The Metabolic Management of the Critically Ill

HOW DO I USE THIS BOOK? This book is organized to answer specific questions about the metabolic and nutritional problems of critically ill patients. Thc questions are listed under five chapter headings in the Contents. Each question is self-contained with its own charts, tables, and references, although, in some instances, you may be referred to another section of the book for additional information. A detailed subject outline appears on the first page of each chapter, and there is an index for cross-reference to specific subjects. A metabolic support plan and accompanying metabolic and nutritional worksheet are locatcd in the Appendix. This plan pro­ vides the best estimates available for predicting the metabolic requirements of patients, and outlines approaches to feeding the hospitalized patient which will satisfy these nutritional needs. Clin­ ical cases are presented in this section to help you get started using the support plan. This volume is a handbook organized for frequent use - place the appropriate tables and nomograms on the bulletin board of the intensive care unit or in your office for convenient reference. Use the metabolic and nutritional support plan and establish the habit of assessing the metabolic requirements of your patients. Refer to the references cited to explore in further detail specific questions or areas of interest. By applying our knowledge of the metabolic and nutritional alterations which occur following disease, we can improve our care of the critically ill.

Contenu

1. Energy and Energy Balance.- 1.1 What is the body's efficiency in converting chemical energy into mechanical work? What is the efficiency in energy conversion to heat?.- 1.2 What is a kilocalorie?.- 1.3 What is thermal balance?.- 1.4 How is heat loss from the body measured? What is direct calorimetry?.- 1.5 What is indirect calorimetry?.- 1.6 How is oxygen consumption related to heat production?.- 1.7 How much oxygen is consumed by normal man? How does oxygen consumption affect respiration?.- 1.8 What does total body oxygen consumption measure?.- 1.9 How is oxygen consumption measured?.- 1.10 Can carbon dioxide production be equated to energy production?.- 1.11 What is RQ? Why is it useful?.- 1.12 How is the fuel source of the energy oxidized by the body determined?.- 1.13 What is BMR? What is RME?.- 1.14 How does body size affect metabolic rate? How do we correct for body weight?.- 1.15 Why is metabolic rate related to body size?.- 1.16 How does metabolic rate vary with age?.- 1.17 Does the sex of the individual affect metabolic rate?.- 1.18 How does body temperature affect metabolism?.- 1.19 How does food intake affect metabolism? What is specific dynamic action?.- 1.20 How is the energy expenditure of activity predicted? How is the total daily energy requirement estimated?.- 1.21 What is the effect of ambient temperature on metabolic rate?.- 1.22 What alterations in heat production occur with starvation.- 1.23 To what extent does injury or infection affect energy production?.- 1.24 What is the role of pain, fear, and anxiety in hypermetabolic states?.- 1.25 How can the energy requirements of critically ill patients be estimated?.- 1.26 What is energy balance?.- 1.27 How is energy balance calculated?.- 1.28 How can the weight alterations of patients be predicted?.- 1.29 To what extent is weight loss detrimental?.- 1.30 How is the nutritional status of a patient determined from body weight?.- 2. Control of Body Temperature: Relationships with Metabolic Control.- 2.1 Why measure oral or rectal temperature?.- 2.2 What is normal body temperature? What are the variations in body temperature around normal?.- 2.3 How is core temperature measured?.- 2.4 How are mean skin temperature and mean body temperature determined?.- 2.5 How is heat lost from the body?.- 2.6 How is evaporative water loss measured?.- 2.7 How does fever affect evaporative water loss? What other diseases alter insensible water loss?.- 2.8 What are the routes of dry heat loss?.- 2.9 How does man insulate between his skin and the surrounding environment?.- 2.10 What determines heat flow to the body surface? What is conductance?.- 2.11 What alterations in core-skin heat transfer are observed in patients?.- 2.12 How does the brain control body temperature?.- 2.13 What is temperature setpoint? What factors alter setpoint?.- 2.14 What are the mediators which alter central temperature setpoint?.- 2.15 How does infection stimulate increased oxygen consumption?.- 2.16 What are the mediators of the febrile response to infection? What is endogenous pyrogen? How does it differ from exogenous or bacterial pyrogen?.- 2.17 What is posttraumatic fever? How should it be controlled?.- 2.18 What other disease processes cause fever?.- 2.19 Should patients have fever? When should fever be treated? How?.- 2.20 What is the relationship between fever and body catabolism?.- 2.21 What is the relationship between pulse rate and fever?.- 2.22 What drugs affect temperature setpoint?.- 2.23 Why do patients become hypothermic in the operating room?.- 2.24 How do electrolytes alter body temperature? What hormones affect temperature setpoint?.- 2.25 How is temperature control related to metabolic control?.- 2.26 Is there evidence for altered hypothalamic function following stress?.- 2.27 Does the altered hypothalamic function in stressed man affect thermoregulation?.- 2.28 What stimulates the hypothalamus to produce "post-traumatic fever"?.- 2.29 How is blood glucose related to body temperature and heat production?.- 2.30 What is heat exhaustion? Heat stroke? How are the heat overload syndromes treated?.- 2.31 What is the role of physical activity and dehydration in overheating?.- 2.32 What are the symptoms and treatment of malignant hyperthermia which occurs during anesthesia?.- 2.33 What causes accidental hypothermia? How is it treated?.- 2.34 How does alcohol cause hypothermia?.- 2.35 Why do patients with gram-negative infection become hypothermic?.- 3. Hormonal Control of Body Fuels.- 3.1 What are hormones?.- 3.2 What are the storage hormones? What are their effects? What are the mobilizing hormones?.- 3.3 How is insulin stored? Released? What is the half-life of insulin?.- 3.4 How is insulin measured? How is the insulin response to glucose assessed?.- 3.5 How is the functional effect of insulin on peripheral tissue determined? What is the instantaneous proportionality constant for glucose disappearance, or k?.- 3.6 What is the effect of insulin on glucose metabolism?.- 3.7 How does insulin affect fat metabolism? Protein metabolism?.- 3.8 What substances stimulate insulin release? What hormones affect insulin elaboration?.- 3.9 How does the autonomic nervous system affect the endocrine pancreas?.- 3.10 What are the metabolic effects of glucagon? What is the I/G ratio?.- 3.11 What stimulates glucagon release?.- 3.12 Is glucagon the hormone of stress?.- 3.13 How are catecholamines synthesized, stored, and released?.- 3.14 How is catecholamine activity assessed?.- 3.15 Why are catecholamines called the hormones of stress?.- 3.16 What are the general effects of sudden sympathetic nervous system discharge? What are the effects of epinephrine and norepinephrine infusion in man?.- 3.17 What are alpha and beta receptors? How are they determined? What do they do?.- 3.18 How do catecholamines stimulate hyperglycemia?.- 3.19 How do catecholamines affect fat mobilization?.- 3.20 Do catecholamines stimulate heat production?.- 3.21 What stimulates heat production in the critically ill patient?.- 3.22 What limits the body's response to catecholamine-mediated stimuli?.- 3.23 What stimulates ACTH? What is the function of ACTH?.- 3.24 How is Cortisol transported in the blood?.- 3.25 How are the corticosteroids classified?.- 3.26 What are the primary effects of glucocorticoids on metabolism?.- 3.27 Are glucocorticoids the hormones responsible for negative nitrogen balance following injury?.- 3.28 Do the antiinflammatory …