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Surgery I

Prevalence of malnutrition in hospitalized pts 15-50%
Cachexia Loss of wt, appetite, mx atrophy, & weakness; usu signifies an underlying dz
Kwashiorkor acute visceral protein depletion. Usually children
Marasmus Simple starvation
Body composition is divided into: fat mass & lean body mass
Early vs late starvation Early: proteolysis is dominant; late: body adapts to conserve protein, fat becomes major energy source
Fat mass: % of total body wt (TBW)? 25-35% TBW
Lean mass: % of total body wt (TBW)? 40% TBW
Lean body mass composition 60% skeletal mx; 20% RBC & conn tissue; 20% organ tissue
peripheral neuropathy may be due to deficiencies in: niacin, thiamine, vitamin B6, vitamin B12
Primary means of measuring protein (nitrogen) balance in body: urine urea nitrogen
marker for significant nutritional depletion: body wt that is: less than 90% of the usual or ideal body wt
Percentage of total body protein contained in skeletal muscle 60% (this is major site of protein catabolism during starvation and/or illness)
Most widely used biochemical marker of muscle mass 24 hr urine creatinine
Creatinine is: degradation product of creatine, an energy storage compound located in skeletal muscle
Most common test to measure breakdown of protein Urinary urea nitrogen
Lean body mass represents: the critical cellular mass necessary for cellular structure & function; 40% of total body weight; Depletion is severe insult & defines pt morbidity & mortality
Skin fold thickness is a reasonable estimate of adipose caloric reserves because: 50% total body fat is subQ; fat is lost proportionally from central stores and subcutaneous tissue
Creatinine- height index (CHI) level that defines skeletal muscle depletion CHI < 80%
Serum albumin half life: 18 - 20 d
Normal serum albumin = > 3.5 g/dL
Serum prealbumin: Sensitive to: acute changes in nutrient intake
Basal (resting) Energy Expenditure (BEE) is calculated by using: Harris-Benedict equation
In pts who have sustained injuries, calculate resting energy expenditure by: bedside indirect calorimetry to determine VO2 and VCO2 (Weir Formula)
Catabolic Index (CI): measures: severity of stress (CI = UUN – 0.5 (dietary nitrogen intake) + 3 g)
Routes for delivering nutrition Enteral. Enteral plus venous. Central venous access (eg, TPN)
Preferred route for delivering nutrition Enteral
Primary fuel source for body Carbohydrates. Metabolized as glucose, stored as glycogen (both depleted from liver/muscle stores in 24-36h of fasting, then fat & protein used)
Essential fatty acids are: linoleic acid and linolenic acid
Fat metabolism yields: fatty acids, glycerol, and ketone bodies (ketone bodies used as fuel during starvation)
Daily protein requirement in healthy adult 0.8 gm/kg/day (minimum 0.54 gm/kg/day). Up to 2x that in stressed pt
Created by: Abarnard