Trauma malnutrition

Conditions such as malnutrition, starvation, infection or trauma can reduce the fuels available for the colonocytes (glutamine, short chain fatty acids) so that the barrier is less effective. 

Most cases of protein-calorie malnutrition in the United States are secondary to a highly catabolic condition, such as trauma ora major infection. 

Unlabeled Uses Hyperlipidemia, lung cancer, male contraception, malnutrition, postmenopausal osteoporosis, rheumatoid arthritis, Sjogren s syndrome, trauma/sur-... 

In developed countries, protein-calorie malnutrition is seen most frequently in hospital patients with chronic illness, or in individuals who suffer from major trauma, severe infection, or the effects of major... 

Iron deficiency is the most common cause of resistance to erythropoietic therapy. Evaluation and treatment of iron deficiency should occur prior to initiation of erythropoietic therapy as previously discussed (see Figs. 44—1 and 44—2). Inflammation (localized or systemic infection, active inflammatory disease, or surgical trauma) is associated with defective iron utilization known as reticuloendothelial block. Reticuloendothelial block is characterized by a reduction in iron delivery from body stores to the bone marrow, and is generally refractory to iron therapy. Failure to respond to erythropoietic therapy requires evaluation of other factors causing resistance, such as infection, inflammation, chronic blood loss, aluminum toxicity, hemoglobinopathies, malnutrition, and hyperparathyroidism. Erythropoietic therapy may be continued in the infected or postoperative patient, although increased doses are often required to maintain or slow the rate of decline in Hgb/Hct. Deficiencies in folate and vitamin Bi2 should also be considered as potential causes of resistance to erythropoietic therapy, as both are essential for optimal erythropoiesis. Patients on hemodialysis or peritoneal dialysis should be routinely... 

One of the characteristics of critical illness is hypermetabolism. Trauma, burn injury, and sepsis are aU catalysts for the release of mediators that initiate and regulate the hypermetabohc response. The metabolic consequences of this response include altered carbohydrate metabolism, increased protein synthesis and degradation, and increased lipid oxidation, which ultimately result in loss of protein and lean body mass." In a previously well-nourished individual, critical illness can result in the onset of kwashiorkor-like malnutrition within 5 to 7 days. In a previously malnourished individual, critical illness can precipitate severe mixed marasmus-kwashiorkor in 3 to 5 days. In a prospective study of 129 patients admitted to the intensive care unit (ICU), 43% were malnourished." The malnourished patients had an increased length of stay in the ICU (a mean of 27 vs. 19 days) and a statistically significantly increased incidence of complications (55% vs. 40%) compared with well-nourished patients with a similar severity of illness. 

Violent offenders in prison have low cortical brain blood flow and hypometabolism in nondominant frontal and temporal lobes, when compared to control subjects. Others have abnormalities in prefrontal regions. Some criminals have metabolic diseases, infections, tumors, malnutrition, poisons, trauma, or take drugs. Many have psychiatric problems, are poor, come from broken homes, or have suffered social ostracism that leads to resentment and hostility. 

Nutrients are given to patients who are at risk for malnutrition caused by disease and by treatment given to cure the disease. Nutrients are also given to strengthen the patient following a trauma such as suigeiy. In this chapter, you ll learn about nutritional support therapies, how to prepare them, how to administer them, and how to avoid any complications that might arise. 

We needed to keep careful track of the development of the 134 survivors for comparison with those exposed while fetuses. At that time we had not yet confirmed that the risk of radiation damage is even greater for the fetus than for children after birth. Nor had we devised research techniques that would allow us to differentiate between defects caused by radiation of the fetus and defects caused by the trauma of the bomb or such other factors as infection and the malnutrition prevalent in Japan during and immediately after the war. 

We had to acknowledge that we could not specify the degree to which radiation had been responsible for the morbidity and mortality, These women had suffered extensive trauma, burns, malnutrition, and infection, each of which could have had a role in the negative pregnancy outcomes. 

Finally, both constant infusion and pulse label techniques using isotopic labels to estimate whole body protein turnover share the common premise that there is a homogeneous metabolic nitrogen pool of which the plasma constitutes an integral part. That this is in fact an oversimplification, has been shown from animal studies [438]. Despite these, and other objections, work will continue in the search for a reliable method for the estimation of protein synthesis, catabolism and turnover in man. To the clinician such a method would provide information about nitrogen loss from the body resulting from malnutrition, postoperative trauma, burns or severe infection and perhaps more importantly an indication of the success or otherwise of the specific therapeutic regime implemented. 

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. 

Looking at the problem from another viewpoint, Corkill (1950) points out that in a number of diseases such as kala-azar, malaria, trypanosomiasis, and amebic dysentery in which periods of latency exist, there may be breakdown of resistance or disturbance of host-parasite balance leading to relapse or exacerbation in response to a variety of stress conditions. Such stresses are trauma, intercurrent infection, malnutrition, and pregnancy. Corkill puts forward the hypothesis that an important factor in this lowered resistance is failure of the host to synthesize antibody 7-globulin under conditions in which there is excessive breakdown of tissue protein or insufficient intake of dietary essential amino acids. Particularly he incriminates lysine, in which a number of widely used tropical staple cereals are notably deficient. 

Treatment and Prevention of Protein-Energy Malnutrition Emergency Care of Severely III Patients Treatment of Protein Depletion in Hospital Patients (With Trauma, Infection, Burns, or After Surgery) Correction of Mild to Moderate Protein-Energy Malnutrition Prevention of Protein-Energy Malnutrition Recent Developments in the Treatment and Prevention of Protein-Energy Malnutrition... 

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