Hypermetabolic state

EN is indicated for the patient who cannot or will not eat enough to meet nutritional requirements and who has a functioning GI tract. Additionally, a method of enteral access must be possible. Potential indications include neoplastic disease, organ failure, hypermetabolic states, GI disease, and neurologic impairment. 

Intrathecal - Early symptoms of baclofen withdrawal may include return of baseline spasticity, pruritus, hypotension, and paresthesias. Some clinical characteristics of the advanced intrathecal baclofen withdrawal syndrome may resemble autonomic dysreflexia, infection (sepsis), malignant hyperthermia, neuroleptic-malignant syndrome, or other conditions associated with a hypermetabolic state or widespread rhabdomyolysis. 

DNOC exposure results in a hypermetabolic state that resembles heat exhaustion and heat stroke. The basal metabolic rate was increased by 70-100% within 3 days in 2 humans given 3 mg/kg/day DNOC (Dodds and Robertson 1933). Headaches, hyperthermia, profuse sweating, increased pulse rate, and dyspnea are other common signs and symptoms associated with DNOC exposure. In severe cases, tachycardia, delirium, coma, and convulsions are usually observed in humans. An increased basal metabolic rate may, therefore, indicate profound metabolic disturbances. 

The authors suggested that the patient s hyperkalemia was precipitated by a hypermetabolic state in which there was reduced glomerular filtration and the beginning of rhabdomyolysis. 

Hyperthyroidism results in a hypermetabolic state due to an excess of thyroid hormones. Hyperthyroidism is more common in women (2%) than men (0.1%). Graves disease is an autoimmune disorder that leads to hyperthyroidism, diffuse goiter, ophthalmopathy, dermopathy, and acropachy. Graves disease is the most common cause of hyperthyroidism, more common than multi- or uninodular goiters. 

During the hyperthyroid state, other drugs that are metabolized by the liver or eliminated renally may need to be adjusted because metabolism may be increased. Patients using drugs with a narrow therapeutic index such as digoxin, warfarin, and phenytoin should be monitored carefully because dosing adjustments will be necessary as the hyperthyroidism or hypermetabolic state resolves. 

A second rare, but potentially fatal, condition associated with acute inhalational anesthetic exposure is malignant hypothermia. This is an autosomal dominant disease in which there is excessive sarcoplasmic release of intracellular Ca " " in skeletal muscles during exposure to inhalational anesthetics. This produces a hypermetabolic state that is manifested as increased muscle rigidity and contracture, tachycardia and metabolic acidosis. Extreme hyperthermia is also present. There are currently a number of worldwide registries for tracking this disease and an ex vivo testing paradigm exists to determine a potentially susceptible persons phenotype. 

Hyperthyroidism is defined as a hypermetabohc condition caused by excessive production of thyroid hormones. This disorder is caused by a number of conditions resulting from excess availability of thyroid hormones (Box 52-3). Some clinicians prefer the general term thyrotoxicosis rather than hyperthyroidism to define the hypermetabolic state associated with increased amounts of thyroid hormone in the circulation. Figure 52-5 depicts the metabolic changes associated with increased avafiability of thyroid hormone. Causes of thyrotoxicosis are divided into two types (1) those associated with frank hyperthyroidism and increased production and secretion of thyroid hormones from the gland, and (2) those that are not. In North America, the most... 

Hypermetabolic states such as trauma, burns, and sepsis Digestive or absorptive disease, nausea, vomiting, or diarrhea Hyperlipidemia Prematurity End-organ effects Weight change or failure to thrive Skin or hair changes... 

Several other biochemical changes may occur with moderate to marked muscle toxicity. Lactic acidosis occurs if there is compromised mitochondrial activity, such as with NRTIs. If muscle injury is severe enough to cause serum CK to increase to several thousand, then serum calcium may decrease due to dystrophic calcification. Serum potassium increases (peracutely) with acidosis, rhabdomyolysis, and myo-globinuric nephrosis. Hemoconcentration occurs with hypermetabolic states (Guis et al. 2005). Whereas creatinine does not significantly increase with rhabdomyolysis due to release of cellular contents, it may increase dramatically with urea due to myoglobinuric nephrosis. 

It is evident that variations in thyroid hormone levels are among the main physiological modulators of in vivo cellular oxidative stress. The hypermetabolic state in hyperthyroidism is associated with increases in free radical production and lipid peroxidation (LP), and the hypomet-abolic state in hypothyroidism is generally associated with a decrease in free radical production and LP in most tissues (Fernandez et ai, 1985 Venditti et ai, 1997). The development of a hyperthyroid state in vertebrates leads to enhancement of their basal metabolic rate due to an increase in the rate of O2 consumption in most tissues, excluding the spleen, testis and adult brain (Barker and Klitgaard, 1952). Thyroid hormones were shown... 

In addition to antithyroid drug, betablockers should be apphed. Surgery is indicated in high-risk patients with IIH if a long-lasting hypermetabolic state cannot be tolerated because of comorbidities. 

Not understood. One suggestion is that furosemide displaces trichloroacetic acid (the metabolite of cloral hydrate) from its protein binding sites, which in its turn displaces levothyroxine or alters the serum pH so that the levels of free levothyroxine rise leading to a hypermetabolic state. ... 

Other circumstances predispose to significant malnutrition in subjects of any age. Severe trauma, burns, or sepsis are hypermetabolic states requiring massive nutritional support such as hyperalimentation. Nutrition in acutely and chronically ill patients is often inadequate. Even in an informed, affluent society, some people, such as alcoholics, are inadequately nourished because of overconsumption of foods of low nutritional value. For example, wet beriberi has reappeared among Japanese teenagers who subsist on soft drinks, noodles, and polished rice (Kawai et aL, 1980). Macrobiotic vegetarians are prone to the neurologic complications of Bj2 efficiency after years of such a diet. 

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