Question

Metabolic Stress

In your own words, describe the metabolic differences between starvation and stress related to resting energy expenditure, primary fuels, circulating hormones and protein status.  Give an example of how you would determine a diet order for a stressed person and for a starved person.

Answer 1

ANSWER:-

Comparison of Starvation and Stress - Resting energy expenditure

- Starvation: decreased
- Stress hypermetabolism: increased

Comparison of Starvation and Stress - Respiratory quotient

- Starvation: 0.6-0.7
- Stress hypermetabolism: 0.8-0.9

Comparison of Starvation and Stress - Mediator activation

- Starvation: ---
- Stress hypermetabolism: +++

Comparison of Starvation and Stress - Primary fuels

- Starvation: fat
- Stress hypermetabolism: mixed

Comparison of Starvation and Stress - Proteolysis

- Starvation: +
- Stress hypermetabolism: +++

Comparison of Starvation and Stress - Branched-chain oxidation

- Starvation: +
- Stress hypermetabolism: +++

Comparison of Starvation and Stress - Hepatic protein synthesis

- Starvation: +
- Stress hypermetabolism: +++

Comparison of Starvation and Stress - Ureagenesis

- Starvation: +
- Stress hypermetabolism: +++

Comparison of Starvation and Stress - Urinary nitrogen loss

- Starvation: +
- Stress hypermetabolism: +++

Comparison of Starvation and Stress - Gluconeogenesis

- Starvation: +
- Stress hypermetabolism: +++

Comparison of Starvation and Stress - Ketone body production

- Starvation: ++++
- Stress hypermetabolism: +

ANSWER 2.

Avoid overfeeding for a starved or stressed patient!
Enrgy requirement : 25-30 kcal/kg usual body weight

Protein requirement :- 1.2-2.0g protein/kg

VITAMINS AND MINERALS:-

no specific guidelines--just individualize

vitamin needs might be higher due to metabolic stress:-

vitamin C for wound healing (collagen)
vitamin K for clotting
thiamin and niacin due to increased kcal needs