Pathophysiology and metabolic response to injury and stress

As described originally by Cuthbertson 5 , the metabolic response to injury includes an immediate shock or ebb phase and is associated with decreased intravascular volume, reduced tissue perfusion, low cardiac output, and relative hypometabolism, where total oxygen consumption is below normal levels 6 . Profound hypovolemia during this stage of injury may predispose or prime such patients for exacerbated hemodynamic and metabolic responses to subsequent injury after a second insult, such as...

References

Molnar, J.A. et al., Synthesis and degradation rates of collagens in vivo in whole skin of rats, studied with 18O2 labeling, Biochem. J., 240, 431, 1986. 2. Molnar, J.A. et al., Relative and absolute changes in soluble and insoluble collagen pool size in skin during normal growth and with dietary protein restriction in rats, Growth, 51, 132, 1987. 3. Molnar, J.A. et al., Synthesis and degradation of collagens in skin of healthy and protein-malnourished rats in vivo, studied by 18O2 labeling,...

Determination of protein synthesis and degradation rates in the epidermis and dermis

Intact skin is composed of dermis and epidermis, which have different structure, function, and turnover growth rates.12 The dermis serves as a base physically and nutritionally supporting the epidermis, whereas the epidermis exerts the barrier function of the skin. Hence, it is important to develop experimental methods not only to quantify protein synthesis in the whole skin, but also to differentiate the metabolic regulation of these two components of the skin, under various physiological and...

S 72

FIGURE 8.13 Burn patients receiving high-dose vitamin C (VC) vs. control (CTRL) demonstrated improved oxygenation (see text). significant advance in the treatment of fluid resuscitation of thermal injury. One may conclude that vitamin C may prove extremely useful as an adjunctive therapy for the management of the burn shock period as well as for minimizing the progression of the severity of the burn wound in the early hours after injury. In a similar fashion, Nathens et al. evaluated the...

Metabolic Effects of Cytokines in Burns Trauma and Sepsis

TNF Primary mediator in inflammatory response, increase in acute phase proteins, reduction in skeletal muscle and diaphragm contractility IL-1 Activation of T cells, iNOS expression, prostaglandin production, inhibition of lipoprotein lipase, procoagulant activity, increase in acute phase proteins IL-6 Key later role in inflammatory cascade, activation of lymphocytes, increase in acute phase proteins, endogenous pyrogen IL-8 Key later role in inflammatory cascade, regulates neutrophil activity...

Carbohydrate requirementsenergy metabolism

In healthy adults, carbohydrate intake should account for 45 to 60 of total consumed calories. Carbohydrate requirements for patients with burn injuries greater than 25 of the body surface area have been recommended at levels up to 60 to 65 of total energy requirement (4,5). Carbohydrate is the key nonprotein energy source for the patient with burns, in particular. In a study by Hart and colleagues of 14 pediatric burn patients, it was shown that the administration of a high-carbohydrate diet...

Essential fatty acids and other specific fatty acids

In the context of wound healing, the obvious role for essential fatty acids is on modulation of inflammation and the immune response.112-114 An examination of the literature in this area will uncover some conflicting data as to the benefits of essential rn-3 and rn-6 fatty acids in wound healing. One study in essential fatty acid deficient (EFAD) rats found that the healing rate of partial-thickness cutaneous burns was significantly decreased compared to controls.115 However, this study also...

Protein and amino acid metabolism

Posttraumatic hypermetabolism is associated with increased catabolism and loss of lean body mass in proportion to the severity of the injury. It is well established that an increased intake of protein is required for wound healing and achievement of nitrogen balance. Patients with sepsis can lose up to 250 g of lean body mass per day if unfed 87 . Muscle proteolysis, a hallmark of protein metabolism in sepsis and trauma, can result in compromised respiratory function and further...

Can Starving Yourself Affect Rate Of Healing Of Surgery Wounds

Disturbances, coma, and connective tissue disorders can also result from excessive vitamin A (21,41-44). Signs of vitamin A intoxication are usually reversed upon cessation of exposure. Recommendations to Optimize Wound Healing Proper wound healing depends upon adequate, and in some situations, augmented vitamin A status of the host. Any deficiency of existing vitamin A deficiency should be corrected as soon as possible so that wound healing may progress at an appropriate rate. Although vitamin...

Nutrition and the metabolic response to injury

Ebb Phase Medical Definition

Cuthbertson described the metabolic response to injury as consisting of an ebb phase and a flow phase.2526 The ebb phase is the period of traumatic shock or hypometabolism during the first few hours or days after injury. This phase is soon replaced by the flow phase that is a period of hypermetabolism that may last for weeks or months depending on the nature of the injury and obstacles to recovery. In the case of minor injury, such as elective surgery, both of these phases may be relatively...

