Nutrition Support in Critical Illness

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Nutrition Support of the Hospitalized Patient

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Therapeutic PrioritiesAirway Control Breathing Circulatory support Tissue oxygenation Acid-base neutrality Electrolyte homeostasis Nutrition support

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HOURSWEEKSINJURYEbb PhaseFlow Phase “Catabolic”01224123METABOLIC RESPONSE TO INJURY

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Mild InjuryModerate InjurySevere Injury

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Mild InjuryModerate InjurySevere Injury

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HYPERMETABOLISM GLUCOSE METABOLISM Glucose production ’d (lactate, alanine, glycerol) Peripheral uptake/use ’d (non-insulin based) Entrance into Kreb’s cycle ’d Lactate, pyruvate ’d Insulin resistance Exogenous glucose can’t suppress GNG

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KETONESPYRUVATEACETYL COALACTATECORI CYCLEGLUCONEOGENIC AMINO ACIDSTCA CYCLELIPOGENESISGLUCOSEPyruvate dehydrogenase inhibition

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HYPERMETABOLISM GLUCOSE METABOLISM Glucose production ’d (lactate, alanine, glycerol) Peripheral uptake/use ’d (non-insulin based) Entrance into Kreb’s cycle ’d Lactate, pyruvate ’d Insulin resistance Exogenous glucose can’t suppress GNG

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Glucose Appearance Rate (GNG) (mg/kg-min)

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Glucose Appearance Rate (GNG) (mg/kg-min)

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HYPERMETABOLISM FAT METABOLISM ’d preference as fuel source 30-40% non-protein calories Ketone body production ’d Lipolysis, TG, FA-TG cycle ’d Hepatic stetatosis

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HYPERMETABOLISM PROTEIN METABOLISM Acute phase reactants ’d ’d efflux from periphery ’d oxidation amino acids (30%)

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ENERGY EXPENDITUREBasal Metabolic Rate (BMR) Basal Energy Expenditure (BEE) Resting Energy Expediture (REE)Activity LevelThermic Effect of Food

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Components of Total Energy Expenditure

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Malnutrition and Critical IllnessCLASSICAL - Months to years STRESSED - Days to weeks

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Last Updated: 8th March 2018

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