Nutritional assessment of Surgical patient
Nutritional assessment of a surgical patient after surgery, trauma or sepsis can be divided into these phases –
Catabolic Phase:
Adrenergic-corticoid phase:
– raised glucagon, GC and catecholamines with decreased insulin.
-rates of GNG, acute phase protein production, and immune cell activity are all still altered during the catabolic phase.
-administration of glucose produces little or no change in rate of protein catabolism.
-glucose turnover increased.
-Cori cycle activity stimulated: 3C intermediates – glucose by pyruvate carboxylase and PEP carboxylase
-lipolysis and FFA oxidation
Early Anabolic Phase:
Corticoid-withdrawal phase:
-within 3-8 days after uncomplicated elective surgery or after weeks in patients with extensive crosssectional tissue injury, sepsis, or ungrafted thermal injury.
-characterized by sharp decline in nitrogen excretion and restoration of appropriate potassium-nitrogen balance.
-early acute phase reactants are supplanted by tissue repair and anabolic factors (eg. IGF-1).
Clinically: initial diuresis of retained water and renewed interest in oral nutrition.
Synthesis of proteins (positive nitrogen balance):
-rapid progressive gain in weight and muscular strength.
-gain of over 100 g of lean body mass/day.
-rate of gain much slower than rate of initial loss.
Late Anabolic Phase:
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