Uncomplicated and Stressed Starvation

Meguid, Michael M.; Collier, M.; Howard, Lyn

doi:10.1016/s0039-6109(16)42435-7

Cited by 23 publications

(3 citation statements)

References 32 publications

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“…Malnutrition represents an additional stress factor that can lead to or even worsen postoperative complications [5]. Infection and consequent activation of the cytokine cascade is a typical example of metabolic aggression that exacerbates the metabolic and nutritional alterations.…”

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confidence: 99%

Postoperative Total Parenteral Nutrition

1999

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Surgical trauma induces complex physiologic changes that lead to catabolism and loss of body cell mass. This reaction is usually mild but can be exacerbated by previous malnutrition and postoperative complications. To avoid severe metabolic distress, nutritional therapy may be prescribed, using the enteral route whenever possible. Postoperative total parenteral nutrition (TPN) is indicated for patients already receiving TPN preoperatively, those severely malnourished prior to major surgery, those unable to eat satisfactorily for 7 days, or patients presenting with severe complications. Postoperative TPN should last for at least 7 days. The total energy requirements are between 30 and 35 kcal/kg/day. About 50% to 70% should be provided in the form of carbohydrates, and 20% to 30% in the form of lipids. The optimal input rates for glucose and lipids are 4 to 5 g/kg/day and 80 mg/kg/hr, respectively. The ideal nitrogen administration is 250 to 300 mg/kg/day, and the optimal calorie/nitrogen ratio is 150 to 200. Some specific amino acids can be added as intravenous dipeptides. An adequate follow-up must include clinical and biochemical parameters. Several trials evaluated the impact of TPN in postoperative patients, but further well designed, controlled clinical trials are still necessary to address a great number of unanswered questions.

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confidence: 99%

Postoperative Total Parenteral Nutrition

1999

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“…Não foram encontradas outras pesquisas analisando a associação dessa variável, como marcadora de prognóstico de cães. A hiperglicemia é comum após o trauma físico ou em doenças críticas devido à secreção de hormônios, como catecolaminas, cortisol, hormônio do crescimento e glucagon, na resposta ao estresse (MEGUID; COLLIER; HOWARD, 1981;PEREIRA, 2007). Esses hormônios são chamados de diabetogênicos, porque aumentam a resistência dos receptores periféricos à ação da insulina (PEREIRA, 2007;MAICÁ;SCHWEIGERT, 2008).…”

Section: Resultsunclassified

Avaliação clínica, laboratorial e perfil eletroforético na determinação do prognóstico de cães hospitalizados

et al. 2014

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ResumoVárias são as doenças que podem acometer os animais de estimação. Reconhecer os enfermos em risco de óbito permitiria intervenções médicas precoces e o estabelecimento de protocolos de monitoração diferenciados, aumentando a sobrevida. O objetivo deste trabalho foi analisar o potencial para marcadores de prognóstico de variáveis clínicas e laboratoriais acessíveis em 185 cães hospitalizados. Os animais foram alocados em dois grupos: os que obtiveram alta e os que foram a óbito, sendo o estado nutricional (EN) clínico definido pela interpretação do escore de condição corporal (ECC), escore de massa muscular (EMM) e índice de massa corpórea (IMC). Foram avaliadas as seguintes variáveis laboratoriais: eritrograma, contagem total de leucócitos, concentração de fibrinogênio, glicemia, cálcio, fósforo, magnésio, colesterol, albumina, proteína total e perfil proteico sérico definido por eletroforese. Foram indicativos de mau prognóstico: baixos valores de ECC, baixos valores de EMM, número total de linfócitos reduzido, hiperfosfatemia, concentrações reduzidas de albumina e de proteína total e diminuição da fração betaglobulina, na eletroforese. Foram indicadores de bom prognóstico: ECC normal ou elevado, adequado EMM e elevação discreta da fração alfa2-globulina, na eletroforese. Os autores não consideraram a glicemia, colesterol e o cálcio como indicadores de prognóstico. Palavras-chave: Paciente crítico, bioquímica sérica, sobrevida AbstractThere are several diseases that can affect pets. Recognize the infirm at risk of death would allow early medical interventions and the establishment of different monitoring protocols, increasing survival. The objective of this work was to analyze the potential for prognostic markers of clinical and laboratory accessible variables in 185 hospitalized dogs. The animals were divided into two groups: those who had hospital outcome and those who have died, being the clinical nutritional status (NS) defined by the interpretation of body condition score (BCS), muscle mass score (MMS) and body mass index (BMI). The following laboratory variables were assessed: blood cell count, total leukocyte count, fibrinogen concentration, glucose, calcium, phosphorus, magnesium, cholesterol, total protein, albumin and serum protein profile defined by electrophoresis. In the present study, were indicative of poor prognosis: low values of BCS, low values of MMS, decreased total number of lymphocytes, hyperphosphatemia,

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“…36 Monitoring urine and plasma creatinine levels, ketones, blood glucose, and ECG (to assess starvation-induced low voltage patterns and arrhythmia) are appropriate parameters to follow. [39][40][41][42][43] In the Hong Kong study, attempts to elicit cooperation in obtaining voluntary urine samples were rebuffed and no patients were catheterized.…”

Section: Pathophysiology Issuesmentioning

confidence: 99%

Hunger Strikers: Historical Perspectives from the Emergency Management of Refugee Camp Asylum Seekers

Burkle

Chan²,

Yeung³

2013

Prehosp. Disaster med.

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The treatment of hunger strikers is always contentious, chaotic and complex. The management is particularly difficult for health professionals as it raises unprecedented clinical, ethical, moral, humanitarian, and legal questions. There are never any easy answers. The current situation of prisoners from the Iraq and Afghanistan Wars currently at the Guantanamo Bay Detention Center in Cuba demands unprecedented transparency, accountability and multilevel coordination to ensure that the rights of the strikers are properly met. There are scant references available in the scientific literature on the emergency management of these tragedies. This historical perspective documents the complex issues faced by emergency physicians in Hong Kong surrounding refugee camp asylum seekers from Vietnam in 1994 and is offered as a useful adjunct in understanding the complex issues faced by emergency health providers and managers.

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Uncomplicated and Stressed Starvation

Cited by 23 publications

References 32 publications

Postoperative Total Parenteral Nutrition

Postoperative Total Parenteral Nutrition

Avaliação clínica, laboratorial e perfil eletroforético na determinação do prognóstico de cães hospitalizados

Hunger Strikers: Historical Perspectives from the Emergency Management of Refugee Camp Asylum Seekers

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