose in cell wont be readily available and open the way they usually are Reliance on protein as glucose source increase gluconeogenesis o The need for amino acid alanine and glutamine become important Alanine primary substrate required for gluconeogenesis Glutamine significant in both immunologic and metabolic pathways Negative nitrogen balance Loss of LBM Catabolism o Common due to nitrogen losses and loss of lean body mass that occurs o Catabolism of skeletal muscle is likely because of increased metabolic stress nd breakdown of protein and lean body mass to meet the needs of body during times Burns Results of tissue injury caused by exposure to heat chemicals radiation or electricity Burn result injury from the skin but damage can results from muscle or bones Injury might seem superficial but can go down to muscle to bones Clinical Manifestations determined by the extent of injury Superficial burns are going to be caused by uv light light flame exposure Table 25 6 burn based on death 795 Superficial partial thickness burns thickness burns caused by scalding spill or splash short flash Deep partial thickness burns scolding spill lame oil grease body exposed to these for a lengthy time rather than a short splash spilled on touches the skin for more than a second Full thickness burns scolding through emersion in a flame steam emersion of oil grease chemicals high voltage electricity s Epidemiology 1 1 million burn victims with 45 000 hospitalizations seen in US each year Mortality rates high but declining