Metabolic Response to Trauma and Nutritional Support Quiz

Metabolic Response to Trauma and Nutritional Support for Surgical Patients

• Metabolic response to trauma refers to the body's reaction to injury or impact, such as surgery, burn, or sepsis.
• The metabolic response consists of two phases: Ebb and Flow. In the Ebb phase, the body tries to decrease energy consumption, characterized by an increase in pulse rate, respiratory rate, cardiac output, and hyperthermia.
• The Flow phase consists of two sub-phases: Catabolic and Anabolic. The Catabolic phase is characterized by a decrease in cardiac output, hypotension, weak pulse, decrease in O2 consumption, and hypothermia.
• The body needs glucose for energy, which is obtained through glycogenolysis and gluconeogenesis in the liver. Cortisol, aldosterone, and ADH hormones help provide glucose and increase Na and water retention.
• The body has three energy sources: glycogen in the liver, body fat, and protein in skeletal muscle.
• In case of prolonged trauma or starvation, the body starts cannibalizing itself, leading to a decrease in body weight, body fat, skeletal muscle wasting, and an increase in glucose in the blood.
• Nutritional therapy can be given orally, enterally (through the gastrointestinal route), or parenterally (through the venous system) to prevent or treat malnutrition.
• Malnourished patients make poor surgical candidates, and surgery causes a stress response that leads to hypermetabolic or catabolic response. Malnutrition increases the risk of post-operative complications.
• Nutritional methods include oral nutritional supplements, nasogastric tube feeding, gastrostomy feeding, jejunal feeding, and parenteral nutrition.
• Rapid recovery after surgery requires a decrease in Nil By Mouth time before surgery, carbohydrate loading before surgery, minimal surgery, rapid feeding after surgery, and early mobilization.
• Diagnostic points for malnutrition include BMI < 20 kg/m2, weight loss > 10% of body weight over the last 3 months, and albumin serum level < 30gm/L (in the absence of hepatic or renal disease).
• Enteral nutrition can be started when bowel function returns, starting with oral clear liquids. If the patient cannot eat enough for 5-7 days, enteral nutrition should be started. Parenteral nutrition is indicated when enteral feeding is not possible, and it can be given through a peripheral or central vein. Complications of enteral and parenteral nutrition include nausea, vomiting, malabsorption, diarrhea, hepatic steatosis, cholestasis, and gastrointestinal atrophy.