2026 Surgery 1: Systemic Response to Injury & Metabolic Support PDF

PCC SOM 2026 SURGERY 1 P.02.02.03 SYSTEMIC RESPONSE TO INJURY AND METABOLIC SUPPORT SURGERY LECTURE LECTURER: Dr. Abraham Cinio DATE: January 20, 2024 D. Metabolism during fasting TOPIC OUTLINE Surgical Metabolism Surgical Metabolism The initial hours following surgical or traumatic injury are metab...

PCC SOM 2026 SURGERY 1 P.02.02.03 SYSTEMIC RESPONSE TO INJURY AND METABOLIC SUPPORT SURGERY LECTURE LECTURER: Dr. Abraham Cinio DATE: January 20, 2024 D. Metabolism during fasting TOPIC OUTLINE Surgical Metabolism Surgical Metabolism The initial hours following surgical or traumatic injury are metabolically associated with a reduced total body expenditure and urinary nitrogen wasting. Following an adequate resuscitation and stabilization of the injured patient, a reprioritization of substrate use ensues to preserve vital organ function and to support repair of injured tissue. This phase of recovery also is characterized by augmented metabolic rates and oxygen consumption, enzymatic preference for readily oxidizable substrates such as glucose, and stimulation of the immune system. Understanding of the collective alterations in amino acid (protein), carbohydrate, and lipid metabolism characteristic of the surgical patient lays the foundation upon which metabolic and nutritional support can be implemented. - - A. Goals of Surgical Nutrition and Support in Trauma Patients Preserve vital organ function Support repair of injured tissue Restoration of homeostasis: o Augmented metabolic rates and o2 consumption. o Enzymatic preference for readily oxidizable substrates such as glucose. o Stimulation of the immune system. Foundation upon which metabolic and nutritional support can be implemented. B. Nutrition in Surgical Patient GOAL: prevent or reverse the catabolic effects of disease or injury thru: - meet the energy requirements - meet the substrate requirements Ultimate validation for nutritional support: leads to improvement in clinical outcome and restoration of function. C. Estimation of Energy Requirements - Overall nutritional assessment - determine the severity of nutrient deficiencies or excess - predict nutritional requirements - use of medications that may influence food intake or urination Fuel metabolism during unstressed fasting states has historically served as the standard to which metabolic alterations after acute injury and critical illness are compared to maintain basal metabolic needs at rest and fasting. Normal health adult requires: 22-25 kcal/kg/day drawn from carbohydrate, lipid, and protein sources. Principal sources of fuel during short-term fasting (