Metallothionein

No treatise of trace elements would be complete without a discussion of binding proteins. The binding proteins for trace elements are of paramount importance for distribution to target sites of metabolism and excretion. These include a variety of proteins to include albumin, ceruloplasmin, a-glycoprotein, transferrin, and MT. MTs, a family of low molecular weight-binding proteins (containing approximately 30 cysteine) for cadmium, copper, and zinc, are increased in several organs during the...

Carbohydrates energy metabolism and wound healing

In general, calories are needed to supply the energy that is necessary for wound healing. Nutritional support generally includes some form of carbohydrates (parenteral dextrose, and enteral lactose, oligosaccharides, etc.). Glucose is a critical nutrient, especially in patients who have experienced significant trauma, such as a burn, as it is required for cellular growth, fibroblastic mobility, and leukocyte activity. As the metabolic rate increases, there is a concomitant increase in the...

Info

Chebassier, N. et al., In vitro induction of matrix metalloproteinase-2 and matrix metalloproteinase-9 expression in keratinocytes by boron and manganese, Exp. Der-matol., 13, 484, 2004. Vincent, J.B., Recent advances in the nutritional biochemistry of trivalent chromium, Proc. Nutr. Soc, 63, 41, 2004. Ryan, G.J. et al., Chromium as adjunctive treatment for type 2 diabetes, Ann. Phar-macother., 37, 876, 2003. Vincent, J.B., The potential value and toxicity of chromium picolinate as a...

Trace Element Dosing

0.01 to 0.2 mg 0.4 to 3 mg 0.1 to 4 mg 0.04 to 0.2 mg 6 to 15 mg 0.3 to 0.5 mg 0.015 to 0.25 mg 0.01 to 0.075 mg 5 to 16 mg There are approximately 2 to 3 g zinc stores, of which about one fifth is in bone and one half is in the liver. Much of the remaining zinc is in the skeletal muscle. Serum binding is about 55 albumin and 40 to an a-macroglobulin (a zinc metalloprotein). Zinc is lost in fistula output and diarrhea (12 and 17 mg l, respectively). Treatment of zinc deficiency may require up...

Table 1424

Treatment of Patient with Significant IWL, Protein Energy Malnutrition, or in a Catabolic State High potency multivitamin, multi-mineral per day After prostate cancer has been ruled out with prostate-specific antigen (PSA) After obtaining a normal PSA in patients over 50 yr of age Until body weight is restored and catabolic state resolved Decrease or temporarily stop oxandrolone if AST or ALT increases by more than three times normal value In order to adjust coumadin dose downward if necessary...

Effecs Of Irr On Wound Healing

FIGURE 3.3 Phospholipids are amphipathic molecules with two fatty acid side chains (R) and a phosphorylated alcohol head group. Linked to the phosphate group is an additional polar group (X) that may consist of choline, ethanolamine, serine, or inositol. ATP, but they are also readily stored in adipocyte TAGs. One reason for this is that LC-SFAs require carnitine acyltransferase for transport into the mitochondria for oxidation,25 so they are, therefore, more readily incorporated into TAGs....

Suggested Daily Intravenous Intake of Essential Trace Elements

2.5 to 4 mg Additional 2 mg Add 12.2 mg l small bowel fluid lost 17.1 mg kg of stool or ileostomy outpute 0.5 to 1.5 mg 10 to 15 ig 0.15 to 0.8 mg a Limited data are available for infants weighing less than 1500 g. Their requirements may be more than the recommendations because of their low body reserves and increased requirements for growth. b Frequent monitoring of blood concentrations in these patients is essential to provide proper dosage. c Premature infants (weight less than 1500 g) up to...

Pantothenic acid and wound healing

In a number of animal studies, oral pantothenic acid or topically applied panthenol was shown to accelerate the closure of skin wounds.28-31 Most of the mechanistic research done in this area involves looking at the impact pantothenic acid has on fibroblast function and concomitant wound closure and scar formation. Substantial amounts of work have also focused on how pantothenic acid enhances both collagen synthesis and collagen cross-linking and the role this vitamin plays in altering trace...

Fat metabolism in the healing wound

The need for proper nutrition to facilitate wound healing is a well-established paradigm in medicine.72-79 However, an understanding of the molecular, biochemical, and cellular processes that occur during wound healing is complicated by the fact that there are multiple types of both acute and chronic wounds. Acute wounds e.g., surgical, trauma, or burns require a different treatment regimen than chronic wounds e.g., venous, pressure, or diabetic ulcers . Moreover, individuals with chronic...